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surgical disorders of the stomach Flashcards

1
Q

list the possible surgical disorder of the stomach

A
  • fb
  • pyloric stenosis
  • neoplasia
  • hiatal hernia
    *
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2
Q

cs of gastric fb

A
  • abdominal pain
  • vomiting
  • anorexia and wt loss
  • gastric fb are seldomly palpable
  • incomplete or intermittent obstruction causes less frequent vomiting
  • mucosal erosions,ulceration or necrosis occurs naturally and may cause melena or hematemesis
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3
Q

diagnosis for gastric fb

A
  • radiography
  • ultrasonography
  • endoscopy
  • laboratory data: metabolic alkalosis, hypochloremia,hypokalemia
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4
Q

treatment for gastric fb

A
  • correction of electrolytes,water and acid-base imbalances.
  • foreign body removal :endoscopy for small light wt ,soft material ie fabric,.gastroctomy for smooth or heavy objects,sharp or heavy objects,sharp bojects
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5
Q

prognosis for gastric fb removal

A
  • excellent in most cases
  • good even if mucosal damage is present
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6
Q

abnormal narrowing of the lumen of the pylorus causing partial obstruction

A
  • pyloric hypertrophy/stenosis
  • occurs predominantly in dogs and less in cats
  • etiology is unknown
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7
Q

discuss the etiolgy of pyloric stenosis

A
  • occurs as a congenital or acquired dz
  • congenital form involves the muscular layer of the pylorus
  • acquiered form is hypertrophy of mucosal or muscular layer of pylorus and sometimes of pylorus antrum
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8
Q

discus sthe signalment of congenital hypertrophy

A
  • puppy or kitten 6-8 weeks
  • brachycephalic breeds
  • siamese cats
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9
Q

cs of pyloric hypertrophy

A
  • emanciation,stunted growth
  • dehydration
  • occassionally fever and increased lung sounds secondary to aspiration of vomitus
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10
Q

discuss diagnosis of pyloric hypertrophy

A
  • history n signalmentespercially age of onset
  • cs
  • laboratory data
  • radiography
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11
Q

discuss radiographic findings of pyloric hypertrophy

A
  • Plain radiographs: enlarged stomach filled with food and fluid
  • positive contrast gastrography:delayed gastric emptying-prescence of barium in stomach beyond 8-12 hrs is abnormal
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12
Q

laboratory abnormalities due to pyloric hypertrophy

A
  • malnutrition:hypoproteinemia,anemia,low BUN,hypoglycemia.
  • pyloric vomiting:dehydration, hypochloremia metabolic alkalosis
  • elevated wbc if aspiration pneumonia occurs
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13
Q

discuss history for pyloric hypertrophy

A
  • intermitent vomiting not always associated with feedingthat increases in frequenc y over mnths
  • wt loss
  • occassionally anemia ,depression,decreased activity
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14
Q

discuss the signalment for acquired pyloric hypertrophy

A
  • middle aged excittable small breeds of dogs, esp lhaso apso and shir-tzu
  • rare in cats
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15
Q

cs of acquired pyloric hypertrophy

A
  • pale mm
  • weakness
  • emanciation
  • dehydration hypochloric metabolic alkalosis
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16
Q

discuss radiographic finding of pyloric hypertrophy

A

positive contrast gastrogram

  • delayed gastric emptying
  • irregular mucosa within pylorus or pyloric antrum
  • filling defect in pylorus
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17
Q

explain when the endoscope is required for pyloric hypertrophy

A
  • narrow lumen in pylorus
  • mucosal/submucosal hypertrophy
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18
Q

discuss the Pyloric Hypertrophy/Stenosis

A
  • Medical treatment not effective
  • Surgery:
  1. Pyloromyotomy
  2. Pyloroplasties
  3. Gastroduodenostomy/gastrojejunostomy
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19
Q

list the commonly used surgical procedures for pyloric hypertrophy

A
  • fredet-ramstedt pyeloromyotomy
  • heineke mikulicz pyloroplasty
  • Y-U antral advancement flap pyloroplasty
    *
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20
Q

what is the indication for fredet-ramstedt

A
  • congenital pyloric stenosis
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21
Q

discuss the surgical technique for fredet-ramstedt

A
  • Partial thickness longitudinal incision

from antrum to duodenum across
pylorus

  • Seromuscular layer incised to allow mucosa to bulge into incision and

expand pylorus

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22
Q

what are the advantages of fredet-ramstedt pyloromyotomy

A
  • quik and easy to perform
  • lumen of pylorus not opened
23
Q

what are the disadvantages of fredet-ramstedt pyrolomyotomy

A
  • effective only in congenital stenosis
  • effects may be temporary -stenosis may recur as the seromuscular incision heals
24
Q

discuss indications for heineke mukulicz pylorectomy

A

congenital or acquired pyloric hypertophy, biopsy

25
Q

explain the surgicsl procedure for heineke mukulicz

A
  • A full- A full—thickness longitudinal incision thickness longitudinal incision

crosses the ventral surface of the
pylorus

  • The incision is closed transversely in

1 layer of simple interrupted sutures

26
Q

what are the advantages of heineke mukulicz pyroloplasty

A
  • Exposure of mucosa for biopsy
  • Less likelihood of recurrence

than pyloromyotomy

27
Q

what are the disadvantages of heineke mukulicz

A
  • Lumen is opened
  • Not usually effective with

acquired pyloric hypertrophy

28
Q

what are the indications for Y-U pyroplasty

A
  • acquired pyloric hypertrophy,
  • resection of mucosa / submucosa
29
Q

discuss the surgical technique for heineke mukulicz

A
  • Make a longitudinal full—thickness pyloric incision.
  • Extend it into the pyloric antrum Extend it into the pyloric antrum making 2 making 2
diverging incisions (Y)
 The incised gastric wall is closed by
 suturing into a “U” shape
30
Q

what are the advantages of Y-U pyloplasty

A
  • Good exposure of mucosa
  • Redundant mucosa and submucosa

can be resected (use 1 layer closure)

