Surgery of the stomach and spleen Flashcards
Which factors are important to consider for a GI surgery in terms of asepsis and which suture are we going to chose?
They are clean-contaminate procedures and we should consider perioperative antibiotics. Change of instruments and gloves, local lavage!
Monofilament, absorbable (PDS), reverse cutting or taper point needle. Closing: submucosa suture holding layer
What are the indications for performing a gastrotomy/gastrectomy?
-> gastric foreign bodies
-> full-thickness biopsy
-> resection of neoplasia (uncommon, requires considerable reconstruction)
-> resection of devitalised tissue (GDV)
Clinical signs are usually vomiting or inappetence. Lab findings would be consistent with dehydration as well as a acid-base imbalance (metabolic acidosis, hypokalemic alkalosis)
occasionally foreign objects can be removed via endoscopy, what kind of FB should always be removed surgically?
Large, rough, liner-like FB
How do we approach a gastrotomy, which points are important?
ventral midline celiotomy, exteriorise the stomach and pack it off, use stay sutures (2/0 PDS - full-thickness through stomach with big bites) and incision is made on greater curvature of the stomach (easily accessible and easier to close)
Which side of the stomach is the most important one to pack off with laparotomy pads?
most important packing is right down the front (liver). If things fall out of the stomach during the procedure it usually runs down that way where they liver sits. So use an additional pad cranially.
What are the options for closing a gastrotomy/gastrectomy?
Can either do single layer appositional closure or 2 layer appositional (mucosa; seromuscular + submucosa)
- simple continuous - in the mucosa
- simple continuous in seromuscular layer engaging submucosa
For partial gastrectomy - stapling equipment
What are the postop considerations/prognosis for a gastrotomy?
-> Fluid and electrolyte support necessary
-> gastroprotectants if necessary
-> Pro-motility drugs (ileus)
-> Food and water as soon as willing to eat - small amounts, bland diet
-> Prognosis excellent for most gastric foreign bodies
Which organs are affected by GDV, what effect does it have on the animal?
Mispositioning of the stomach; torsion along long axis, distension with gas (food) - “bloat”
-> Shock - compresses the caudal vena cava causing marked portal hypertension
-> Gastric/splenic necrosis
-> Multi-organ failure (clotting, cardiac arrhythmias)
What are the risk factors for GDV?
Predisposing factors include:
- Large/giant breeds
- Conformation (thoracic depth) lots of room in cranial abdomen for the stomach to twist on its own axis
- First degree relatives
- Increased age
What is the pathophysiology of GDV?
GDV stop gas from escaping with pylorus and oesophagus blocked off, this puts pressure on the caudal vena cava and portal vein to decrease the venous return resulting in hypovolemic shock.
Infarction and avulsion of the gastro epiploic vessels that run along the greater curvature of the stomach.
What are the clinical sign of a dog with GDV?
-> Acute, non-productive retching
-> Salivation
-> Abdominal distention and discomfort
-> Tachypnea, dyspnea, weakness, collapse
-> Pale or injected mucous membranes
-> Weak peripheral pulse/pulse deficit
How do we diagnose a GDV?
Right lateral radiograph
-> large gas filled stomach
-> compartmentalisation
-> displacement of pylorus
-> splenomegaly/displacement
-> abdominal fluid/free gas
How do we acutely treat GDV?
Stabilise!
-> Shock/fluid therapy
-> Stomach decompression - big stomach tube under GA
-> Pain management
How do we surgically treat GDV?
Surgical management ASAP
-> Reposition the stomach
-> Assess gastric and splenic viability (greater curvature)
-> Permanently fix antrum to right cranial abdominal quadrant (gastropexy)
-> Decompress stomach
-> Derotate stomach - RHS (pull pylorus ventral)
-> Once derotated do an abdominal explore - look at spleen and focus on head and tail of spleen (areas where we can get compromise to blood supply, the short gastric arteries and veins are most likely to break)
-> If tear to spleen do partial splenectomy
-> Check gastro-oesophageal junction
-> Evaluate stomach viability (resection recommended if necrotic part, NOT inversion!)
-> Gastropexy
Which suture material and size do we use for an incisional gastropexy?
2/0 PDS
