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RUSVM Small Animal Surgery 1 > Surgery Of The Stomach > Flashcards

Surgery Of The Stomach Flashcards

1
Q

What artery supplies the greater curvature of the stomach?

A

Left gastroepiloic a (branch of the splenic artery —> celiac artery)

Right gastroepiloic a (branch of the gastroduodenal —> hepatic artery—>celiac artery)

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2
Q

What are the layers of the stomach. Which of these is the holding layer?

A

Serosa
Muscular
Submusoca holding layer
Mucosa (glandular)

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3
Q

What are the healing characteristics of the stomach?

A

Standard phases of wound healing

Short duration of healing

  • > extensive and redundant blood supply
  • > reduced bacterial numbers
  • > rapidly regenerating epithelium
  • > omentum

Smooth muscle cells contribute to collagen production

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4
Q

How should you prepare a patient for a gastric surgery?

A

Correct electrolyte imbalances

Correct hydration

Fast 8-12hrs

H2 antagonists
PPI -omeprazole

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5
Q

What is the approach used in gastric surgery?

A

Dorsal recumbency

Ventral midline celiotomy (xyphoid to pubis)

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6
Q

When doing an abdominal exploratory, when you enter the abdomen through a ventral midline celiotomy, you encounter the _____________ which can be ligated and resected if needed for visualization

A

Falciform ligament

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7
Q

What instruments can help hold open the abdomen for visualization?

A

Balfour retractors

Self retaining/ non traumatic retractors

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8
Q

How is the stomach traditionally closed?

A

Double inverting

  • cushing pattern: serosa, muscularis, and submucosa
  • lembert pattern: serosa and muscularis

Alternately can do a simple continuous to decrease bleeding into lumen followed by cushing or Lembert

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9
Q

When is a single layer gastric closure indicated?

A 
Pyloric outflow tract 
Reduced gastric volume 
Thickened gastric wall 
—> simple interrupted 
—> simple continuous
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10
Q

What suture material is used in gastric closure?

A

Material resistant to degradation for 14 days (time needed to regain gastric wall strength)

Monofilament, absorbable

Polydioxanone
Polyglyconate
Poliglecaperone 25

OR
Stables

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11
Q

What subjective criteria can be used to determine gastric viability?

A

Gastric wall thickness “Slip”
Serosal surface colour
Serosal capillary perfusion
Peristalsis

Non viable - thinning of wall, grey- green- black colour

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12
Q

What are the indications for gastric biopsy? How is it performed>?

A

Gross disease
Clinical signs of upper GI disease

Mucosal - endoscopy
Submucosal - surgical

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13
Q

What is the most common indication for gastrotomy?

A

Gastric foreign body

Dog>cat

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14
Q

What is the signalment for gastric foreign body?

A

Younger
Previous history of FB ingestion

Conditions that predispose to PICA
—> iron deficiency
—> hepatic encephalopathy
—> pancreatic exocrine insufficiency

Visualized FB ingestion

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15
Q

Clinical signs of gastric foreign body?

A

Vomiting - not always or can be intermittent
—> outflow obstruction
—>gastric distention
—> mucosal irritation

Lethargy
Abdominal pin
Anorexia

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16
Q

What laboratory findings can be associated with gastric foreign body?

A 
Hemoconcentration (dehydration) 
Anemia 
Leukocytosis 
Pre-renal azotemia 
Metabolic alkalosis vs acidosis 
Hypokalemia, hypochloremia
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17
Q

If you suspect a gastric foreign body, what diagnositics would you do?

A

Rads
US
Contrast studies
Endoscopy

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18
Q

How can you medically manage gastric foreign bodies?

A

Fluid therapy - rehydrate and correct electrolyte imbalances

Monitor -serial radiographs

Induction of vomiting - apomorphine in dogs and xylazine in cats

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19
Q

How do you perform a gastrotomy?

A

Isolate stomach, secure with stay sutures

Incision into hypovascular area on ventral aspect (between greater and lesser curvature)

Stab incision into gastric lumen and enlarged with Metzenbaum scissors

Suction
Removal of FB

Double closure
Lavage with sterile saline (warm) -300ml/kg
Change gloves before closing abdomen

20
Q

How will manage your patients post op gastrotomy?

A

Fluid therapy

Food and water within 12hours —> protein helps healing

If vomiting — ID cause and treat (prokinentics and antiemetic)

H2 blockers

21
Q

What is congenital pyloric stenosis? What breeds is it usually seen in?

A

Hypertrophy of the circular muscles of the pyloris

Brachiochephalic (boxers and bulldogs)
Siamese cats

22
Q

What is the possible etiology for congenital pyloric stenosis ?

A

Excess gastric production (trophic for gastric smooth muscle and mucosa)

Clincial signs at weaning

23
Q

Clinical signs of congenital pyloric stenosis ?

