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LA Clinical Medicine > Unit 3 - Obstructive GI Disease > Flashcards

Unit 3 - Obstructive GI Disease Flashcards

1
Q

What are the predisposing factors for duodenal outflow obstruction?

A

Ulcers, penetrating foreign bodies, intraluminal/extraluminal masses, adhesions adjacent to sigmoid flexure, duodenal sigmoid flexure volvulus

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2
Q

How do cows with duodenal outflow obstructions typically present?

A

Anorexia, decreased milk and fecal production, tachycardia, depression, decreased rumen contractions, ruminal/abdominal distention, and signs of colic

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3
Q

What electrolyte derangements are associated with duodenal outflow obstructions?

A

Hyponatremia, hypokalemia, hypochloremia, and hyperphosphatemia; metabolic alkalosis

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4
Q

What supportive/stabilization care should be given to patients with duodenal outflow obstruction?

A

Fluid therapy, correct electrolyte imbalance, NSAIDs (after stabilization), and broad-spectrum antimicrobials perioperatively

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5
Q

What is the surgical approach to correcting a duodenal outflow obstruction?

A

Right paralumbar fossa either standing or left lateral recumbency (GA)

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6
Q

How is the definitive diagnosis of a duodenal outflow obstruction made?

A

Through abdominal exploration

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7
Q

How do you treat duodenal outflow obstructions?

A

Remove the obstruction via surgery

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8
Q

If the obstructive duodenal lesion cannot be removed, what surgical procedure is done?

A

A duodenal bypass - side-to-side duodenoduodenostomy

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9
Q

The (inside/outside) intestinal portion of the intussusception is known as the intussuscipens, and the (inside/outside) portion of the intussusception is knwon as the intussusceptum.

A

outside; inside

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10
Q

What are the predisposing factors for intussusception?

A

Enteritis, intestinal parasitism, mural granuloma, abscess or hematoma, neoplasia, sudden diet changes, and medications

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11
Q

What age of calves are at a greater risk for intussusception?

A

1-2 month old calves

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12
Q

Intussusception has an increased prevalence in ______ _____ and a decreased risk in _______.

A

Brown Swiss; Hereford

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13
Q

What are the most common locations for intussusception?

A

Small intestine - 84%
Colocolic - 11%
Ileocolic - 2%

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14
Q

How do cattle with intussusception typically present?

A 
Mild to moderate abdominal pain
Anorectic
Lethargic
Reluctant to walk
Tachycardic
Sucussable fluid wave
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15
Q

What will fecal material be like in patients with intussusception?

A

Scant, with mucus or melena

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16
Q

What will you feel on rectal palpation in a patient with intussusception?

A

Dilated loops of intestine

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17
Q

How do you stabilize patients with intussusception?

A

Fluid therapy, NSAIDs, and perioperative broad-spectrum antimicrobials

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18
Q

What is the surgical approach for intussusception?

A

Right paralumbar fossa either standing or left lateral recumbency

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19
Q

What will an intussusception feel like on palpation (during sx)?

A

The proximal end will be distended and friable and the distal end will be empty

It will be firm and congested

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20
Q

T/F: Reduction is the preferred surgical treatment for intussusception.

A

False

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21
Q

What is the preferred surgical treatment for intussusception?

A

Resection and anastomosis

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22
Q

What are the general steps to a resection and anastomosis of an intussusception?

A
  1. Isolate the region of intussusception with moist laparotomy sponges.
  2. Clamp off the boundaries of the resection
  3. Resect bowel
  4. Perform a one or two (one is better if you can) layer inverting closure with absorbable suture and a taper needle
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23
Q

What is intestinal volvulus?

A

Twisting of the intestines along the mesenteric axis either causing an obstruction or vascular strangulation

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24
Q

What is intestinal volvulus secondary to?

A

ileus

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25
Q

What locations are predisposed to intestinal volvulus?

A

Distal jejunum and ileum

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26
Q

What clinical signs are associated with intestinal volvulus?

A 
Moderate to severe abdominal pain
Abdominal distention
Feces scant, mucoid
Tachycardic, tachypneic
Dehydration
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27
Q

What electrolyte imbalance is associated with intestinal volvulus?

A

Hypochloremic metabolic alkalosis

28
Q

What does hypochloremic metabolic alkalaosis caused by intestinal volvulus progress to with bowl ischemia?

A

Metabolic acidosis

29
Q

What will you see on US in patients with intestinal volvulus?

A

distended intestines

30
Q

How do you stabilize patients with intestinal volvulus?

A

Fluid therapy, chloride, NSAIDs, and perioperative broad-spectrum antimicrobials

31
Q

What is the surgical approach to an intestinal volvulus?

A

Right paralumbar fossa either standing or left lateral recumbency

32
Q

What will an intestinal volvulus look like? Feel like?

A

It will be firm and congested

The proximal end will be distended and friable, and the distal end will be empty

33
Q

What is the goal of surgery for an intestinal volvulus?

