Sx of the Stomach- Exam 2 Flashcards by Caitlyn Crawford

T/F: The stomach has a strong blood supply

TRUE

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What are the gastric layers?

Serosa
Muscular
Submucosa
Mucosa

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Which layer of the stomach is the holding layer?

Submucosa

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

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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Which cells contribute to collagen production?

Smooth muscle cells- increase healing

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

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

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What is the time of gastric emptying of the stomach?

6-8 hours

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

Ventral midline celiotomy- xiphoid to pubis

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

Falciform ligament

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

Balfour retractors

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What is the traditional gastric closure method?

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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What is the difference of the connelle and cushing pattern?

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

Simple continuous + inverting pattern (cushing/lempert)

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What type of closure is used in the pylorus?

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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What are the options for suture material for gastric closure?

Monofilament, absorbable- PDS, polyglyconate, poliglecaprone 25

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

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

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

TRUE

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What are some subjective factors used for determining gastric viability?

Gastric wall thickness- “slip”

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

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What are some indications of performing a gastric biopsy?

Gross disease

Clinical signs of upper GI disease

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What is the most common indication for a gastrotomy?

Foreign bodies- more commonly found in younger dogs

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

Iron deficiency
Hepatic encephalopathy
Pancreatic exocrine insufficiency

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What are CS of gastric foreign bodies?

Vomiting- not always present
Lethargy
Abdominal Pain
Anorexia

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

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

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What are some diagnostic modalities used in foreign body patients?

Rads- best initial dx test
US
Contrast studies
Endoscopy

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

Fluid therapy- REHYDRATE

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

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

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

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

When should you allow food PO from gastrotomy sx?

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

Where should the incision be for a gastrotomy sx?

Hypovascular area on ventral aspect between greater and lesser curvature

What instruments can be used to enlarge a gastric incision?

Metzenbaum scissors

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

Risk of contamination from lumenal content

What is congenital pyloric stenosis?

Hypertrophy of circular muscles of the pylorus | Commonly seen in brachiocephalic breeds and siamese cats

When do clinical signs for congenital pyloric stenosis appear?

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

What are CS of congenital pyloric stenosis?

Intermittent V+ | Normal to decreased body condition

What gastric layer is involved in congenital pyloric stenosis?

Muscular layer only

What gastric layer is involved in acquired congenital pyloric stenosis?

Muscular or mucosa or both

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

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

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

Pyloromyotomy- incision into & through mucosa | Transverse pyloroplasty

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

Fredet-ramstedt procedure- used ONLY FOR CONGENITAL stenosis

What is the other name for a transverse pyloroplasty?

Heineke-Mikulicz procedure

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

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

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

3-5 cm full thickness incision over pylorus | Not effective w/ acquired stenosis

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

Good outcome

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

Concurrent megaesophagus/esophagitis

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

Mucosal and muscular layers

What is the signalment for chronic hypertrophic pyloric gastropathy?

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

What is a suspected cause of chronic hypertrophic pyloric gastropathy?

Increased gastrin secretion

What is a cs seen with chronic hypertrophic pyloric gastropathy?

Intermittent vomiting-few hours after eating

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

Gastric distension and delayed gastric emptying

US evaluates what when dx chronic hypertrophic pyloric gastropathy?

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

What are the pathologic classifications of chronic hypertrophic pyloric gastropathy?

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

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

TRUE

What are the three sx management procedures for CHPG?

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

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

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

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

All diseased tissue can be removed=aggressive tx

What is the prognosis for a patient with CHPG?

Good-excellent

What are three indications to perform a gastrectomy?

Neoplasia Ulceration Significant pyloric outflow obstruction

What is a bilroth I?

Place duodenum directly into the stomach

When is submucosal resection indicated?

Slow growing tumors- marginal excision usually sufficient | Ex: leiomyoma in cardia

When is a partial gastrectomy indicated?

When lesion is extensive or w/ concurrent ulceration | Ex: Bilroth I

What is a bilroth II gastroenterostomy?

Partial gastrectomy followed by gastroenterostomy | Bringing jejunum directly to the stomach

When is a bilroth II indicated?

Extensive gastric resection making gastroduodenostomy impossible(advanced neoplasia invading duodenum

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

BILE DUCT- this structure needs to be re-routed

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

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)

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

Pythium spp. | Aquatic oomycete

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

GULF COAST STATES

What is the pathophysiology of phycomycosis?

Severe inflammatory and infiltrative lesion Induce intense fibrotic reaction Transmural thickening

What is the most common area affected by transmural thickening?

Gastric outflow area

What is an important CS of phycomycosis?

palpable mass

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

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

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

Eosinophilic pyogranulomatous inflammation

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

TRUE

What is the tx for a patient with phycomycosis?

Wide sx excision- affects majority of the stomach

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

FALSE- very ineffective

What is the prognosis for a patient with phycomycosis?

Guarded to poor | MST=26.5 days