Surgery Of The Colon Flashcards
3 divisions of the colon?
Ascending
Transverse
Descending
Which side of the abdo is the ascending colon found?
RHS
What does the ascending colon run cranial to?
Right colic flexure
Which direction does the transverse colon run?
R –> L
Where does the transverse colon run to on the LHS?
Left colic flexure
What is the arterial supply of the colon?
Cranial abdominal branches of the aorta
What branch supplies the ascending colon?
ileocolic
What branch supplies the transverse colon?
Right colic
What branch supplies the proximal descending colon?
Middle colic
What do the colon supply arteries then divide and branch into?
Short irregular vasa recta
Which border do the arteries enter?
Mesenteric
The distal portion of the descending colon is supplied initially by the A) branch of the caudal abdominal branches of the aorta and then more distally by the B) artery which run similarly along the mesenteric border.
A) left colic
B) cranial rectal
Due to the particular longitudinal course of the blood simply to the colon, when considering a segmental resection of the colon - where should this be done?
Level of the vasa recta
What is the ascending colon attached to? (2)
- Mesocolon
- Mesoduodenum
Why is the ascending colon difficult to visualise/exteriorise in surgery?
Attachments are short - 2-3cm
What is revealed in the colonic manoeuvre?
L sublumbar fossa
What is lifts in the colonic manoeurve?
Descending colon
What are reabsorbed in the colon? (4)
- Water
- Sodium
- Chloride
- Short chain fatty acid
What is secreted in the colon? (2)
Bicarbonate
Mucous
What are the reasons for increased complications for colon surgery? (5)
- High bacterial load
- Short mesenteric attachments
- Damage to mesenteric blood supply
- Infect
- Surgeon familiarity
Peri-operative natibacterial prophylaxis for colon surgery?
Cefuroxime (20 mg/kg q90m from induction to abdominal closure) and metronidazole (10 mg/kg q8h) are often used in combination.
Use of post op antibiotics in colon surgery?
However, following uncomplicated colonic surgery there is no indication for postoperative use of antibiotics and with an increasing risk of bacterial resistance, veterinary surgeons have responsibilities to limit the use of antibacterial medication.
What is the term for caecal resection?
Thyhlectomy
When is a typhlectomy indicated? (6)
- Perforation
- Caecal inversion
- Impaction
- Inversion
- Severe thyphlitits
- Neoplasia
What should try to be preserved in a thyplectomy?
Ileo-colic junction
Prior to resection, what needs to be done with the caecal when inverted?
Evert it!
What suturing is done for a typhlectomy? Include material?
Following resection between two sets of clamps, a Parker-Kerr suture pattern can be used to oversew the remaining clamp, inverting the edges of the incision. An inverting Lembert pattern can then be used to reinforce the incision. 1.5-2 metric synthetic monofilament absorbable suture material is appropriate
If using a stapler, what stapler height should be used for typhlectomy?
2mm
What is done during a typhlectomy?
Following dissection of the ileocaecal fold, atraumatic clamps such as Doyen bowl forceps are placed across the base of the caecum
What type of biopsy if preferred for colon?
Excisional
Colotomy:
How to SURGICALLY prepare the area? (2)
- Isolate with lap swabs or sponges
- The contents of the identified section should be moved proximally and distally to further minimise risk of contamination
Where is the colotomy incision made?
Antimesenteric border
How to facilitate minimal handling with colotomy?
A full thickness monofilament stay suture can be placed through the colon at the proposed site of biopsy with an elliptical incision then made around this stay suture.
How to suture colotomy site:
- Prep/
- Material
- Pattern
- cleaned before being sutured
- monofilament absorbable material (polydioxanone or polyglyconate are good choices)
-simple continuous or simple interrupted pattern. It is possible to add an inverting layer (Lembert suture).
Following colon suture; what is done before abdo closure? (2)
- Clean colon site
- Abdo flush
(can omentalise - not not needed)
Indications for colectomy (5)
Neoplasia
Megacolon
Perforation
Trauma
Chronic Intussusception.
Most common condition + species for colon surgery?
megacolon - cat