Surgical Disorders of the Stomach Flashcards
What is often the main reason we perform a exploratory celiotomy?
Gastric FB
What is the most dangerous bones for dogs?
Why?
Pork bones
tend to shatter & make spicules
What animals are more likely to present with Gastric FBs?
Young animals
dog > cat
What type of FBs do cats like to get?
Linear FBs
C/S of Gastric FBs
- Abdominal pain
- Vomiting
- Anorexia + wt. loss
- Melena or hematemesis
- due to mucosal erosion, ulceration or necrosis
C/S of Incomplete/Intermittent obstruction?
- Less frequent vomiting
- Gastric or pyloric vomiting
- Less severe H2O & electrolyte deficiets
- Anorexia & wt. loss may be the predominant signs
What Lab results may suggest a Gastric FB?
- Metablic alkalosis
- Hypochloremia
- Hypokalemia
How can you remove a Gastric FB?
(2)
-
Endoscopy
- small, light wt., smooth soft material (fabric)
-
Gastrotomy
- heavy, sharp or rough surfaced objects (balls, bones, toys)
What should you always do before performing an exploratory celiotomy to remove a gastric FB?
Take rads!!!
(b/c things may have moved)
Describe what happens w/ Pyloric Hypertrophy/Stenosis.
Who gets it more frequently?
- Have abnormal narrowing of the pyloric lumen → causes partial obstruction → prevents bolus from entering the duodenum
- Dogs
Which layer of the pylorus is involved in Congenital Pyloric Hypertrophy/Stenosis?
Muscular layer
What layers of the pylorus are affected in Acquired Pyloric Hypertrophy/Stenosis?
Mucosal or muscular layer
(rarely, the pyloric antrum)
Signalment of Congenital Pyloric Hypertrophy/Stenosis?
- young animals (≈ 6-8 wks)
- Brachycephalic dog breeds
- Siamese Cats
HX & C/S of Congenital Pyloric Hypertrophy/Stenosis?
-
HX
- once wean → vomit 24 hr. after eating
- + ravenous appetite
-
C/S
- Emaciation
- Stunted growth
- Dehydrated
- Aspiration → + fever, + increased lung sounds
What are some lab abormalities that point towards Congenital Pyloric Hypertrophy/Stenosis?
-
Malnutrition:
- Hypoproteinemia; Anemia; low BUN; hypoglycemia
-
Pyloric vomiting:
- Dehydration; Hypochloremia; Metabolic alkalosis
-
Aspiration pneumonia:
- Elevated WBCs
When is presence of barium in the stomach considered ABNORMAL?
(time interval)
beyond 8-12 hrs.
Signalment for Acquired Pyloric Hypertrophy/Stenosis?
Middle aged, excitable small breed DOGS
(Lhasa Apso & Shih Tzu)
HX & C/S of Acquired Pyloric Hypertrophy/Stenosis?
-
HX
- Intermittent vomiting that increases in frequency
- not always associated w/ feeding
- Wt. loss
- Occasionally → anemia, depression, reduced activity
- Intermittent vomiting that increases in frequency
-
C/S
- Pale MM
- Emaciated & weak
- Dehydration
- Hypochloremic Metabolic Alkalosis
TX of Pyloric Hypertrophy/Stenosis?
(4 options)
- Pyloromyotomy
- Pyloroplasty
- Gastroduodenostomy
- Gastrojejunostomy
(MUST DO SX, need to be experienced)
What surgical techniques can be used to repair Congenitial Pyloric Stenosis?
Fredet-Ramstedt Pyloromyotomy
Heineke-Mikulicz Pyloroplasty
What are the advantages of the Fredet-Ramstedt Pyloromyotomy?
- Quick & easy to perform
- Lumen of pylorus is NOT opened
Disadvantages of Fredet-Ramstedt Pyloromyotomy?
- 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
- To avoid →Take a strip of muscularis & serosa during SX
Advantages of Heineke-Milkulicz Pyloroplasty?
- TXs both forms of pyloric stenosis
- Exposes mucosa → can get BX
- Less chance of stenosis reoccuring
Disadvantages of Heineke-Milkulicz Pyloroplasty?
