Upper GI Surgery Flashcards
What are the clinical signs of Choke?
1) BLOAT
- Type 1 Vagal indigestion
2) Salivation
3) Coughing/Retching
4) Extended head and neck
5) Protruding tongue
What is the first sign you will see in a cow with esophageal choke?
BLOAT
-the cow needs to erructate, if this is blocked your going to bloat
How do you diagnose Esophageal Choke in cattle?
1) PE, passage of stomach tube
2) Endosocpy
3) Radiographs
—Surgery and contrast films
—Esophagography (contrast) Barium
4)ultrasound
What are some Differential Diagnosis for Esophageal choke?
1) Pharyngeal trauma
2) Rabies
When diagnosing Esophageal Choke what diagnostic tools are KEY-according to Pappa French?
- PE
- Pass stomach tube
What is the Etiiology of Esophageal Choke?
1)Foreign body obstruction
- hedge apple, potato
- cabbage, beet, turnips, corn
- sharp foreign bodies
What are the complications of Esophageal choke?
1) unable to eructate = BLOAT
2) loss of saliva = metabolic acidosis
3) Aspiration pneumonia
How would you treat an Esophageal Choke Medically?
1) manual retrieval if obstruction is proximal
2) wire snare - may damage mucosa
3) if distal Push into rumen
SEDATION, Buscopan, Lidocaine
How would you treat an Esophageal choke surgically?
ESOPHAGOTOMY
- Only if medical treatment option are exhausted
- many complications
What should your mainstay of treatment be for esophageal choke? Medical vs surgical
MEDICAL first always
There are too many complications with esophagotomy
What is the the initial treatment of Choke?
DECOMPRESS the rumen!!!!
- needle and suction
- REd Devil Trocar
Hold of feed and water until resolved
How long can you hold a cow off feed and water before they are affected?
48 hours
What are the layers you pass through during an Esophageal Anatomy?
Layers:
- Adventitious layer
- Muscular layer
- Submucosa
- Mucosa
No Serosal Covering
What are the associated structures you could see during an esophagotomy?
Associated structures:
- Recurrent Large Gael nerve
- Carotid sheath
- Vagosympathetic trunk
- Tracheal lymphatic trunk
- Deep cervical Inn
Why are there so many complications for esophageal surgery?
1) Dirty procedure
2) No serosal layer
3) constant movement
4) constant suture line tension
5) proximity of laryngeal nerve
Describe the process of Cervical Esophagotomy.
1)pass the to level of obstruction
2)Exteriorize and isolate
3)linear incision in esophagus
-over healthy tissue (if possible)
4)remove obstruction
5) if healthy tissue—>CLOSE
If compromised tissue —>2nd intention healing required and daily wound care
- may need to place rumen fistula
- NO Food/Water for 24-48hrs post op
- IV fluids with electrolyte supplementation
What approach should be taken for cervical esophagotomy with PRIMARY repair?
-Lateral/ventrolateral approach
Following incision for a cervical esophagotomy (Primary repair), How many layers separate and what are they?
Incision separates into 2 layers
- Muscular
- Mucosa/submucosa
What suture is used to close a cervical esophagotomy?
-where do you bury the knot
- PDS to close
- IN the LUMEN
What type of strength does Mucosa/Submucosa provide? (Cervical esophagotomy)
TENSILE strethgth for closure
T/F: Lack of serosa contributes to complications post op
TRUE
When is ESOPHAGOSTOMY necessary?
1) if tissue is compromised
2) caudal to repaired esophagus
Describe Esophagostomy
1) caudal to repaired esophagus
2) Place POLYETHYLENE NG tube (0.25-1 OD)
3) secure tube
4) leave in place min 7-10 days (allow stoma formation**
5) allow to heal by 2nd intention
What material is used for Esophagostomy tube?
Polyethylene NG tube (0.25-1” OD)
How long must an Esophagostomy tube be left to allow stoma formation?
7-10days***
How do esophagostomy heal?
2nd intention
What can be used for immediate relief of chronic bloat (type 1 indigestion)?
Temporary Rumen Fistula
Where do you place a temporary Rumen fistula?
