surgery for vomiting

Question 1

Exploratory laparotomy for therapeutic purposes is indicated for?

Answer 1

• control of haemorrhage
• correction of the source of contamination or infection
• elimination of the cause of pain
• removal of mass lesions
• removal of visceral obstructions
• removal of traumatised organs
• relief of non-responsive dystocia
• removal of abnormal accumulation of fluids
• supportive care, e.g. enteral tube placement, cystostomy tube

Question 2

Exploratory laparotomy for preventative purposes is indicated for:

Answer 2

• reduce the incidence of a particular disease, e.g. gastropexy for GDV
• reduce the recurrence of a particular disease, e.g. enteroplication for intussusception

Question 3

Exploratory laparotomy for diagnostic or prognostic purposes is indicated if:

Answer 3

• a diagnosis may only be made by inspection or palpation of the abdominal contents
• a diagnosis depends on samples obtained at laparotomy:
  ◦ culture of samples
  ◦ cytological or histological analysis of samples

Question 4

For an exploratory laperotomy, The entire abdominal cavity should be divided into regions to ensure that all of the organs are inspected. A simple procedure is to divide the abdomen into 5 regions, what are these?

Answer 4

1. Cranial quadrant
2. Intestinal tract
3. Right paravertebral region
4. Left paravertebral region
5. Caudal quadrant

Question 5

how is the liniea alba closed? what is used?

Answer 5

• External rectus sheath is the critical layer
  don’t want to go through the rectus muscle as this is painful

Continuous suture patterns preferable
* even distribution of tension along length
* 6 throws at each end (sliding self-locking knot and Aberdeen knot)

Absorbable monofilament; e.g, polydioxanone or polyglyconate
- e.g. commonly either 2/0 or 0 (dogs) or 3/0 or 2/0 (cats)

Question 6

what is the post op management of ex lap

Answer 6

• Restricted exercise for 2-3 weeks
• Monitor the incision for redness, swelling, oozing, heat, pain to touch, etc.
• Re-examination appointment 4-5 days, post operatively
• Monitor urination / defaecation
• Monitor behaviour and feeding
• Removal of skin sutures (if required) 7-10 days, post operatively

Question 7

what is the treatment for oesophageal FB ?

Answer 7

• In most instances, an emergency requiring immediate removal
• Most can be removed endoscopically using grasping forceps
• Refer to a centre that has the appropriate equipment and expertise
• Approximately 10% cannot be removed orally and are pushed into the stomach; bony FBs will then be digested with no requirement for a gastrotomy
• if they have a fish hook, can be left over night, if a solid FB then is an emergency

Question 8

what is the post removal managemtn of oesophageal FB?

Answer 8

• Medical therapy to reduce likelihood of stricture formation
  ◦ H2 antagonist
  ◦ Proton-pump inhibitor
  ◦ sucralfate
• Analgesics
• Feed soft food
  Might heal by forming a stenosis - need to warn owner

Question 9

what are the indications for gastric surgery?

Answer 9

• Placement of gastric feeding tubes (percutaneous endoscopic gastrostomy (PEG), open gastrostomy, etc.)
• Gastrotomy for removal of a gastric foreign body
• Gastropexy to prevent volvulus
• Correction of gastric dilatation volvulus (GDV)
• Pyloroplasty to manage gastric outflow disease
• Partial gastrectomy for resection of a gastric tumour, ulceration, etc.

Question 10

what are the indications for small interstine surgery?

Answer 10

• Full thickness biopsy (e.g., inflammatory bowel disease)
• Enterotomy for removal of a foreign body
• Enterectomy (e.g., foreign body, intussusception, tumour, etc.)
• Enteroplication (potential aspect in the management of intussusception)
• Cholecystoenterostomy (biliary tract bypass procedure)

Question 11

what are the indications for large intestinal surgery?

Answer 11

Colopexy (e.g., as part of management of perineal hernia)
Colotomy (e.g., impaction, foreign body (rarely))
Colectomy (e.g., tumour, polyp)
Subtotal colectomy (e.g., megacolon in the cat)

Question 12

what are the indications for pancreatic surgery?

Answer 12

Biopsy - pancreatitis
Islet cell tumour – insulinoma
Pancreatitis
Pancreatic abscess
Pancreatic pseudocyst
Pancreatic abscess
Pancreatic tumour – carcinoma

Question 13

how do you close a gastrotomy?

Answer 13

• 4 layers that stay togeter in 2 layers - submucosal- mucosal layer and seromuscular layer
  ◦ can close all 4 layers together
  ◦ can close in 2 layers
• suture holding layer is the submucosal layer

Question 14

describe what you can see on this radiograph

Answer 14

distended gas filled loops of intestine, - oral intestine, proximal to the FB

single smooth, radiodense foreign body in the mid ventral abdomen, 1.25x the length of the L4 vertebrae