Surgical Approaches - Gastrointestinal

Question 1

what is an -otomy surgery?

Answer 1

cutting open/dividing tissue during surgery, after which the tissue is repaired to allow it to heal normally

Question 2

what is an -ostomy surgery?

Answer 2

the creating of an opening/stoma which communicates with the outside through the skin

Question 3

what is an -oscopy preocedure?

Answer 3

use of a device or instrument to give visual access inside a cavity

Question 4

what is an -ectomy procedure?

Answer 4

the surgical removal of all/part of a structure

Question 5

what are the roles of the veterinary nurse in GI surgery?

Answer 5

pre-op care of the animal

surgical prep of the animal

preparation of surgical equipment

assistance during surgery

anaesthetic management

post-op care of animal

post-op advice to owners

Question 6

what is the main factor involved in pre-op care of the GI surgical patient?

Answer 6

identification and stabilisation of fluid and electrolyte status via IV

Question 7

is pre-op starving recommended for GI surgery?

Answer 7

yes, 12 hours but may not have enough warning if emergency surgery

Question 8

are enemas commonly performed before GI surgery?

Answer 8

not usually required - often just makes faecal material more liquid and harder to deal with

Question 9

are antibiotics used pre-op?

Answer 9

usually only used intra- and post-op

Question 10

what pre-op step may be considered in a GDV patient?

Answer 10

passing a stomach tube to relieve pressure

Question 11

how do you prep for oral surgery?

Answer 11

flush mouth with saline to remove debris

Question 12

how do you prep the patient for a ventral midline laparotomy?

Answer 12

clip and aseptically prep a wide area to allow for a large incision and examination of entire abdominal contents

area should cover from above xiphoid to below pubis

Question 13

how do you prep the patient for anal/rectal surgery?

Answer 13

specific positioning - check with surgeon

anal ops may require packing and/or a purse string suture

Question 14

what are the temperature concerns during GI surgery?

Answer 14

high heat loss due to open abdomen - plan temperature regulation and warming

Question 15

how do you reduce the risk of regurgitation during GI surgery?

Answer 15

ensure a good seal on ET tube

patient can be tilted slightly with head lowered (allows drainage)

Question 16

what specific instruments/equipment might you need for GI surgery?

Answer 16

laparotomy swabs + suction

histopathology pots

specific instruments - gelpis, atraumatic bowel clamps

2 sets of surgical kits/tray drapes/gloves, additional spare instruments

pre-warmed saline for lavage

stomach tube and bucket

endoscope (depending on procedure)

Question 17

what is the role of the vet nurse during GI surgery?

Answer 17

surgical assistance - clamping intestines

keep exposed GI contents moist

keep contaminated instruments separate

control suction machine

have additional swabs and instruments to hand

take biopsy samples from surgeon

Question 18

what type of suture material is best for GI viscera?

Answer 18

short duration absorbable, synthetic monofilament (avoid braided)

Question 19

what is the best suture needle choice for GI surgery?

Answer 19

round body is least traumatic (avoid cutting needle)

Question 20

what type of surgery is GI surgery (cleanliness-wise)?

Answer 20

Considered clean-contaminated

Question 21

when is GI surgery NOT considered clean-contaminated?

Answer 21

if tissue viability is in question

if contamination has already occurred

if gross contamination occurs during surgery e.g. spillage of GI contents

Question 22

what are the common antibiotics used peri/post-operatively in GI surgery?

Answer 22

broad spectrum e.g. amoxycillin + clavulanic acid (amoxyclav) and metronidazole

Question 23

when are antibiotics always needed with GI surgery?

Answer 23

if contamination occurs peri-operatively

Question 24

why do oronasal fistulae need surgical repair?

Answer 24

to stop food material impacting in nasal cavity

Question 25

what are the common types of oral surgery?

Answer 25

oral tumour removal oral fistulae repair cleft palate surgery foreign bodies and penetrating injuries

Question 26

what are the pre-op considerations for oral surgery?

Answer 26

make sure to thoroughly flush any debris form mouth

Question 27

what are the post-op nursing considerations for oral surgery?

Answer 27

ensure patient can eat/drink - soft but formed food | feeding tube may be required

Question 28

what are the main types of oesophageal surgeries?

Answer 28

oesophageal foreign bodies | oesophageal stricture

Question 29

what are the pre-op nursing considerations for oesophageal surgeries?

Answer 29

treatment of hypovolaemia/dehydration as needed - IVFT

Question 30

what are the post-op nursing considerations for oesophageal surgery?