  • Greater expansion of pylorus
31
Q

what are the disadvantages of Y-U pyloplasty

A
  • Lumen is opened
  • More lengthy procedure
32
Q

what are the indications for Pylorectomy and

Gastroduodenostomy (Billroth I)

A
  • severe acquired pyloric hypertrophy,
  • necrosis of pylorus,
  • neoplasia
33
Q

discuss the surgical procedure for Pylorectomy and

Gastroduodenostomy (Billroth I)

A
  • Ligate branches of right and left gastric vessels vessels
  • Remove omentum omentum and mesentery
  • Identify and preserve duodenal papilla
  • Excise pylorus and proximal duodenum between clamps
  • Correct lumen disparity by partially closing gastric incision
  • 1 or 2 layer closure of pyloric antrum to duodenum, closing far side (back wall) of

incision first

34
Q

what are the advantages of Pylorectomy and

Gastroduodenostomy (Billroth I)

A
  • Abnormal tissue removed completely
  • All tissue layers excised for biopsy
  • Large increase in size of opening to

pylorus

35
Q

what are the disadvantages of Pylorectomy and

Gastroduodenostomy

A
  • Technically difficult, lengthy procedure
  • Increased risk of leakage compared to

pyloroplasty techniques

36
Q

what are the indications for partial gastroctomy

A
  • neoplasia, ischemic injury (GDV) or penetrating injury (ulcer or trauma)
  • Ischemic injury commonly occurs at the

greater curvature

  • Ischemic injury involving both

curvatures is not suitable for surgery

37
Q

explain the incisional techique for partial gastrecctomy

A
  • branches of the gastroepiploic vessels to the affected area are ligated.
  • a continuous suture may be run concurrently with resection
  • the incision is closed in 2 layers
38
Q

discuss the morphological appearance of the adenocarcinoma

A
  • primarily may be scirrhous or infiltrative
  • scirrhous:firm and white on serosal surface
  • infiltrative:expansive with central crator and ulceration on mucosal surface.
39
Q

treatment for gadenocarcinoma

A
  • Partial gastrectomy
40
Q

what are the disadvantage of partial gastrectomy when treating adenocarcinoma

A
  • more difficult on lesser curvature
  • gastroduodenostomy or gastrojejunostomy often required
  • cholecystoenterotomy may be required with pyloric tumers
41
Q

indications for gastrojejunostomy

A
  • neoplasia
  • necrosis of pylorus or antral region of stomach
42
Q

discuss the surgical technique of pylorectomy and gastrojejunostomy

A
  • ligate branches of right and left gastric and gastroepiploic vessesls
  • remove omentum and mesentery, identify deodenal papillae
  • resect pylorus,pyloric antrum and proximal deodenum
  • Close duodenal and antral stumps
  • Complete with side-to-side anastomosis of stomach and a loop of proximal jejunum
43
Q

advantages of gastrojejunostomy (billroth)

A
  • abnormal tissue removed
  • compared to bilroth 1,reduces tension on suture line when extensive resection is required
44
Q

disadvantages of pylorectomy and gastrojejunostomy (biliroth)

A
  • difficult legnthy procedure,not rewarding
  • marginal ulceration of jejunal limb from exposure to gastric fluid
45
Q

discuss the prognosis for gastric adenoma

A

complete excusion is curative

46
Q

discuss the prognosis for leiomyoma/ leiomyosarcoma

A

mean survival:1 yr

47
Q

discuss the pregnosis for adenocarcinoma

A

surgery is palliative (preventing surfuring)

mean survival is 6 mnths

48
Q

define heital hernia

A

protrution of abdominal esophagus, gastroesophageal junction and sometimes a portion of gastric fundus through the esophageal hiatus of the diaphragm into the caudal mediastinum

49
Q

discuss etiology for hiatal hernia

A
  • usually congenital,associated with abnormalities of hiatus, espercially of the phrenicoesophageal lig.
  • possible traumatic
  • may be associated with upper airway obstruction
50
Q

discuss the signalment for hiatal hernia

A
  • dogs and cats
  • male shar peei and bulldogs predisposed
51
Q

discuss the history for hiatal hernia

A
  • often asymptomatic
  • reguagitation ,vomiting or dyspnea
  • hematemesis
  • anorexia,wt loss
52
Q

diagnosis for heital hernia

A
  • radiography,flouroctomy
  • endoscopy (esophagitis)
53
Q

surgical treatment for heital henia

A
  • for symptomatic patients only
  • gastroplexy-left sided fundus to body wall
  • hiatal reduction and esophagopexy
  • gastrostomy tube
  • nissen fundoplication -indicated only if reflux and esophagitis are present

small animal surgery (3 decks)

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