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SA Sx > Sx of the Stomach- Exam 2 > Flashcards

Sx of the Stomach- Exam 2 Flashcards

1
Q

T/F: The stomach has a strong blood supply

A

TRUE

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2
Q

What are the gastric layers?

A

Serosa
Muscular
Submucosa
Mucosa

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3
Q

Which layer of the stomach is the holding layer?

A

Submucosa

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4
Q

What are the 4 properties that benefit wound healing in the stomach?

A

Short duration of healing due to: extensive/redundant blood supply, reduced bacterial numbers, rapidly regenerating epithelium, omentum (good wound healing properties)

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5
Q

Which cells contribute to collagen production?

A

Smooth muscle cells- increase healing

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6
Q

What 5 factors should be addressed for pre-surgical preparation?

A 
Correct electrolyte imbalances
Hydration status fasting
H2 antagonists (decrease acidity)
Proton pump inhibitors
Prophylactic antibiotic use (questionable)
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7
Q

What is the time of gastric emptying of the stomach?

A

6-8 hours

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8
Q

What is the most common surgical approach to access the stomach?

A

Ventral midline celiotomy- xiphoid to pubis

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9
Q

What should be removed for better visualization when performing an abdominal exploratory?

A

Falciform ligament

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10
Q

What instruments are used in an abdominal exploratory for better visualization?

A

Balfour retractors

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11
Q

What is the traditional gastric closure method?

A

Two layer closure
Double inverting –> two inverting patterns on top of each other (one MUST include the submucosa)
Cushing pattern oversewn with lembert

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12
Q

What is the difference of the connelle and cushing pattern?

A

Connell: Takes bite deep and goes into the lumen (avoid this pattern in organs with lumens- suture exposed to acidic material will cause it to break apart)
Cushing: can go into mucosa, DOESN’T go into lumen

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13
Q

What is an alternate closure technique that can be used in the stomach?

A

Simple continuous + inverting pattern (cushing/lempert)

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14
Q

What type of closure is used in the pylorus?

A

Single layer closure (simple interrupted/simple continuous)- typically an appositional pattern
You don’t want to cause stricture in the pylorus

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15
Q

What are the options for suture material for gastric closure?

A

Monofilament, absorbable- PDS, polyglyconate, poliglecaprone 25

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16
Q

What are the three staplign devices that can be used for gastric mucosa?

A 
Thoracoabdominal Stapler (TA)
Gastrointestinal anastomosis (GIA)
Skin stapler- not used in stomach due to thickness
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17
Q

T/F: Subjective criteria is mainly used to determine gastric viability

A

TRUE

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18
Q

What are some subjective factors used for determining gastric viability?

A

Gastric wall thickness- “slip”

And color of mucosa- grey-green to black=non-viable

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19
Q

What are some indications of performing a gastric biopsy?

A

Gross disease

Clinical signs of upper GI disease

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20
Q

What is the most common indication for a gastrotomy?

A

Foreign bodies- more commonly found in younger dogs

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21
Q

What are three conditions that predispose PICA (eating random things)

A

Iron deficiency
Hepatic encephalopathy
Pancreatic exocrine insufficiency

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22
Q

What are CS of gastric foreign bodies?

A

Vomiting- not always present
Lethargy
Abdominal Pain
Anorexia

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23
Q

What are some laboratory findings in a gastric foreign body patient?

A 
Hemoconcentration vs. anemia
Leukocytosis
Pre-renal azotemia
Metabolic alkalosis vs. acidosis
Hypokalemia, Hypochloremia
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24
Q

What are some diagnostic modalities used in foreign body patients?

A

Rads- best initial dx test
US
Contrast studies
Endoscopy

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25
Q

What is an important medical management strategy for foreign body patients?

A

Fluid therapy- REHYDRATE

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26
Q

What kind of rads should be taken when dx a foreign body patient?

A

Serial rads- important to take the time delay of gastric emptying into account, make sure the object didn’t move from original position before surgery

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27
Q

What are the drugs that induce vomiting in cats and dogs?

A

Cats: xylazine
Dogs: apomorphine
MAKE SURE OBJECT IS SMALL ENOUGH TO BE THROWN UP BEFORE!

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28
Q

When should you allow food PO from gastrotomy sx?

A

within 12 hours- found that the protein improves the healing process

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29
Q

Where should the incision be for a gastrotomy sx?

A

Hypovascular area on ventral aspect between greater and lesser curvature

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30
Q

What instruments can be used to enlarge a gastric incision?

A

Metzenbaum scissors

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31
Q

Why should instruments and gloves be changed prior to abdominal closure during a gastrotomy?

A

Risk of contamination from lumenal content

32
Q

What is congenital pyloric stenosis?

A

Hypertrophy of circular muscles of the pylorus

Commonly seen in brachiocephalic breeds and siamese cats

33
Q

When do clinical signs for congenital pyloric stenosis appear?

A

At weaning- patients have been drinking milk their whole life- when on solids you notice malformation due to this issue

34
Q

What are CS of congenital pyloric stenosis?

A

Intermittent V+

Normal to decreased body condition

35
Q

What gastric layer is involved in congenital pyloric stenosis?

A

Muscular layer only

36
Q

What gastric layer is involved in acquired congenital pyloric stenosis?

A

Muscular or mucosa or both

37
Q

What are some dx methods used for benign gastric outflow obstruction?

