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Small Animal Surgery > Surgical Disorders of the Stomach > Flashcards

Surgical Disorders of the Stomach Flashcards

1
Q

What is often the main reason we perform a exploratory celiotomy?

A

Gastric FB

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2
Q

What is the most dangerous bones for dogs?

Why?

A

Pork bones

tend to shatter & make spicules

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3
Q

What animals are more likely to present with Gastric FBs?

A

Young animals

dog > cat

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4
Q

What type of FBs do cats like to get?

A

Linear FBs

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5
Q

C/S of Gastric FBs

A
  • Abdominal pain
  • Vomiting
  • Anorexia + wt. loss
  • Melena or hematemesis
    • due to mucosal erosion, ulceration or necrosis
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6
Q

C/S of Incomplete/Intermittent obstruction?

A
  • Less frequent vomiting
    • Gastric or pyloric vomiting
  • Less severe H2O & electrolyte deficiets
  • Anorexia & wt. loss may be the predominant signs
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7
Q

What Lab results may suggest a Gastric FB?

A
  • Metablic alkalosis
  • Hypochloremia
  • Hypokalemia
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8
Q

How can you remove a Gastric FB?

(2)

A
  • Endoscopy
    • small, light wt., smooth soft material (fabric)
  • Gastrotomy
    • heavy, sharp or rough surfaced objects (balls, bones, toys)
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9
Q

What should you always do before performing an exploratory celiotomy to remove a gastric FB?

A

Take rads!!!

(b/c things may have moved)

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10
Q

Describe what happens w/ Pyloric Hypertrophy/Stenosis.

Who gets it more frequently?

A
  • Have abnormal narrowing of the pyloric lumen → causes partial obstruction → prevents bolus from entering the duodenum
  • Dogs
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11
Q

Which layer of the pylorus is involved in Congenital Pyloric Hypertrophy/Stenosis?

A

Muscular layer

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12
Q

What layers of the pylorus are affected in Acquired Pyloric Hypertrophy/Stenosis?

A

Mucosal or muscular layer

(rarely, the pyloric antrum)

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13
Q

Signalment of Congenital Pyloric Hypertrophy/Stenosis?

A
  • young animals (≈ 6-8 wks)
  • Brachycephalic dog breeds
  • Siamese Cats
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14
Q

HX & C/S of Congenital Pyloric Hypertrophy/Stenosis?

A
  • HX
    • once wean → vomit 24 hr. after eating
    • + ravenous appetite
  • C/S
    • Emaciation
    • Stunted growth
    • Dehydrated
    • Aspiration → + fever, + increased lung sounds
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15
Q

What are some lab abormalities that point towards Congenital Pyloric Hypertrophy/Stenosis?

A
  • Malnutrition:
    • Hypoproteinemia; Anemia; low BUN; hypoglycemia
  • Pyloric vomiting:
    • Dehydration; Hypochloremia; Metabolic alkalosis
  • Aspiration pneumonia:
    • Elevated WBCs
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16
Q

When is presence of barium in the stomach considered ABNORMAL?

(time interval)

A

beyond 8-12 hrs.

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17
Q

Signalment for Acquired Pyloric Hypertrophy/Stenosis?

A

Middle aged, excitable small breed DOGS

(Lhasa Apso & Shih Tzu)

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18
Q

HX & C/S of Acquired Pyloric Hypertrophy/Stenosis?

A
  • HX
    • Intermittent vomiting that increases in frequency
      • not always associated w/ feeding
    • Wt. loss
    • Occasionally → anemia, depression, reduced activity
  • C/S
    • Pale MM
    • Emaciated & weak
    • Dehydration
    • Hypochloremic Metabolic Alkalosis
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19
Q

TX of Pyloric Hypertrophy/Stenosis?

(4 options)

A
  • Pyloromyotomy
  • Pyloroplasty
  • Gastroduodenostomy
  • Gastrojejunostomy

(MUST DO SX, need to be experienced)

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20
Q

What surgical techniques can be used to repair Congenitial Pyloric Stenosis?

A

Fredet-Ramstedt Pyloromyotomy

Heineke-Mikulicz Pyloroplasty

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21
Q

What are the advantages of the Fredet-Ramstedt Pyloromyotomy?

A
  • Quick & easy to perform
  • Lumen of pylorus is NOT opened
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22
Q

Disadvantages of Fredet-Ramstedt Pyloromyotomy?

A
  • ONLY treats congenital form
  • Stenosis may reoccur once seromuscular incision heals
    • To avoid →Take a strip of muscularis & serosa during SX
      • makes it more difficult to heal back
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23
Q

Advantages of Heineke-Milkulicz Pyloroplasty?

A
  • TXs both forms of pyloric stenosis
  • Exposes mucosa → can get BX
  • Less chance of stenosis reoccuring
24
Q

Disadvantages of Heineke-Milkulicz Pyloroplasty?

