Surgery of the ailmentary tract Flashcards
Describe GDV
A condition normally seen in deep chested animals e.g. Greyhounds, German Shepherds, Pointers etc
Usually the animal has been fed, normally on dry food, and then exercised
What are the early clinical signs of GDV?
Depression
Salivation
Attempting to vomit (unproductive retching)
Distended abdomen
‘Flank’ watching
Collapse
Tachycardia with possible arrhythmias and tachypnoea
Pale mucus membranes and increases CRT
Describe the pathogenesis of GDV
Stomach dilates due to accumulation of gas or fluid
The dilation can progress to a torsion if the stomach starts to rotate
The rotation twists the distal oesophagus and the duodenum stopping anything leaving the stomach in either direction
Stomach continues to extend putting pressure on the hepatic portal vein and caudal vena cava – reducing venous return
Hypovolaemic shock occurs due to the reduced blood flow back to the heart
Blood flow to the stomach is compromised resulting in necrosis of the stomach wall
Describe management of GDV
Orogastric intubation
Percutaneous needle
One or both methods used in an attempt to stabilise the patient prior to surgery
What equipment is needed for a orogastric intubation?
Wide-bore stomach tube
7.5cm wide roll of adhesive bandage with a hollow plastic core
Funnel
Bucket
Warmed normal (0.9%) saline, lactated Ringer’s (Hartmann’s) solution or tap water
Describe patient prep for an orogastric intubation
Sedated if anxious – care hypotension
Right lateral abdominal radiograph
Place on table or trolley to use gravity
Sitting or sternal, right lateral if needed
Describe placement of orogastric intubation
Mark stomach tube – level of dogs nose to 11th rib
Insert the bandage into the dogs mouth.
Hold closed or apply tape as a muzzle
Insert stomach tube through bandage core.
Rotation of the tube can help passage
What equipment is needed for a percutaneous needle?
Normal surgical prep equipment
16 or 18G over the needle intravenous catheter.
Describe patient prep for a percutaneous needle
Sedation and radiography as above
Position patient in left lateral or sternal recumbency
Aseptic skin preparation over the most distended part of the right abdominal wall.
Describe how to use a percutaneous needle for a GDV
Define the site of greatest tympany
Insert the catheter though the abdominal wall directly into the stomach
Remove the stylet of the catheter and allow air to escape freely from the stomach.
What are the goals of surgery for a GDV?
To decompress the stomach
Return the stomach to its normal anatomical position. Normally the stomach rotates in a clockwise direction
Evaluate organs such as the stomach, spleen and pancreas for viability
Perform a gastropexy to prevent recurrence.
What is an gastrotomy?
incision into the stomach
When is a gastrotomy required for a GDV?
indicated to remove any large food particles still in the stomach and unreleased gas
What are GDV patients susceptible to?
hypotension, cardiac arrhythmias
Why is GDV surgery high risk?
Immediately after the stomach is returned to its normal position due to the release of toxins into the blood stream
What is a gastropexy?
Recommended treatment following a GDV
Surgical fixation of the stomach. Most commonly to the abdominal wall
Describe complications of a gastropexy
Wound infection
Seroma formation
Abdominal wall dehiscence
Gastrotomy dehiscence
Peritonitis
Intestinal Ileus
Vomiting
Describe post operative care for GDV surgery
Close patient monitoring is essential in the first 48 hours
The prognosis should always be guarded – endotoxic shock
Intravenous fluids should continue until the animal is eating well
Reintroduction of food gradually of a bland nature. Timing is dependant on the vets management
How can you prevent GDV?
Feed animals at least twice daily
Do not exercise after food
Feed from a height
Describe foreign bodies
Normally caused by the ingestion of non digestible materials
The location of the object will depend on its size, larger items tend to stay within the stomach
What are the clinical signs of a foreign body?
Persistent vomiting
Anorexia
Dehydration
Abdominal discomfort
How do you diagnose a foreign body?
Some foreign bodies can be palpated
Confirmation is normally undertaken by radiography
Contrast media may be required
What surgery options are available for a foreign body?
Exploratory Laparotomy to determine (confirm) needed procedure
Gastrotomy:
Incision into the stomach to create an opening
Use of ‘stay sutures’ to ease the procedure
Enterotomy:
Incision into the intestine to create an opening
Use of Doyle’s Intestinal forceps or assistants fingers to clamp bowel
Describe an enterectomy
Removal of a section of bowel if the tissue has been compromised
Use of Doyle’s forceps or assistants fingers to clamp to bowel
Anastomosis to reconnect the intestine
Following surgery Omentum is wrapped around the operation site
Describe a linear foreign body
Result in a partial obstruction only
Vague symptoms seen
Commonly in cats linear fb’s are anchored around the tongue
Why might a linear foreign body be dangerous?
Intestines ‘bunch up’ around FB
FB may cut through mesenteric border and result in multiple perforations
Removal involves multiple enterotomies and careful inspection of GI tract
Describe post operative care for the removal of a foreign body
Intravenous fluids until the animal is eating well
Introduction of small, bland meals
Observation for vomiting and diarrhoea
Monitor for signs of peritonitis –
- Pyrexia
Gradual reintroduction of normal diet
What is intussusception?
Invagination of one part of the intestine into another.
Classified according to the site at which they occur. Commonly - ileocaecocolic
Increased motility in a segment of intestine (hyper motility) adjacent to a segment that has lack of motility (ileus) can cause the hyper motile segment to telescope into the segment with ileus, resulting in an intussusception.
What are the most common animals to get an intussesception?
APPROXIMATELY 80% OF CASES LESS THAN ONE YEAR
IN DOGS MOST CASES THREE MONTHS OR YOUNGER.
What are the causes of an intussusception?
Bowel hypermobility secondary to diseases such as –
Enteritis
Intestinal parasites
Intestinal Foreign bodies
Intestinal masses
Previous surgery
What are the clinical signs of intussusception?
Vomiting
Diarrhoea
Dehydration
Abdominal pain
Tenesmus (ineffectual and painful straining to defecate)
Describe surgery for an intussusception
Exploratory laporotomy:
- Attempt to manually ‘milk out’ the intussusceptum
- Resection of the intussusceptum and anastomosis is often required
Intussusceptions can recur. Enteroplication is required to prevent this.
This involves suturing loops of intestine together to form adhesions
Describe an abdominal lavage
Indicated following many abdominal surgical procedures in an attempt to reduce the level of contamination
Large volumes of warmed, sterile, isotonic fluids (Hartmann’s) into the abdomen
Suction to remove until they come away clear
Repeat lavage as needed.
All lavage fluid must be removed as remaining fluid reduces the ability of the immune system to clear remaining bacteria
Waterproof surgical drapes should ideally be used to prevent strike through
What equipment can you use for an abdominal lavage?
Poole Suction Tip and a Suction machine
50ml catheter tip syringe
Define Anastomosis
establishment of communication between two section of bowel (rejoining of two pieces of bowel following an enterectomy)
Define an Enterectomy
Removal of a section of bowel if the tissue has been compromised
Define Enteroplication
Creation of permanent adhesions between loops of bowel
Define Enterotomy
Incision into the intestine to create an opening
Define Exploratory Laparotomy
Incision into the abdomen to examine the contents
Define Intussusception
invagination of one part of the intestine into another
Define Gastropexy
surgical fixation of the stomach, most commonly to the abdominal wall
Define Gastrotomy
incision into the stomach