A

Rads- gastric distention
Delayed gastric emptying- contents still present after > 8 hrs of fasting
Contrast rads- apple core appearance @ pylorus
US

38
Q

What are two surgical management methods for congenital pyloric stenosis tx?

A

Pyloromyotomy- incision into & through mucosa

Transverse pyloroplasty

39
Q

What is the other name for a pyloromyotomy and when is it used?

A

Fredet-ramstedt procedure- used ONLY FOR CONGENITAL stenosis

40
Q

What is the other name for a transverse pyloroplasty?

A

Heineke-Mikulicz procedure

41
Q

How big is the incision for a fredet-ramstedt procedure?

A

1-2 cm. through serosa and muscularis layers of long axis of pylorus

42
Q

How big is the incision for the Heineke-Mikulicz procedure?

A

3-5 cm full thickness incision over pylorus

Not effective w/ acquired stenosis

43
Q

What is the prognosis for patients after sx correction of benign gastric outflow obstruction?

A

Good outcome

44
Q

What other abnormality may be seen in cats with benign gastric outflow obstruction?

A

Concurrent megaesophagus/esophagitis

45
Q

What layers of the stomach does chronic hypertrophic pyloric gastropathy involve?

A

Mucosal and muscular layers

46
Q

What is the signalment for chronic hypertrophic pyloric gastropathy?

A

Small breed dogs (shih-tzu, lhasa apso, maltese)
Males > females
Middle aged dogs

47
Q

What is a suspected cause of chronic hypertrophic pyloric gastropathy?

A

Increased gastrin secretion

48
Q

What is a cs seen with chronic hypertrophic pyloric gastropathy?

A

Intermittent vomiting-few hours after eating

49
Q

What is seen on contrast rads with chronic hypertrophic pyloric gastropathy?

A

Gastric distension and delayed gastric emptying

50
Q

US evaluates what when dx chronic hypertrophic pyloric gastropathy?

A

Muscle/pyloric wall thickness
Muscularis < 4mm
Pyloric wall < 9mm

51
Q

What are the pathologic classifications of chronic hypertrophic pyloric gastropathy?

A

Grade I: muscular hypertrophy ONLY
Grade II: mucosal hyperplasia w/ glandular cystic dilation ONLY (muscular layer is NOT affected)
Grade III: muscular hypertrophy AND mucosal hyperplasia

52
Q

T/F: Regardless of the grade of CHPG, inflammation is always present

53
Q

What are the three sx management procedures for CHPG?

A

Heineke-Mikulicz Pyloroplasty
Y-U pyloroplasty
Pylorectomy w/ gastroduodenostomy (Bilroth I)

54
Q

Describe a Y-U pyloroplasty and one pro/con of this?

A

Single pedicle advancement from antrum across pylorus
Pro: increase diameter of pylorus
Con: potential necrosis of flap tip (flap made like a V)

55
Q

What is a pro to performing a pylorectomy w/ gastroduodenostomy for CHPG?

A

All diseased tissue can be removed=aggressive tx

56
Q

What is the prognosis for a patient with CHPG?

A

Good-excellent

57
Q

What are three indications to perform a gastrectomy?

A

Neoplasia
Ulceration
Significant pyloric outflow obstruction

58
Q

What is a bilroth I?

A

Place duodenum directly into the stomach

59
Q

When is submucosal resection indicated?

A

Slow growing tumors- marginal excision usually sufficient

Ex: leiomyoma in cardia

60
Q

When is a partial gastrectomy indicated?

A

When lesion is extensive or w/ concurrent ulceration

Ex: Bilroth I

61
Q

What is a bilroth II gastroenterostomy?

A

Partial gastrectomy followed by gastroenterostomy

Bringing jejunum directly to the stomach

62
Q

When is a bilroth II indicated?

A

Extensive gastric resection making gastroduodenostomy impossible(advanced neoplasia invading duodenum

63
Q

What is an important structure to take into account when performing a Bilroth II?

A

BILE DUCT- this structure needs to be re-routed

64
Q

What are the three major complications of a Bilroth II sx?

A

Alkaline gastritis: bile and pancreatic secretions flow into stomach
Blind Loop syndrome: gastric contents moe orally and putrefy
Marginal ulceration: ulceration of jejunal mucosa (acidic contents)

65
Q

What is the most common cause of phycomycosis in the US?

A

Pythium spp.

Aquatic oomycete

66
Q

What region of the US is at risk for developing phycomycosis?

A

GULF COAST STATES

67
Q

What is the pathophysiology of phycomycosis?

A

Severe inflammatory and infiltrative lesion
Induce intense fibrotic reaction
Transmural thickening

68
Q

What is the most common area affected by transmural thickening?

A

Gastric outflow area

69
Q

What is an important CS of phycomycosis?

A

palpable mass

70
Q

Why won’t you see anything on endoscopy when dx phycomycosis?

A

This disease only affects the submucosal and muscularis layers
Endoscopy only evaluates the mucosal layer

71
Q

What will a full thickness biopsy reveal for a patient with phycomycosis?

A

Eosinophilic pyogranulomatous inflammation

72
Q

T/F: There is an ELISA test available for P. insidiosum Ab?

73
Q

What is the tx for a patient with phycomycosis?

A

Wide sx excision- affects majority of the stomach

74
Q

T/F: Medical therapy is extremely effective for patients with phycomycosis?

A

FALSE- very ineffective

75
Q

What is the prognosis for a patient with phycomycosis?

A

Guarded to poor

MST=26.5 days

SA Sx (22 decks)

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