Surgical Approaches - Gastrointestinal Flashcards
what is an -otomy surgery?
cutting open/dividing tissue during surgery, after which the tissue is repaired to allow it to heal normally
what is an -ostomy surgery?
the creating of an opening/stoma which communicates with the outside through the skin
what is an -oscopy preocedure?
use of a device or instrument to give visual access inside a cavity
what is an -ectomy procedure?
the surgical removal of all/part of a structure
what are the roles of the veterinary nurse in GI surgery?
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
what is the main factor involved in pre-op care of the GI surgical patient?
identification and stabilisation of fluid and electrolyte status via IV
is pre-op starving recommended for GI surgery?
yes, 12 hours but may not have enough warning if emergency surgery
are enemas commonly performed before GI surgery?
not usually required - often just makes faecal material more liquid and harder to deal with
are antibiotics used pre-op?
usually only used intra- and post-op
what pre-op step may be considered in a GDV patient?
passing a stomach tube to relieve pressure
how do you prep for oral surgery?
flush mouth with saline to remove debris
how do you prep the patient for a ventral midline laparotomy?
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
how do you prep the patient for anal/rectal surgery?
specific positioning - check with surgeon
anal ops may require packing and/or a purse string suture
what are the temperature concerns during GI surgery?
high heat loss due to open abdomen - plan temperature regulation and warming
how do you reduce the risk of regurgitation during GI surgery?
ensure a good seal on ET tube
patient can be tilted slightly with head lowered (allows drainage)
what specific instruments/equipment might you need for GI surgery?
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)
what is the role of the vet nurse during GI surgery?
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
what type of suture material is best for GI viscera?
short duration absorbable, synthetic monofilament (avoid braided)
what is the best suture needle choice for GI surgery?
round body is least traumatic (avoid cutting needle)
what type of surgery is GI surgery (cleanliness-wise)?
Considered clean-contaminated
when is GI surgery NOT considered clean-contaminated?
if tissue viability is in question
if contamination has already occurred
if gross contamination occurs during surgery e.g. spillage of GI contents
what are the common antibiotics used peri/post-operatively in GI surgery?
broad spectrum e.g. amoxycillin + clavulanic acid (amoxyclav) and metronidazole
when are antibiotics always needed with GI surgery?
if contamination occurs peri-operatively
why do oronasal fistulae need surgical repair?
to stop food material impacting in nasal cavity
what are the common types of oral surgery?
oral tumour removal
oral fistulae repair
cleft palate surgery
foreign bodies and penetrating injuries
what are the pre-op considerations for oral surgery?
make sure to thoroughly flush any debris form mouth
what are the post-op nursing considerations for oral surgery?
ensure patient can eat/drink - soft but formed food
feeding tube may be required
what are the main types of oesophageal surgeries?
oesophageal foreign bodies
oesophageal stricture
what are the pre-op nursing considerations for oesophageal surgeries?
treatment of hypovolaemia/dehydration as needed - IVFT
what are the post-op nursing considerations for oesophageal surgery?
consider use of feeding tube if oesophagus damaged and needs time to heal
liquidised diet may be necessary
what are the main types of gastric surgery?
foreign body removal pyloric obstruction gastric neoplasia GDV tube gastrotomy
what is the main sign of a gastric foreign body?
persistent or intermittent vomiting
what is a pyloric obstruction?
foreign body or thickening/neoplasia at outflow of stomach - surgery may widen or remove the pylorus
what other life-threatening conditions can GDV result in?
severe hypovolaemia
toxic shock
gastric wall necrosis
ventricular dysrhythmia
disseminated intravascular coagulation
what is a tube gastrotomy?
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
what are the pre-/intra-op nursing considerations for gastric surgery?
treatment of dehydration/hypovolaemia as needed - IVFT
preparation of a wide surgical site
keep a close eye on heat and moisture loss during surgery
what are the post-op nursing considerations for gastric surgery?
feeding a low fat/bland diet (liquidised if pyloric obstruction)
continued treatment of fluid/electrolyte losses
monitor for arrhythmias in GDV
what are the 6 stages of the treatment plan for GDV?
- Rapid IV fluid admin to treat shock
- IV antibiotics
- decompression of stomach by passing stomach tube
- right lateral radiograph to confirm GDV
- ECG to check for ventricular dysrhythmias
- surgery to decompress and de-rotate stomach and assess stomach wall viability; gastropexy may be performed
what are the main types of small intestinal surgery?
intestinal biopsy enterotomy - foreign body removal enterectomy - removal of section of SI intussusception tumour removal
what is intussusception?
where the small intestine invaginates into itself - tissue may become necrotic and need resecting
what are the pre-op nursing considerations for SI surgery?
treatment of hypovolaemia/dehydration as needed - IVFT
preparation of a wide surgical site
what are the intra-op nursing considerations for SI surgery?
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
what are the post-op nursing considerations for SI surgery?
make sure biopsy samples are labelled with site
encourage eating/drinking - bland low fat diet
what are the main types of large intestinal surgery?
intestinal biopsy - endoscopy or laparotomy
colectomy - removal of colon
which is LI surgery higher risk than SI surgery?
LI has increased bacterial load and slower healing time
what are the pre-op nursing considerations for LI surgery?
avoid enemas - slurry more likely to spill
pre-operative antibiotics may be indicated
what are the post-op nursing considerations fo LI surgery?
make sure biopsy samples are labelled with site
post-op nutritional support to aid healing
what are the main types of anal/rectal surgery?
rectal polyps/tumours rectal prolapse imperforate anus anal sac removal anal furunculosis
what is an imperforate anus?
congenital condition where anus does not join with rectum - can sometimes be corrected surgically
why might the anal sacs need to be removed?
due to chronic sacculitis/impaction/abscessation
what are the pre-/intra-op considerations for anal/rectal surgery?
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
what are the post-op considerations for anal/rectal surgery?
post-operative nutritional support to aid healing
what is peritonitis?
contamination or irritation of the peritoneum leading to an inflammatory response
infection develops and leads to severe illness, sepsis, shock and cardiovascular collapse
what are the clinical signs of peritonitis?
pyrexia anorexia depression tachycardia vomiting ascites abdominal pain
how is peritonitis treated?
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
