Fichas
GI Surgery
Fichas del conjunto (45)
- 1What is haematemesis?when you vomit out blood and it looks like coffee granules
- 2What is melaenadigested blood from the upper intestinal tract
- 3Why will you see an alkalosis during gastric vomiting?b/c you are loosing a lot of H+ so the body pulls out H+ from the cells to replace it but has to exchange this for a K+ leading to low K levels and an alkalosis due to not enough acid
- 4Why will you see low Cl during vomiting?b/c CL is connected to H in HCl
- 5What losses do you see during chronic vomiting, and diarrhea?dehydration and electrolyte loss
weight loss
hypoalbuminaemia - 6What do you see when there is anemia?hypoalbuminaemia
anemia - 7What can you do in most cases to correct this?intravenous fluids and intravenous K
- 8Should we use prophylactic antibiotics during GI surgery?only if immune defenses are compromised:
-debiliated animals
-gastrointestinal surgery
-extensive gastro-intestinal resections
-surgeries more than 90 minutes
depends where the surgery is - eg stomach kills most bacteria, while antibiotics are always indicated for SI and colon surgery - 9How can we decrease bacterial contamination (apart from using antibiotics?)isolate the site of GI entry
use a separate set of instruments for contaminated part of surgery - then another set to close abdomen
lavage wound after closure
change gloves
lavage abdomen w/ sterile saline - dilutes out bacteria so not as many are present - 10How do you decrease bacterial contamination in the LI?• Mechanical preparation - clean out the poo before you start surgery
• Routine for human colorectal surgery to decrease bacterial contamination
• However no evidence to support use in vet med
• Liquid faeces maybe more likely to bypass atraumatic clamps and purse string sutures
A low residue diet and at least 12-14 hours of starvation recommended - 11What is the strongest layer in the intestinal wall and why?submucosa
due to high collagen content - also the greatest stretch - 12What is the rate of wound healing along the intestinal tract?stomach (fastest)
small intestine
LI (slowest) - 13What are two things that negatively impact intestinal wound healing?compromise to blood supply
traumatic surgical technique - 14How can you reduce traumatic surgical technique?atraumatic debakey forceps
atraumatic bowel clamps - keep intestinal content from spilling out
stay sutures: reduces number of times you have to pick up and handle the stomach/intestines and bruise it - 15What should you not have the animals on b/f a GI surgerysteriods (decreases rate of healing)
Chemotherapy and radiation (delay for 3 weeks post surgery) - 16What sutures would you use in a GI surgery ?full thickness appositional
simple interrupted
simple continuous
metal staples - 17What is the best type of suture? Multifilament or monofilament?monofilament is best (PDS II) and lasts longer than monocryl and is absorb able
- 18What are the 4 phases of intestinal wound healing?1: Haemostasis: the formation of a Platelet Fibrin Clot - days 1-4
2: Inflammation: microbial killing and wound debridement - days 1-5
3: Proliferation of Granulation: Fibroblast proliferation, collagen synthesis, Angiogenesis - Days 3-weeks
4: Remodelling- takes weeks-years - 19What are some advantages of an exploratory laparotomy?diagnose or correct a cause of intra-abdominal disease, biopsies (if you don't find anything)
- 20What is a gastrotomy?An incision that is made into the stomach
- 21What is the blood supply to the stomach and why does it repair itself so easily after surgery?• Need to make a big incision in order to access the stomach -- b.c it is tucked up quite high up
• The main blood supply to the stomach comes from the aorta
• The celiac artery gives rise to the following:
○ Hepatic artery--> splenic artery-->left gastric artery
• There is a continuous loop of blood vessels surrounding the stomach which is why it repairs itself so easily after surgery
So you can ligate one vessel and the other two vessels will come around and compensate - 22Where is the incision made in a gastrotomy?b/w the lesser and greater curvature of the stomach (the middle)
also means the stomach can be held up quite easily and we can decrease the amount of stomach contents that are spilled - 23How would you repair a gastrotomy ?first suture the mucosa and submucosa: simple continous
then suture the serosa and muscularis - an inverting lembert (wound edges are inverted in order to prevent leakage of stomach contents) - 24Where should you sample in a SI biopsy?Sample closer to the intestine itself - this is better as there is a rich blood supply that can loop from both sides (b/c of the radiating blood supply)
DON"T sample: at the root - kill a whole section of intestine
DON'T sample near the descending duodenum - might ligate vessels to pancreas (its closeby) - 25How do you tell the difference b/w the ileum and the jejunum• You can tell the difference b/w the ileum and jejunum:
○ Jejunum only has blood coming from one side
○ Ileum has blood coming from both sides
This is important as you are more likely to get a diagnosis for IBD from the ileum rather than the jejunum - 26Why should you not biopsy the LI?should not unless a lesion is specificially identified - increased risk of wound breakdown in the LI (doesn't heal well)
