GoConqr has a new look! Let us know what you think.

Sign up free

Flashcards

Gastrointestinal surgery 2

Rachael Jones 4. Gastrointestinal English 60 cards

Cards in this deck (60)

  1. 1What are the layers of the stomach, small intestines and colon?• Mucosa
    • Sub-mucosa
    • Muscularis (two layers of muscle)
    • Serosa
  2. 2Which layer holds strength so is very important for suturing?Sub-mucosa
  3. 3How should I manipulate the bowel?• Halsted’s principles
    • Keep moist
    • Isolate from abdomen
    • Stay sutures where possible
    • Atraumatic instruments
  4. 4What are Halsted's principles?• Aseptic technique
    • Sharp dissection
    • Good haemostasis and preservation of blood supply
    • Gentle tissue handling
    • Accurate tissue apposition with avoidance of tension and closure
    of dead space
    • Removal of devitalised tissue
  5. 5How can you perform gentle tissue handling?• Limit exposure and handling – desiccation
    and abrasion
    • Stay sutures
    • Isolate with moist swabs
  6. 6What is a feature of atraumatic instruments?Tend to have longitudinal striations so as not to damage the bowel
  7. 7How can you assess intestinal viability?1• Subjective
    • Colour
    • Palpation
    • Peristalsis
    • Local pulsation
    • Bleeding from cut serosa / muscularis
    2 • Objective
    • Fluorescein
    • Pulse oximetry
  8. 8Give a list of surgical diseases of the stomach?• Foreign bodies
    • Gastric dilatation and volvulus (GDV)
    • Neoplasia – carcinoma
    • Perforated gastric ulceration
    • Pyloric outflow obstruction
    • Hiatal hernia
  9. 9How do you perform a gastrotomy?• Pack off stomach with moist swabs
    • Longitudinal incision in body of stomach
    • Two distinct layers
  10. 10What are the 2 distinct layers of the stomach during gastrotomy?1. Serosa and muscle
    2. Submucosa and mucosa
  11. 11What is the suture pattern for closing the stomach?• Two layers
    • Inverting or appositional
    • Continuous
    - Simple continuous in both is fine
  12. 12What would you perform a partial gastrectomy?- Tumours or necrosis due to GDV
    - Remove a portion of the stomach
    - Body is easier due to lots of tissue
  13. 13What is a • Pyloromyotomy / pyloroplasty used for?Outflow obstruction - so used to adjust the pylorus
  14. 14What is a Billroth 1 for?Removal of the pylorus
    - Tumour or severe necrosis
    - Duodenum back into stomach
  15. 15Give a list of surgical diseases of the small intestines.• Foreign bodies
    * Simple
    * Linear
    • Intussusception
    • Neoplasia
    • Mesenteric volvulus
  16. 16What is the result of mesenteric volvulus?Route of mesentery twisted resulting in necrotic tissue
  17. 17What are the 2 options you have when there is a intestinal foreign body?1. Enterotomy
    2. Resect damaged tissue and FB and then anastomose
  18. 18How is an enterotomy performed?• Pack off intestine – bowel clamps / fingers
    • Longitudinal antimesenteric incision
    distal to FB
    • Evaluate for necrosis
    • +/- resection and anastomosis
  19. 19What is important when closing the intestines?- Engaging the submucosa
    - Full thickness and leave in the lumen
    - Simple interrupted sutures to allow equal expansion of viscera
  20. 20How big a bite should you take for sutures?2-4mm
    sutures 2-4mm apart
  21. 21How can you perform an intestinal biopsy?1• Elliptical incision
    2• New skin punch biopsy (typically 6 mm)
    • Close the circular defect in a transverse
    fashion
  22. 22What type of margin is required for a mass?3-5cm
  23. 23How do you place bowel clamps?Using the tip and making sure that only bowel is clamped off
  24. 24How do you perform a resection and anastomosis of the SI?- 2 clamps on both ends to occlude the area to be resected
    - Use the outer clamp as a cutting guide
    - Cut
    - Ligate vessels in mesentery
    - Separate SI for histopath
    - Anatomose the 2 ends
  25. 25What is the best way to anastomose the SI?- Start at mesenteric end
    - Suture top and bottom
    - Divide each section in half every time until completed
    - Interrupted sutures
    - For continuous, still do top and bottom and work round to the other suture
  26. 26What is important before finishing a resection and anastomosis?Suture the mesentery if any holes preventing any stangulation
  27. 27What is the check list for after finishing a resection and anastomosis?• Check suture line
    • Place additional sutures as necessary
    • Suture mesentery
    • Lavage anastomosis
    • Wrap with omentum
  28. 28What do you do if there is a size disparity for an anastomosis?- Cut the smaller section on an angle to provide a greater surface to suture
    - Make the gap between sutures smaller on the smaller SI and larger on teh wider section
  29. 29What is another way of closing if you don't want to suture?Surgical staplers:
    1. one row
    2. linear cutter staplers
  30. 30Which suture material do you use for an anastomosis and general gut surgery?• Polydioxanone (PDS) / Biosyn
    • 1.5 or 2 metric (4/0 or 3/0)
