Surgery of the stomach, small + large intestine, rectum + anus Flashcards
1
Q
What is a hiatal hernia? Tx?
A
- Herniation of cardia of stomach through oesophageal hiatus
- May present as gastrooesophageal intussusception
- Treat surgically if persistent =
- Suture reduction of hiatus
- Oesophagopexy
- Left fundic gastropexy
2
Q
How would you close a gastrotomy?
A
- 1 or 2 layer closure
- First layer in mucosa / submucosa (simple continuous / interrupted / cushing / lembert)
- Second layer in serosa / muscularis / submucosa (Cushing / lembert)
3
Q
Why would you perform partial gastrectomy?
A
- Necrosis (GDV)
- Neoplasia
- Ulceration
4
Q
What dogs are predisposed to GDV?
What can predispose them?
* Is GDV significant?
A
- Purebred large / giant dogs
-Gordon setter, standard poodle, Weimeraner, Irish setter, Great Dane, St. Bernard - Predisposing factors =
-Increased thoracic depth : width ratio
-Fearful / aggressive temperament
-Feeding few meals, eating rapidly - EMERGENCY - LIFE-THREATENING
5
Q
What is the pathophysiology of GDV?
A
- Haemodynamic effects = Reduced abdominal blood flow and venous return leads to cardiogenic shock, splenic congestion
- Respiratory dysfunction = Increased intra-abdominal pressure limits diaphragmatic movement
- Cardiac dysfunction = Reduced perfusion / MDF cause myocardial ischaemia / necrosis and arrhythmias
- Gastric wall necrosis = Increased intragastric pressure compressing vessels +/- avulsion of short gastric arteries and reduces perfusion, causing necrosis
- Bacterial translocation = Mucosal ischaemia compromises mucosal integrity and allows bacterial translocation leading to sepsis / endotoxic shock
- Reperfusion injury = Due to free radical production after correction of GDV
6
Q
How do you treat gastric dilation volvulus?
A
- 2 immediate priorities =
- Fluid therapy
- Decompression of stomach
- All GDV cases require gastroplexy to prevent recurrence (suture to abdominal wall)
7
Q
How is fluids administered in GDV?
A
- Shock therapy = 2 cephalic cannulae
- Infusion pump / compression sleeve in large dogs
- Colloids, crystalloids, hypertonic saline
8
Q
How can you decompress the stomach (GDV)?
A
- Stomach tube - foal tube, done conscious
- Needle paracentesis - via flank (14-16G, 1.5/2inch needle)
- Temporary gastrostomy - LA, via flank, stay sutures
9
Q
When would you remove the spleen after a GDV?
A
- If thrombi or splenic torsion palpated
- If only congestion = will resolve when stomach repositioned
10
Q
When would you perform partial gastrectomy in regard to GDV?
A
- If gastric necrosis - assess colour =
- red / purple = congestion / haemorrhage - usually recovers
- Grey / greenish = non viable
- Thickness + pliability = thinning of wall = necrosis
- Increased mortality if partial gastrectomy required
11
Q
What should be done with GDV post op
A
- Fluids
- Monitor ECG for 24hrs postop - VPCs common
- Monitor electrolytes
- Nil by mouth 24-48hrs then water and small amounts food
- Gastric mucosal protectants = Sucralfate + Antacids
- If vomiting = metoclopramide
12
Q
What are causes of gastric outflow obstruction?
Tx?
A
- Neoplasia
- Pyloric stenosis
- Hypertrophic gastritis
- Pyloric muscular hypertrophy / dysfunction
- Tx = surgical - pyloroplasty (y-U antral flap)
13
Q
What are Billroth I + II?
A
- Billroth I = Gastroduodenostomy
- Billroth II = Gastrojejunostomy
- allows resection of large amount of distal stomach and pylorus (NEOPLASIA)
14
Q
How would you treat linear foreign bodies? (thread / string - dangling down GIT)
A
- DON’T JUST PULL IT - Gut Perforations
- Conservative management - if FB fixed under tongue + can be cut (no evidence of peritonitis)
- Surgical Tx - if FB not fixed at tongue or signs of peritonitis
15
Q
What are different causes of rectal prolapse?
A
- Persistent faecal tenesmus
- Defects in rectal / anal support
- Denervation of anal sphincter