Answer 30

consider use of feeding tube if oesophagus damaged and needs time to heal liquidised diet may be necessary

Question 31

what are the main types of gastric surgery?

Answer 31

``` foreign body removal pyloric obstruction gastric neoplasia GDV tube gastrotomy ```

Question 32

what is the main sign of a gastric foreign body?

Answer 32

persistent or intermittent vomiting

Question 33

what is a pyloric obstruction?

Answer 33

foreign body or thickening/neoplasia at outflow of stomach - surgery may widen or remove the pylorus

Question 34

what other life-threatening conditions can GDV result in?

Answer 34

severe hypovolaemia toxic shock gastric wall necrosis ventricular dysrhythmia disseminated intravascular coagulation

Question 35

what is a tube gastrotomy?

Answer 35

surgical or endoscopic placement of a tube for nutritional support or decompression of the stomach - tube is anchored in the stomach and exits through the body wall

Question 36

what are the pre-/intra-op nursing considerations for gastric surgery?

Answer 36

treatment of dehydration/hypovolaemia as needed - IVFT preparation of a wide surgical site keep a close eye on heat and moisture loss during surgery

Question 37

what are the post-op nursing considerations for gastric surgery?

Answer 37

feeding a low fat/bland diet (liquidised if pyloric obstruction) continued treatment of fluid/electrolyte losses monitor for arrhythmias in GDV

Question 38

what are the 6 stages of the treatment plan for GDV?

Answer 38

1. Rapid IV fluid admin to treat shock 2. IV antibiotics 3. decompression of stomach by passing stomach tube 4. right lateral radiograph to confirm GDV 5. ECG to check for ventricular dysrhythmias 6. surgery to decompress and de-rotate stomach and assess stomach wall viability; gastropexy may be performed

Question 39

what are the main types of small intestinal surgery?

Answer 39

``` intestinal biopsy enterotomy - foreign body removal enterectomy - removal of section of SI intussusception tumour removal ```

Question 40

what is intussusception?

Answer 40

where the small intestine invaginates into itself - tissue may become necrotic and need resecting

Question 41

what are the pre-op nursing considerations for SI surgery?

Answer 41

treatment of hypovolaemia/dehydration as needed - IVFT preparation of a wide surgical site

Question 42

what are the intra-op nursing considerations for SI surgery?

Answer 42

keep intestinal contents moist whilst lifted out of abdomen keep careful eye on heat loss bowel clamps or a scrubbed assistant's fingers ay be used to 'clamp off' gut whilst operated on

Question 43

what are the post-op nursing considerations for SI surgery?

Answer 43

make sure biopsy samples are labelled with site encourage eating/drinking - bland low fat diet

Question 44

what are the main types of large intestinal surgery?

Answer 44

intestinal biopsy - endoscopy or laparotomy | colectomy - removal of colon

Question 45

which is LI surgery higher risk than SI surgery?

Answer 45

LI has increased bacterial load and slower healing time

Question 46

what are the pre-op nursing considerations for LI surgery?

Answer 46

avoid enemas - slurry more likely to spill | pre-operative antibiotics may be indicated

Question 47

what are the post-op nursing considerations fo LI surgery?

Answer 47

make sure biopsy samples are labelled with site | post-op nutritional support to aid healing

Question 48

what are the main types of anal/rectal surgery?

Answer 48

``` rectal polyps/tumours rectal prolapse imperforate anus anal sac removal anal furunculosis ```

Question 49

what is an imperforate anus?

Answer 49

congenital condition where anus does not join with rectum - can sometimes be corrected surgically

Question 50

why might the anal sacs need to be removed?

Answer 50

due to chronic sacculitis/impaction/abscessation

Question 51

what are the pre-/intra-op considerations for anal/rectal surgery?

Answer 51

ask surgeon for preferred positioning protect prolapses prior to surgery - keep moist and lubricated, prevent self-mutilation peri-anal surgery may require purse-string suture placement

Question 52

what are the post-op considerations for anal/rectal surgery?

Answer 52

post-operative nutritional support to aid healing

Question 53

what is peritonitis?

Answer 53

contamination or irritation of the peritoneum leading to an inflammatory response infection develops and leads to severe illness, sepsis, shock and cardiovascular collapse

Question 54

what are the clinical signs of peritonitis?

Answer 54

``` pyrexia anorexia depression tachycardia vomiting ascites abdominal pain ```

Question 55

how is peritonitis treated?

Answer 55

surgical exploration of abdomen to find source of contamination + thorough lavage infection managed with open peritoneal drainage intensive nursing - IVFT, bandage care, close monitoring of albumin and electrolytes