Surgical investigations and interventions Flashcards
What are the 4 purposes you could use an exlap for
diagnostic
prognostic
therapeutic
preventative purposes
If you dont find anything on exlap, what should you do
take samples
Name the 5 regions of the abdomen
- Cranial quadrant
- Intestinal tract
- Right paravertebral region
- Left paravertebral region
- Caudal quadrant
what is the best way to close the linea alba
continuous suture pattern
so even distribution of tension
absorbable monofilament
describe post-op management of an exploratory laporotomy
Restricted exercise for 2-3 weeks
Monitor the incision
monitor behavious and feeding
removal of skin sutures 7-10 days post-op
list 3 indications of oesophageal surgery
Placement of oesophagostomy feeding tube (common)
Removal of an oesophageal foreign body
Partial oesophagectomy for resection of an oesophageal tumour (very rare)
describe how to approach investigating a potential oesophageal foreign body
high index of suspicion from clinical history
plain radiography
endoscopy
list 3 disorders that PEG tubes are most commonly placed in
dysphagia
oesophageal disorders
chronic diseases that may require long-term nutritional assistance
what is a PEG tube
percutaneous endoscopic gastrostomy
are a minimally invasive and highly effective method for providing proper nutrition to dogs and cats.
What is the suture holding layer of the stomach
submucosal layer
How can we differentiate the dueodenum and jeunum
the duodeno-jejunal ligament is present at the point where they change
what fixes the bowels semi in place
the mesentery
how can we visualise structures under all the intestines
using the mesenteric dam - lift the mesentery and use it to pick up all of the intestines and scoop them to the side
what do we expose in the duodenal mesenteric dam manoeuvre
caudal vena cava, caudal pole of the right kidneys, right lateral liver lobe
what do we expose in the colonic mesenteric dam manoeuvre
the left kidney and adrenal gland
if a dog has had previous midline surgery, what do we need to be careful of when operating
adhesions between the previous lilnea alba closure site and any organs
where is the external rectal sheath easy to catch
cranial to the umbilicus
what pattern and suture material do we use to close the linea alba
continuous suture pattern with an absorbable monofilament (i.e. PDS)
does the linea alba ever return to its full strength
No
how long does it take for the linea alba to return to 60-80% of its original strength
60 days
when should you recheck afte an exlap
around 4-5 days to ensure adequate wound healing and to check for dehiscence
how long till an animal can exercise properly following exlap
2-3 weeks
List 6 advantages of NGT
non-invasive
well-tolerated
doesn’t prevent eating or drinking
doesn’t require GA
easy to place
can be managed by owners at home
List 6 disadvantages of NGT
not suitable if patient is vomiting or unconscious
not suitable if patients lag a gag reflex or have megaoesophagus
easily dislodged
has a small bore
only useful for short term
can cause rhinitis or epistaxis
List 5 advantages of oesophagostomy tubes
large bores can be used
well tolerated
can be used long-term
animals can eat orally
can be managed by owners at home
List 5 disadvantages of oesophagostomy tubes
requires GA for placement
surgical procedure required
infections can occur
can’t be used in vomiting patients
can be hard to place in challenging or obese patients
List 3 advantages of a gastrotomy tube
can be used long-term
wide bores can be used
owners can manage these at home
List 5 disadvantages of gastrotomy tubes
not suitable for animals that are vomiting or have a GI obstruction
placement requires GA and specialised equipment
feeding has to be delayed after placement
risk of severe complications
has to remain in place for at least 7-10 days
why does a gastrotomy tube need to stay in place for 7-10 days
in order to allow adhesions to form between the stomach and the abdominal wall - prevents leakage of stomach contents into the abdomen
where do we want oesophagostomy tubes to sit
in the distal portion of the oesophagus - if we push pas the sphincter, we may get reflux
why do we tend to put oesophagostomy tubes in all cats having had oral surgery
they tend not to eat afterwards so it is a good idea to have one
do oesophageal foreign bodies cause vomiting or regurgitation
regurgitation
List the clinical signs of oesophageal foreign body
retching
regurgitation
ptyalism
anorexia
restlessness
cervical pain
what is pytalism
excessive salivation
where is the most common site of obstruction in the oesophagus
between the heart base and the diaphragm
what is the issue with barbed fish hooks
if you pull these out you can tear the tissues
how can most oesophageal foreign bodies be removed
endoscopically using forceps
- some may need surgery, some may be able to be pushed into the stomach
if an owner says their dog has eaten a fish hook and the line is still hanging out what should you tell them to do
tie the line to the collar
common complication post oesophageal foreign body
oesophagitis
what can happen if there was a severe oesophagitis
stenosis
define stenosis
narrowing, stricture
what can we do to prevent stenosis formation post OFB removal
H2 antagonists
Proton pump inhibitors
sucralfate
analgesia
soft food
why do we not want to do open surgery on the oesophagus
the oesophagus has no serosal surface and there is a lot of movement so the wound will likely breakdown
where do most gastric tumours develop
in the lesser curvature of the stomach
where do we aim to place the PEG tube
into the greater curvature - on the animals left caudal to the ribs
how do we make our incision into the stomach
place stay sutures and lift the stomach out of the abdomen, then pack the abdomen full of swabs and make an incision into a stomach, being careful to miss any blood vessels
what are the two layers you can close the stomach in
submucosal mucosal layer and the seromuscular layer
what are the different methods for closing the stomach
single layer full thickness
double layer
simple interrupted, continuous or inversions
what suture material do we close the stomach with
monofilament, absorbable suture - PDS
what can we do after we have closed the stomach to promote healing
omentalise it
what is a cholecystoenterostomy
Creation of a connection between the gallbladder and intestine
how can we clamp of the bowels
using atraumatic clamps or using an assistants fingers
can you take punch biopsies of the small intestines
yes but a lot of the time they won’t go full thickness and they are harder to close
how do we recognise the ileum
it has antimesenteric blood supply
what happens in cases with linear foreign bodies
the intestine tries to pass the FB but can’t as it is anchored somewhere, this results in the intestines scrunching up
how do we remove linear FBs
cut the anchor point and then using multiple enterotomy points, move the FB along each site until you are able to remove the whole thing
where do linear FBs commonly anchor
around the tongue or in the stomach
why can linear FBs be disastrous
there can be multiple perforation sites where the FB has been pulled through the wall and there might be too many to resect them all
what do we have to be mindful of when doing an enterectomy
not leaving behind tissue that no longer has a blood supply
how do we close the bowel after an enterectomy
end to end anastamosis - can do simple interrpted or simple continuous
when do most surgical wounds break down
within the first 3-4 days
if we are unsure about whether a wound has broken down or not, what can we do
open up and check - better to do a surgery before peritonitis occurs
if closure on the intestines breaks down, what do we have to do
an enterectomy
what is an intussusception
telescoping of the intestines
what is an insulinoma
a benign tumor of the pancreas that causes hypoglycemia by secreting additional insulin