A

Intermittent vomiting

  • chronic
  • horse after feeding
  • partially digested
  • does fine with liquid

Normal to decreased body condition

24
Q

What diagnostics can you do for congenital pyloric stenosis?

A

Radiographs

  • gastric distention
  • delayed gastric emptying —> still has contents after fast of >8hrs

Contrast rads — “apple core”

Ultrasound 
Endoscopy (cant see muscle)
25
Q

What are the methods of managing congenital pyloric stenosis?

A

Pyloromyotomy AKA Fredet-Ramstedt procedure : 1-2cm incision though the serosa and muscularis layers of long axis of pylorus

Transverse pyloroplasty AKA Heineken-Mikuicz procedure: 3-5cm full thickness incision over pylorus, biopsy, then orient incision transverse and Close appositional

26
Q

What is the prognosis for congenital pyloric stenosis?

A

Outcome after surgical correction of benign conditions of pylorus

27
Q

What is chronic hypertrophic pyloric gastropathy? What is the usual signalment ?

A

Acquired mucosal and/or muscular hypertrophy

Small dogs - shih-tzu, Lhasa apso, Maltese
Male>female
Middle aged to older

28
Q

What is the etiology of chronic hypertrophic pyloric gastropathy (CHPG)?

A

Increased gastrin secretion
Acute stress
Inflammatory dz
Trauma

29
Q

How can you differentiate congenital pyloric stenosis from chronic hypertrophic pyloric gastropathy?

A

Similar clinical signs

Differentiate by signalment

Congenital — young brachycephalic breed, beginning after weaning

Chronic — middle aged small dogs

30
Q

What would you see on rads of a dog with CHPG?

A

Gastric distention

Delayed gastric emptying

31
Q

What diagnostic method can you evaluate muscle wall thickness of the pylorus?

A

Ultrasound

32
Q

How is CHPG graded?

A

Grade 1 - muscular hypertrophy ONLY

Grade 2- mucosal hyperplasia with glandular cystic dilation ONY

Grade 3- muscular hypertrophy AND mucosal hyperplasia

33
Q

How is CHPG managed?

A

Heineke-Mikulicz pyloroplasty

Y-U pyloroplasty

Pylorectomy with gastroduodenostomy (Bilroth I)

34
Q

What procedure for CHPG involved a single pedicle advancement from the antrum across the pylorus?

A

Y-U advancement pyloroplasty

35
Q

What are the advantages and disadvantages of a Y-U advancement pyloroplasty?

A

Advantages

  • increase diameter of pylorus
  • access to excise hypertrophied mucosa

Disadvantage
-potential necrosis of flap tip

36
Q

What is a Bilroth 1 ?

A

Pylorectomy- gastroduodenostomy

Removal of the pylorus and sphincter and stomach attaches to the duodenum

37
Q

What is the prognosis for CHPG?

A

Good to excellent

Poor outcome associated with technical failures

Selection of most appropriate technique important
Ability to recognize and treat underlying cause

38
Q

What are indications for gastrectomy?

A

Neoplasia
- location determines type of resection
Ulceration
Significant pyloric outflow obstruction

39
Q

What is the best method for removal of a slow growing leiomyoma in the cardia?

A

Submucosal resection

40
Q

What type of surgery is indicted when there is a lesion with extensive ulceration in the fundus of the stomach

A

Partial gastrectomy

—> GDV often clues tear and revitalization of the greater curvature of the stomach.. remove this section and close

41
Q

What is a Bilroth II?

A

Partial gastrectomy followed by gastroenterostomy

42
Q

When is a Bilroth II indicated?

A

Extensive gastric resection required making gastroduodenostomy impossible

43
Q

Complications to a Bilroth II?

A

Alkaline gastritis - bile and pancreatic secretion flow into stomach

Blind loop syndrome — gastric contents move orally and putrefy

Marginal ulceration — ulceration of jejunal mucosa (not used to seeing acid contents)

44
Q

What is the pathophysiology of phycomycosis?

A

Aquatic oomycete (pythium sp) —> ingestion —> severe inflammatory and infiltrative lesion —> induce intense fibrotic reaction —> transmural thickening (gastric outflow area most commonly affected)

45
Q

Clinical signs of phycomycosis ?

A 
Vomiting 
Inappetence 
Weight loss 
Diarrhea 
Palpable mass
46
Q

How can you diagnose phycomycosis ?

A

Endoscopy - difficult to find organism (submucosal and muscularis affected)

Histopath - eosinophilic phygranulomatous inflammation (deep tissue samples of fibrotic material)

ELISA for P. Insidiosum AB

47
Q

Treatment for phycomycosis ?

A

Wide surgical excision

Medical therapy ineffective - antifungals

Poor prognosis

RUSVM Small Animal Surgery 1 (39 decks)

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