Also don't go into the LI for a foreign body - at this point it should pass on its own - 27What should you avoid during a liver biopsy?the caudal vena cava on the right side of the liver
b/f you do this consider doing a FNA or trucut biopsy as these are less invasive under US guidance - 28How do you take a liver biopsy?• Take the tip of the liver lobe - doesn't matter too much where it is if you know its generalized disease
• Leave the pair of haemostats on for five minutes then cut the piece of the liver lobe that you need to decrease bleeding - b/c they have created haemostasis
• If you have a specific nodule or mass then a generalized sample does you no good
This skin biopsy punch takes a sample from a specific area. There will be more bleeding so you want to pack the area with a hemostatic agent to prevent excess bleeding - 29What do the pancreas and duodenum share their blood supply with?caudal and cranial pancreatico-duodenal arteries
- 30Where should you take a biopsy from the pancreas?take the left limb of the pancreas for biopsy (the edge)
not the middle due to important blood vessels and major duodenal papilla where the common bile duct and pancreatic ducts enter the intestine - 31What are some clinical signs of a foreign body?• Can occur in any age, but more common in young animals
• Previous foreign body ingestion
• Known foreign body ingestion
• Vomiting
• Lethargy
• Abdominal pain
• Depression
• Anorexia
• Dehydration
• Gastric distention
• Melaena or haematemesis (vomiting of blood)
Dyspnoea if aspiration pneumonia - 32How would you do an intestinal resection• Milk out the intestinal contents from the intestine to be resected
• Isolate intestine w/ atraumatic clamps
• Ligate mesenteric vessels
• Incise mesentery
• Incise intestine close to clamps on intestine to be resected
• Blue = neoplasia
• Green = what you have to take out as well - need to take out at least 3 cm on each side of neoplasia
Fat hides the blood vessels in this case - not like the cat from before with no fat at all - 33What are 2 ways you can support a wound?omentalisation - when you wrap the omentum around the wound
serosal patch (tack together 3 or 4 sections of intestine together if you are worried about the wound not healing - 34What is the history of an intestinal foreign body ?• History
• Persistent vomiting, frequently projectile
• Anorexia
• Depression
• No defaecation
• Clinical exam:
○ Dehydration
○ Depression
○ Abdominal pain
○ Intrabdominal mass
○ String around the tongue
Sometimes on a radiograph you won't see the foreign body right away, but will see air building up in the intestines, indicating a blockage - 35Where should you cut for an intestinal foreign body ?cut at the anti-mesenteric side
cut just beside the object - 36What is the difference b/w a neoplasia and an FB on a radiograph?• We don't have the same obstruction pattern where we have a lot of air
• We are not seeing the detail that we would normally expect - so we are probably seeing some fluid
• A few "gravel signs" small white dots that are indicative of a partial obstruction
• If you do an ultrasound and you don't see the 5 layers you would expect --> could be a tumour - 37what is an intussception?invagination of one portion of the GI tract into the lumen of an adjoining segment
-blood is prevented from leaving the intestine while more blood is pumped into the intestine by the arteries - eventually leading to occlusion by pressure - 38Why does an intusseception happen?the intestines are moving too much
eg worms of an animal w/ a history of vomiting - 39What are the two surgical treatment options for intussception?reduction - pull out intestine from other portion
resection - cut intestine and resect healthy portions back together - 40What is further treatment you can do to try and prevent intussception?Enteroplication
tack intestines together
no hard evidence this is appropriate however - 41What is the prognosis for intussception surgery in general?good in young animals, though has a 6-27% recurrence
more at risk in parvo puppies - 42When is the highest risk of intestinal wound breakdown after surgery?3-5 days later - risk of septic peritonitis
- 43What are some clinical signs of septic peritonitis?○ Vomiting
○ Anorexia and depression
○ Abdominal pain
○ Abdominal enlargement
○ Hypovolaemic shock (when your body loses more than 20% of fluids)
○ Pyrexia (fever)
○ Discharge from abdominal wound
○ Diarrhea
○ Haematochezia (passage of fresh blood through the anus, usually in or with the stools (opposite of melena)
○ Melaena (faeces w/ digested, black blood) , haematemesis (vomiting of blood usually from the upper gastrointestinal tract) - 44How do you diagnose septic peritonitis?peritoneal abdominocentesis
will see intracelluar bacteria and neutrophils - 45What is the treatment and prognosis of septic peritonitis?pre-op stabilisation and antibiosis
find and correct the leak surgically
peritoneal lavage and drainage
intensive post op care
intravenous fluids
nutrition is essential
prognosis is 50/50
Información
- Descripción
- BVetMed 3: Alimentary Fichas sobre GI Surgery , creado por Erin Loogman el 26/03/2019.
- Creado por
- Erin Loogman
- Visitas
- 0
- Valoración