Surgery of the stomach, small + large intestine, rectum + anus

Question 1

What is a hiatal hernia? Tx?

Answer 1

• 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

Question 2

How would you close a gastrotomy?

Answer 2

• 1 or 2 layer closure
• First layer in mucosa / submucosa (simple continuous / interrupted / cushing / lembert)
• Second layer in serosa / muscularis / submucosa (Cushing / lembert)

Question 3

Why would you perform partial gastrectomy?

Answer 3

• Necrosis (GDV)
• Neoplasia
• Ulceration

Question 4

What dogs are predisposed to GDV?
What can predispose them?
* Is GDV significant?

Answer 4

• 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

Question 5

What is the pathophysiology of GDV?

Answer 5

• 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

Question 6

How do you treat gastric dilation volvulus?

Answer 6

• 2 immediate priorities =
• Fluid therapy
• Decompression of stomach
• All GDV cases require gastroplexy to prevent recurrence (suture to abdominal wall)

Question 7

How is fluids administered in GDV?

Answer 7

• Shock therapy = 2 cephalic cannulae
• Infusion pump / compression sleeve in large dogs
• Colloids, crystalloids, hypertonic saline

Question 8

How can you decompress the stomach (GDV)?

Answer 8

• Stomach tube - foal tube, done conscious
• Needle paracentesis - via flank (14-16G, 1.5/2inch needle)
• Temporary gastrostomy - LA, via flank, stay sutures

Question 9

When would you remove the spleen after a GDV?

Answer 9

• If thrombi or splenic torsion palpated
• If only congestion = will resolve when stomach repositioned

Question 10

When would you perform partial gastrectomy in regard to GDV?

Answer 10

• 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

Question 11

What should be done with GDV post op

Answer 11

• 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

Question 12

What are causes of gastric outflow obstruction?
Tx?

Answer 12

• Neoplasia
• Pyloric stenosis
• Hypertrophic gastritis
• Pyloric muscular hypertrophy / dysfunction
• Tx = surgical - pyloroplasty (y-U antral flap)

Question 13

What are Billroth I + II?

Answer 13

• Billroth I = Gastroduodenostomy
• Billroth II = Gastrojejunostomy
• allows resection of large amount of distal stomach and pylorus (NEOPLASIA)

Question 14

How would you treat linear foreign bodies? (thread / string - dangling down GIT)

Answer 14

• 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

Question 15

What are different causes of rectal prolapse?

Answer 15

• Persistent faecal tenesmus
• Defects in rectal / anal support
• Denervation of anal sphincter

Question 16

What is treatment of rectal prolapse?

Answer 16

• Diagnose and treat underlying disease
• Reduce prolapse
• Surgical correction =
• Purse-string suture for 1-5d
• Colopexy - similar to incisional gastropexy
• Resection and anastomosis

Question 17

What is post op care of rectal prolapse?

Answer 17

• Stool softeners
• Low bulk diet
• Sedation to reduce tenesmus

Question 18

What is anal furunculosis? What dogs are predisposed? What is the likely cause?

Answer 18

• Chronic, ulcerative fistulous tracts surrounding anus, up to 360º involvement
• GSDs predisposed, also in Labrador, setters and collies
• Most likely autoimmune in origin

Question 19

• What are clinical signs of anal furunculosis?
• Tx?

Answer 19

• CS = Tenesmus, Pruritus, Fistulae / sinus tracts around anus
• Tx = Medical therapy best - Ciclosporin
• Surgical excision - messy + complicated