A
  • Open the lumen
  • Not ususally very effective for Acquired form
25
Q

What the best surgical prodecure for correcting Acquired Pyloric Hypertrophy/Stenosis?

A

Y-U Advanced Flap Pyloroplasty

26
Q

Advantages of Y-U Advanced Flap Pyloroplasty?

(3)

A
  • Good exposure of the mucosa
  • Can resect redundant mucosa & submucosa → 1 layer closure
  • Greater expansion of the pylorus
27
Q

Disadvantages of Y-U Advanced Flap Pyloroplasty

A
  • Lumen in opened
  • More lengthy procedure (time)
28
Q

Which SX technique involves Non-Pentrating SX?

A

Fredet-Ramdstedt Pyloromyotomy

29
Q

Why must the flap have a very wide base?

(for the Y-U Advanced Flap Pyloroplasty)

A

To maintain a good blood supply & prevent perforation

30
Q

Why would you use a Billlroth I Surgical procedure?

(Plyorectomy + Gastroduodenostomy)

A
  • Severe acquired Pyloric Hypertrohpy
  • Necrosis of the pylorus
  • Neoplasia
31
Q

Main advantage of the Billroth I Surgical Technique?

A

Large increase in size of the pyloric opening

32
Q

Where do you excise the pylorus & proximal dueodenum in the Billroth I Technique?

A

between the clamps

33
Q

Indications for a Partial Gastrectomy?

A
  • Neoplasia
  • Ischemic injury
    • most commonly occurs @ the Greature Curvature
      • If greater & less curvatures are involved → White House
  • Penetrating injury
34
Q

What vessels are important to ligate when performing a Partial Gastrectomy?

A

Branches of the gastroepiploic vessels

35
Q

What is the most commong Malignant gastric neoplasm in dogs?

Signalment?

A
  • Adenocarcinoma
  • Males > females
  • ~ 8 years old
36
Q

What is the most common malignant gastric tumor in cats?

A

Lymphosarcoma

37
Q

Where are malignant gastric neoplasms commonly located?

A

Lesser curvature

pyloric antrum

38
Q

What Radiographic finding is suggestive of a tumor in the Pyloric Antrum?

A

“Apple-core” lesion

39
Q

DDX for tumors in the pyloric antrum?

(2)

A

Pyloric Hypertrophy/Stenosis

Pythiosis/Phycomycosis

40
Q

Who typically gets Pythiosis?

Why do we care?

A
  • hunting dogs
  • animals in the Gulf States
  • mimics invasive carcinoma
  • Can extend to the pancreas, omentm, LN or contiguous viscera
  • Must remove surgically
41
Q

Where are the 3 primary sites of metatsis for Gastric Adenocarcinoma?

A
  1. Regional LN (70-80%)
  2. Liver
  3. Lungs
42
Q

What is the term for a firm, white 1º neoplasm on the serosal surface?

A

Scirrhous

43
Q

What is the term for 1º neoplasm that is expansile w/ central crater & ulceration on the mucosal surface?

A

Infiltrative

44
Q

Why would you perform a Billroth II?

(Pylorectomy + Gastrojejunostomy)

A

Neoplasia
or Necrosis

45
Q

Are there Non-Surgical Treatments for Gastric Neoplasia?

A

NO

  • No effective Chemo for adenocarcinoma
  • Gastric lymphosarc doesn’t respond to chemo
  • Radiation is too harmful to surrounding delicate tissues
46
Q

Prognosis for Gastric Neoplasia?

A
  • Adenoma → cure w/ complete excision
  • Leiomyoma/Leimyosarc → 1 yr
  • Adenocarcinoma → 6 m.
47
Q

Protrusion of abdominal esophagus, gastro-esophageal jxn & sometimes a portion of the gastric fundus through the esophageal hiatus of the diaphragm into the cranial mediastinum/thoracic cavity

A

Hiatal hernia

48
Q

What is the usual cause of Hiatal Hernias?

A

Congenital abnormality of the esophageal hiatus

(especially the phrenicosplenic ligament)

49
Q

Which dog breeds are pre-disposed to hiatal hernias?

A

Shar-Pei

Bulldogs

(Males)

50
Q

What’s a good DX test for Hiatal Hernias?

Why?

A
  • Fluoroscopy →see motion/mvment of a displaced esophagus
  • Rads
51
Q

When do you surgically repair a Hiatal Hernia?

A

Only for symptomatic patients

(vomiting, regurgitation, gastric esophageal reflux)

52
Q

Which side of the fundus is attached to the body wall in a Gastropexy to TX a Hiatal Hernia?

A

LEFT side of the fundus

53
Q

Which side of the fundus is attached to the body wall in Gastropexy to TX GDV?

A

RIGHT side of the fundus

54
Q

When is a Nissen Fundoplication indicated?

A

Only if gastric reflux & esophagitis are present

(used to stop reflux)

55
Q

Which nerve must you avoid when performing a Nissen Fundoplication?

A

Vagus n.

Small Animal Surgery (10 decks)

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