- Open the lumen
- Not ususally very effective for Acquired form
What the best surgical prodecure for correcting Acquired Pyloric Hypertrophy/Stenosis?
Y-U Advanced Flap Pyloroplasty
Advantages of Y-U Advanced Flap Pyloroplasty?
(3)
- Good exposure of the mucosa
- Can resect redundant mucosa & submucosa → 1 layer closure
- Greater expansion of the pylorus
Disadvantages of Y-U Advanced Flap Pyloroplasty
- Lumen in opened
- More lengthy procedure (time)
Which SX technique involves Non-Pentrating SX?
Fredet-Ramdstedt Pyloromyotomy
Why must the flap have a very wide base?
(for the Y-U Advanced Flap Pyloroplasty)
To maintain a good blood supply & prevent perforation
Why would you use a Billlroth I Surgical procedure?
(Plyorectomy + Gastroduodenostomy)
- Severe acquired Pyloric Hypertrohpy
- Necrosis of the pylorus
- Neoplasia
Main advantage of the Billroth I Surgical Technique?
Large increase in size of the pyloric opening
Where do you excise the pylorus & proximal dueodenum in the Billroth I Technique?
between the clamps
Indications for a Partial Gastrectomy?
- Neoplasia
- Ischemic injury
- most commonly occurs @ the Greature Curvature
- If greater & less curvatures are involved → White House
- most commonly occurs @ the Greature Curvature
- Penetrating injury
What vessels are important to ligate when performing a Partial Gastrectomy?
Branches of the gastroepiploic vessels
What is the most commong Malignant gastric neoplasm in dogs?
Signalment?
- Adenocarcinoma
- Males > females
- ~ 8 years old
What is the most common malignant gastric tumor in cats?
Lymphosarcoma
Where are malignant gastric neoplasms commonly located?
Lesser curvature
pyloric antrum
What Radiographic finding is suggestive of a tumor in the Pyloric Antrum?
“Apple-core” lesion
DDX for tumors in the pyloric antrum?
(2)
Pyloric Hypertrophy/Stenosis
Pythiosis/Phycomycosis
Who typically gets Pythiosis?
Why do we care?
- hunting dogs
- animals in the Gulf States
- mimics invasive carcinoma
- Can extend to the pancreas, omentm, LN or contiguous viscera
- Must remove surgically
Where are the 3 primary sites of metatsis for Gastric Adenocarcinoma?
- Regional LN (70-80%)
- Liver
- Lungs
What is the term for a firm, white 1º neoplasm on the serosal surface?
Scirrhous
What is the term for 1º neoplasm that is expansile w/ central crater & ulceration on the mucosal surface?
Infiltrative
Why would you perform a Billroth II?
(Pylorectomy + Gastrojejunostomy)
Neoplasia
or Necrosis
Are there Non-Surgical Treatments for Gastric Neoplasia?
NO
- No effective Chemo for adenocarcinoma
- Gastric lymphosarc doesn’t respond to chemo
- Radiation is too harmful to surrounding delicate tissues
Prognosis for Gastric Neoplasia?
- Adenoma → cure w/ complete excision
- Leiomyoma/Leimyosarc → 1 yr
- Adenocarcinoma → 6 m.
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
Hiatal hernia
What is the usual cause of Hiatal Hernias?
Congenital abnormality of the esophageal hiatus
(especially the phrenicosplenic ligament)
Which dog breeds are pre-disposed to hiatal hernias?
Shar-Pei
Bulldogs
(Males)
What’s a good DX test for Hiatal Hernias?
Why?
- Fluoroscopy →see motion/mvment of a displaced esophagus
- Rads
When do you surgically repair a Hiatal Hernia?
Only for symptomatic patients
(vomiting, regurgitation, gastric esophageal reflux)
Which side of the fundus is attached to the body wall in a Gastropexy to TX a Hiatal Hernia?
LEFT side of the fundus
Which side of the fundus is attached to the body wall in Gastropexy to TX GDV?
RIGHT side of the fundus
When is a Nissen Fundoplication indicated?
Only if gastric reflux & esophagitis are present
(used to stop reflux)
Which nerve must you avoid when performing a Nissen Fundoplication?
Vagus n.