In the rumen bruh so put it in the :
Upper LEFT paralumbar fossa!!!!
What size of skin is removed for a temporary rumen fistula?
5cm X 3cm
Describe the placement of a Temporary Rumen Fistula.
1) 5X3cmm circle through skin
- upper Left paralumbar fossa
2) Blunt direction of GRID muscle layers
3) grasp and tent rumen wall
4) suture rumen to skin in MATTRESS pattern
5) Need 1” of rumen sticking out of skin
What suture pattern is used to suture the rumen to the skin for a temporary rumen fistula?
Mattress pattern
How long does it take for a temporary rumen fistula to close
Few weeks
What can be used to secure a temporary rumen fistula?
35ml syringe casing
What are the indications for a Rumenotomy?
1) Chronic bloat
2) Foreign body
3) Reticular abscess
4) Type 2 vagal indigestion
—failure of Omaha’s transport
—results in distention of reticulum/rumen
—multiple causes
What should be done pre-op for rumenotomy?
1) off feed 24-36 hrs
2) single dose of pre-op antibiotics
3) left flank approach
What type of surgery is a Rumenotomy?
Clean-contaminated procedure
What is the antibiotic of choice for pre-op Rumenotomy?
Procaine Penicillin
What suture pattern is used to suture the rumen to the skin for a Rumenotomy?
Cushing
Which aspect of the incision should be sutured for for a Rumenotomy?
Start suturing at the DORSAL aspect
-creating a seal between skin and rumen
T/F: during a rumenotomy the ventral aspect of the incision has the same amount of sutures as the dorsal aspec
FALSE
The ventral aspect has extra sutures
What type of forceps are used to grasp the rumen and hooked onto a rumen board, during Rumenotomy?
Non-crushing rumen forceps
- allow exteriorize toon of rumen
- incision is made dorsally
How do you remove the fluid during a rumenotomy?
1) gravity
2) Kingman Tube
What type of closure is required for a rumenotomy?
2 layer closure
- inverting
- lavage site
When closing a rumenotomy what must be done (order)?
1)2 layer inverting closure of RUMEN
…….Prior to body wall closure……
I
2)Change gloves/sleeve
3)Change instruments
What is the prognosis for Rumenotomy?
Depends on reason for surgery:
Foreign Body:
-Good—>doesn’t penetrate thoracic cavity or involve right side of reticulum
- Guarded—>involvement of right side of reticulum
- Poor—>FB penetrated diaphragm
You perform a Rumenotomy on a cow and find that the thoracic cavity is intact and there is no involvement of the right side of the reticulum……What is your prognosis?
GOOD
You perform a Rumenotomy and find there is penetration of the right side of the reticulum …..What is your prognosis?
GUARDED
You perform a Rumenotomy and find a FB has penetrated the diaphragm …What is your prognosis?
POOR
What is TRP
Traumatic reticular pericarditis
What are the CS of TRP?
1) Tachycardia with muffled heart sounds
- Washing machine murmur
2) GI issues
- 7days, febrile, painful
3) Right heart failure
- Distended Jugular
- Brisket edema
- TAchypnea
How would you Diagnose TRP?
1) Radiographs
2) Ultrasound
3) Pericardiocentesis
T/F tulathromycin is NOT allow in LACTATING animals greater than 20 months of age
TRUE
What are some differential diagnosis for TRP?
1) Pericardial disease
2) Bovine Leukemia
3) Lymphosarcoma
What IV anesthesia would you use to sedate a 2 year old heifer for TRP?
1) Xylaxine
2) Ketamine
3) Butorphanol
You culture Trueperella progenies in a 2yo Heifer. Sample came from cloudy, grey-brown, putrid pericardial fluid.
What would you use to treat this?
Procaine Penicillin
What are some Differential Diagnosis for RIGHT sided Heart Failure?
1) TRP
2) Endocarditits
3) Lymphosarcoma
4) Mediastinal mass
How would you treat a cow with Traumatic Pericaditis?
1) Pericardectomy
2) Rib resection
3) Foreign body removal
*sequelae—>usually die of constrictive pericarditis