    - Absorbable synthetic
  31. 31What suture pattern should you use for SI?• Appositional
    • Continuous or interrupted
    • Must engage submucosa
  32. 32Give 2 ways to reinforce the suture line.• Omental patch
    • Serosal patch
  33. 33What is a omental patch?• Abdominal policeman
    • Vascular and lymphatic supply
    • Angiogenic, immunogenic and adhesive properties
  34. 34What is a serosal patch?• Gastric and duodenal perforation
    • Re-enforce intestinal repairs
    • Anti-mesenteric border of jejunum sutured around site
  35. 35What is important with a linear foreign body?Find the site at which it is anchored (normally tongue or pylorus) and deal with it
  36. 36How do you diagnose linear foreign bodies?- Radiographs
    - Distinctive pattern due to intestines getting stacked up and gas being bunched up
  37. 37What tends to be the way with getting rid of a linear foreign body?Release anchor point
    Gastrotomy and enterotomies
  38. 38What are the clinical signs with intussusception?• Vomiting
    • Diarrhoea
    • Weight loss / anorexia
    • Abdominal mass
    • Dehydration
    • Abdominal pain
    • Tenesmus
    • Rectal protrusion
  39. 39What are the causes of intussusception?Variety of causes
  40. 40What can be used to diagnose an intussusception?Radiographs
  41. 41How can intusussception be treated?• Manual reduction: milk the guts out of each other, fine if small and new
    • Resection and anastomosis: when large and been there a while, tends also to have damage
  42. 42What is enteroplication?Suturing SI together to stop intusussception
  43. 43What are features of enteroplication?• Recurrence – up to 25%
    • May vary with underlying cause
    • Reduce recurrence but other complications
  44. 44How much of the bowel can be removed?• Short bowel syndrome
    • Extensive resection 70-85%
    • Ileocolic valve?
  45. 45What are the clinical signs if too much is removed?• Maldigestion / malabsorption
    • Decreased mucosal SA
    • Hypersecretion
    • Bacterial overgrowth
    • Decreased transit time
    • Watery diarrhoea and weight loss
  46. 46What is the treatment for short bowel syndrome?• IV fluids / TPN
    • Enteral feeding 6-8x daily
    • Highly digestible diet
    • Fibre
    • Anti-diarrhoeals
    • Antibiotics
  47. 47What is the outcome for bowel removal?Good for 80% of dogs
  48. 48What should you not touch during GI surgery?• Large intestine is bad for surgeons!
    * Healing
    * Avoid colonic surgery if possible!
    • Bile and pancreatic ducts
    • Proximal duodenum
    • Pancreas?
  49. 49How do you reduce contamination?• Pack off organs with swabs
    • Second “Dirty” or “GI” Kit
    • Lavage prior to closure
  50. 50How can you lavage the abdomen?- Bottles of saline
    - Jugs/ bowls
  51. 51What are features of dehiscence following GI surgery?• 5-15% risk following intestinal surgery
    • Monitor for signs – 2-5 days
    * Vomiting
    * Depression
    * Anorexia
    * Abdominal pain
    • Rapid diagnosis and treatment key to success
  52. 52What tends to be seen/ clinical signs with septic peritonitis?1• Cardiovascular
    • HR 180
    • Poor peripheral pulses
    • Injected MMs
    • Fast capillary refill time
    2• Respiratory
    • Increased rate
    • Lung sounds normal
    3• Neurological
    • Obtunded
    • Weak
  53. 53How do you diagnose septic peritonitis?Sample abdominal fluids
    - Look at in house with Diff-Quik
    - Looking for neutrophils with intracellular bacteria
    - Rods
  54. 54What is the treatment for septic peritonitis?• Challenging
    • Rapid and aggressive treatment
    * Rapid stabilisation
    * Ex lap for correction of disease process
    * Reduction of contamination
    * Prevention of on-going infection /
    inflammation
    * Intensive postoperative care
  55. 55What is the outcome with septic peritonitis?• High mortality and morbidity
  56. 56What is the goals of surgery fro septic peritonitis?• Explore abdomen
    • Diagnose & control source of contamination
    • Lavage
    • On-going drainage
    • Nutritional support
  57. 57What types of drainage can be used?- Open peritoneal drainage (labour intensive)
    - Closed suction drains (work better)
  58. 58What should be placed if not eating post septic peritonitis surgery?Feeding tube
  59. 59What is the post-op care for septic peritonitis?• Intensive care necessary
    • Removal of drain
    • Some animals may have on-going sepsis
    and require repeat surgery
    • Very expensive (£4000- £6000)
  60. 60What is the prognosis for septic peritonitis?• Varies with underlying cause
    * Post-surgery poor prognosis
    * Bile peritonitis
    • Mortality 20-70%
    • Risk factors
    * Refractory hypotension?
    * Development of MODS

Information

Description
4. Gastrointestinal (SA gastrointestinal surgery - Mickey Tivers) Flashcards on Gastrointestinal surgery 2, created by Rachael Jones on 27/10/2018.
Created by
Rachael Jones
Views
0
Rating

More on Gastrointestinal Surgery

Feedback

What is it about?

What do you think of the new look?

How do you like it?