A

Reduce the volvulus and assess the viability of the intestine

34
Q

What is torsion of the mesenteric root?

A

Volvulus of the entire small intestinal tract

35
Q

How do cattle with torsion of the mesenteric root present?

A

Severe abdominal pain
Bilateral abdominal distention
Tachycardia, tachypnea
Dehydration

36
Q

What should be given for stabilization of patients with mesenteric root torsion?

A

Fluid therapy, calcium, chloride, NSAIDs, and perioperative broad-spectrum antimicrobials

37
Q

What is the surgical approach for tx if mesenteric root torsion?

A

Right paralumbar fossa either standing or left lateral recumbency

38
Q

What is the goal of surgery for torsion of the mesenteric root? What do you need to be aware of?

A

Reduce the torsion - beware of endotoxin release

39
Q

What is cecal dilation?

A

Distention of the cecum without a twist

40
Q

What is cecal torsion?

A

Rotation along the long axis of the cecum

41
Q

What is cecal volvulus?

A

Rotation at the ileo-ceco-colic junction or proximal ascending colon

42
Q

What are some potential causes of cecal dilation or dislocation?

A

Potentially caused by motility disturbances such as hypocalcemia, elevated VFA concentrations, and masses

43
Q

How do cattle with cecal dilation or dislocation present?

A 
Decreased milk yield
Decrease appetite, feces
Poor rumen motility
Mild abdominal pain
Right flank ping, succussion
44
Q

T/F: Cattle with cecal dilation or dislocation may have hematologic and serum biochemical parameters within normal limits.

A

True

45
Q

What medical management is recommended for cecal dilation, dislocation?

A

Fluids - IV preferred with KCL
NSAIDs
Prokinetic - bethanechol, neostigmine
Withold feed for 24 hours, then slow return

46
Q

When is an exploratory celiotomy indicated in patients with cecal dilation, dislocation?

A

If there is no improvement within 24 hours

47
Q

What is the approach for correction of cecal dilation, dislocation?

A

Right paralumbar fossa either standing or left lateral recumbency

48
Q

What is the goal of surgery for cecal dilation, dislocation?

A

Decompression of gas filled viscus

Gently correct dislocation

49
Q

What is a typhlotomy?

A

Incision into the ventral location of the cecum, empty, and flush the cecum

50
Q

What is a typhlotomy closed with?

A

Absorbable suture in an inverting pattern

51
Q

When should you evaluate your typhlotomy closure?

A

Evaluate fill after 10 minutes and repeat if needed

52
Q

T/F: You should oversew your typhlotomy closure with an inverting pattern

A

True

53
Q

How do you perform a cecal amputation?

A

Ligate cecal branches of cecal artery and vein close to ICC ligament
Transect ICC ligament
Place two intestinal clamps, one from mesenteric side and one from antimesenteric side
Transect cecum
Stump is closed with a double layer, inverting pattern using absorbable, monofilament suture

54
Q

What is a type I rectal prolapse?

A

Rectal mucosa only

55
Q

What is a type II rectal prolapse?

A

All layers of the rectum

56
Q

What is a type III rectal prolapse?

A

The descending colon intussuscepts into the rectum in addition to type II prolapse

57
Q

What is a type IV rectal prolapse?

A

When the peritoneal rectum and/or descending colon form intussusception, anal sphincter causes constriction

58
Q

What types of rectal prolapses are common? Rare?

A

Common - type I or II

Rare - type III or IV

59
Q

What are the predisposing factors for rectal prolapses?

A

Increased abdominal pressure - respiratory disease, coughing, high feed intake, increased abdominal fill, diarrhea, scours, colitis, cystitis, and tenesmus from dystocia

60
Q

How are rectal prolapses managed?

A

Resolve prolapse
Eliminate straining
Address predisposing factors

61
Q

What steps are best to evaluate a rectal prolapse?

A

Administer (lidocaine) caudal epidural
Clean prolapsed tissue with mild antiseptic
Evaluate for necrosis and tears

62
Q

In cases of no necrosis or tears present with a rectal prolapse, what is the protocol for replacement?

A

Gentle reduction and placement of a purse-string suture

63
Q

In cases of severe edema with a rectal prolapse, what is the protocol for replacement?

A

Place hyperosmotic solution on the prolapse and wrap it in a moist towel to reduce it. Then, place the purse-string suture

64
Q

To replace a rectal prolapse a purse-string suture should be placed with _______ _____. The rectal opening should be ____ to _____ fingers width. The suture should be removed in __ ______.

A

umbilical tape
two to three fingers
1 week

65
Q

When is amputation of a rectal prolapse indicated?

A

If there is necrotic mucosa or tears present

66
Q

Explain the procedure of amputating a rectal prolapse.

A

Insert tubing into the rectum
Cross-pin near the anus with spinal needles
Circumferential incision proximal to necrotic tissue
Suture inner mucosa to outer mucosa with monofilament absorbable suture
Routine purse-string for 1 week

LA Clinical Medicine (33 decks)

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