Surgical investigations - vomiting/regurg

Question 1

When is an exploratory laparotomy for diagnostic or prognostic purposes indicated?

Answer 1

Exploratory laparotomy for diagnostic or prognostic purposes is indicated if:
* a diagnosis may only be made by inspection or palpation of the abdominal contents
* a diagnosis depends on samples obtained at laparotomy:
* culture of samples
* cytological or histological analysis of samples

Question 2

When is an explaoratory laparotomy indicated for therpeutic purpose?

Answer 2

• control of haemorrhage
• correction of the source of contamination or infection
• elimination of the cause of pain
• removal of mass lesions
• removal of visceral obstructions
• removal of traumatised organs
• relief of non-responsive dystocia
• removal of abnormal accumulation of fluids
• supportive care, e.g. enteral tube placement, cystostomy tube

Question 3

When is an exlap indicated for a preventative purpose?

Answer 3

• reduce the incidence of a particular disease, e.g. gastropexy for GDV
• reduce the recurrence of a particular disease, e.g. enteroplication for intussusception

Question 4

What are common mistakes makde during an exlap?

Answer 4

• failure to make a large enough incision
• failure to explore the entire abdominal cavity
• failure to take appropriate biopsies
• failure to be prepared for the likely diagnosis or diagnoses
• failure to approach the intra-operative findings in a logical fashion

Question 5

What 5 regions is the abdominal cavity divided into? What organs do we find in each region?

Answer 5

Cranial quadrant - liver and stomach
Intestinal tract - stomach to SI and LI
Right paravertebral region - kidney, ovary
Left paravertebral region - kidney, ovary
Caudal quadrant - bladder, rectum, prostate, uterus

Question 6

What manoeuvre exposes right kidney?

Answer 6

duodenal manoeuvre

Question 7

What manoeuvre exposes left kidney?

Answer 7

colonic manoeuvre

Question 8

How is the linea alba closed?

Answer 8

• simple continuous
• 6 throws at each end
• absorbable monofilament

Question 9

What are indications for oesophageal surgery?

Answer 9

• Placement of oesophagostomy feeding tube (common)
• Removal of an oesophageal foreign body
• Partial oesophagectomy for resection of an oesophageal tumour (very rare)

Question 10

What clinical signs are associated with an oesophageal foreign body? How is it diagnosed? How is it treated? What post removal management is needed?

Answer 10

Clinical signs
* Retching
* Regurgitation (food & water)
* Vomiting (?) (can owner differentiate regurgitation from vomiting?)
* Ptyalism
* Anorexia
* Restlessness
* Cervical pain

Investigations
* High index of suspicion from clinical history
* Plain radiography (in most instances)
* Endoscopy

Treatment
* In most instances, an emergency requiring immediate removal
* Most can be removed endoscopically using grasping forceps
* Refer to a centre that has the appropriate equipment and expertise
* Approximately 10% cannot be removed orally and are pushed into the stomach; bony FBs will then be digested with no requirement for a gastrotomy

Post removal management
* Medical therapy to reduce likelihood of stricture formation
◦ H2 antagonist
◦ Proton-pump inhibitor
◦ sucralfate
* Analgesics
* Feed soft food

Question 11

What are indications for gastric surgery?

Answer 11

• Placement of gastric feeding tubes (percutaneous endoscopic gastrostomy (PEG), open gastrostomy, etc.)
• Gastrotomy for removal of a gastric foreign body
• Gastropexy to prevent volvulus
• Correction of gastric dilatation volvulus (GDV)
• Pyloroplasty to manage gastric outflow disease
• Partial gastrectomy for resection of a gastric tumour, ulceration, etc.

Question 12

What animals are PEGs placed in?

Answer 12

Animals with
* dysphagia
* oesophageal disorders
* chronic diseases that may require long-term nutritional assistance

Question 13

What are indications for small intestinal surgery?

Answer 13

• Full thickness biopsy (e.g., inflammatory bowel disease)
• Enterotomy for removal of a foreign body
• Enterectomy (e.g., foreign body, intussusception, tumour, etc.)
• Enteroplication (potential aspect in the management of intussusception)
• Cholecystoenterostomy (biliary tract bypass procedure)

Question 14

What are indications for large intestinal surgery?

Answer 14

• Colopexy (e.g., as part of management of perineal hernia)
• Colotomy (e.g., impaction, foreign body (rarely))
• Colectomy (e.g., tumour, polyp)
• Subtotal colectomy (e.g., megacolon in the cat)

Question 15

What are indications for pancreatic surgery?

Answer 15

Biopsy - pancreatitis
Islet cell tumour – insulinoma
Pancreatitis
Pancreatic abscess
Pancreatic pseudocyst
Pancreatic abscess
Pancreatic tumour – carcinoma

Question 16

What are the differences between dog and cat pancreas?

Answer 16

• Dog
  ◦ Pancreatic duct - small (absent 8%)
  ◦ Accessory pancreatic duct - large
• Cat
  ◦ Pancreatic duct - present
  ◦ Accessory pancreatic duct - absent (80%)