Flashcards
Gastrointestinal surgery
Cards in this deck (53)
- 1What is the Pre-operative assessment of Animals?- History and signalment
- Physical exam
- minimum database/ blood work
- Stabilization
- Imaging
- Emergency vs. elective sx - 2What can be seen on Diagnostic imaging - radiography of the GI tract?- intestinal obstruction (causes dilation of the intestine)
- masses
- FB - 3How can distention of the intestines be seen on radiographs?- If intestine is double the height of L2 body than is distended
- 4What can be seen in the GI using Ultrasound?- fluid
- masses
- intussusception
- FB - 5How is the animal prepared for GI surgery?- Starve overnight for elective sx
- Adults 12-18hrs
- Puppies and kittens 4-6hrs
- No enema
- Acute abdomen- surgery ASAP following stabilisation - 6Are ABs indicated in GI surgery?Are indicated if:
- clean contaminated and contaminated surgery
- Therapeutic AB if dirty surgery or septic peritonitis - 7When are AB given for GI surgery?- Given at induction
- repeated every 1.5-2 hrs until wound closure
Generally Amoxycillin clavulanate (augmentin) or cefuroxime - 8What is an exploratory laparotomy?- It is a systematic exploration of contents of the abdomen
- diagnostic tool vs. treatment
- avoid the "peak and Shriek" : must get as much pre-op information as possible and be prepared to deal with all eventualities - 9Where is the incision for a exploratory laparotomy made?Down the ventral midline: enter adbodmen through linea alba typically at umbilicus or at xiphoid down to para-preputial in male dogs.
- also paracostal, flank and inguinal excisions can be made - 10What layer might have to be removed during an exploratory lap?The falciform fat: can be removed with diathermy esp. if found cranially
- 11How can exploratory lap. be made easier?- ensure good access by use of retractors and suction (esp. if perfusion)
- use a big incision
- duodenal and colic manoeuvers
- exteriorize organs (but ensure they are kept moist)
- abdominal swabs to pack organs out the way - 12How should the gastrointestinal tract be evaluated?- be systematic e.g. cranial to caudal
- start at the oesophageal hiatus
- check the stomach (palpate the whole stomach for FB or masses)-> duodenum -> jejunum and ileum -> caecum and colon - 13What is easy to miss when assessing the stomach?- any dorsal perforations.
- Will need to cut through omentum & lift it up to see the dorsal surface otherwise will not find. - 14How can you find the ileum compared to the jejunum?- the presence of anti-mesenteric blood vessels (this vessel runs along the ileum, rather than running from the mesentry)
- 15What else must be checked during an exploratory lap?- The other organs!
- liver and biliary tract
- prancreas (BOTH limbs)
- mesenteric LN
- rectum
- spleen
- adrenal glands
- kidneys, ureters, bladder and urethra
- prostate/ ovaries and uterus - 16What are 'Duodenal manoeuvres'?The duodenum is pulled up and medially to use the mesentry to allow better visualisation of abdominal space.
(colic manoeuvre is the same) - 17How is the Abdomine closed after ex. lap?- Closure of the linea alba: synthetic absorbable suture with long duration of tensile strength e.g. PDS, use a continuous vs interrupted pattern
- Suture rectus sheath
- routine closure of sub-cut tissue and skin - 18What Post-op care should be given to GI ex. lap cases?Pain relief:
- opioids
- but avoid NSAIDs
I.V. Fluids
Feed 8-12 hrs post-op: feed little and often initially. Local nutrition is important for enterocyte function - 19What Feeding tubes are there?- oesophagostomy tube
- gastrostomy (into stomach)
- jejunostomy (rare used) - 20What are the complications of GI surgery?- haemorrhage, wound breakdown, wound infection (ALWAYS COUNT SWABS)
- Adhesions
- intestinal wound dehiscence and septic peritonitis - 21What is Ileus?- Decreased intestinal activity (loss of peristalsis movement)
- 22What are the risk factors for ileus?- long surgery
- handling intestine
- big resection - 23What are the clinical signs of ileus?- abdominal pain
- vomiting
- abdominal distension - 24What is the Tx for Ileus?- metocloproamide (upregulates gut movement)
- 25What are the layers of the Stomach, SI and colon?- Mucosa
- sub-mucosa
- muscularis (two layers of muscle)
- serosa - 26How should the bowel be manipulated?- Halsted's principle
- Keep moist
- Isolate from abdomen
- Stay sutures where possible
- Atraumatic instruments e.g. Doyen bowel clamps, or Debakey forceps? - 27What is 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 (increases risk of infection)
- Removal of devitalised tissue - 28What is it important to remember when manipulating the bowel?- limit exposure and handling as causes desiccation and abrasion
- Stay sutures can be clipped to drape and mean that bowel does not move into space created and limits handling
- Isolate with MOIST swabs - 29How can the Intestinal Viability be assessed?Subjective:
- colour
- palpation
- peristalsis
- local pulsation
- bleeding from cut serosa/ muscularis
Objective: fluorescein or pulse oximetry - 30What are surgical diseases of the stomach?- FB
- Gastric Dilatation and Volvulus (GDV)
- Neoplasia - carcinoma
- Perforated gastric ulceration
- Pyloric outflow obstruction
- Hiatal hernia - 31How is a Gastrotomy performed?- Pack off the stomach with moist swabs
- make a longitudinal incision in body of stomach
- Remember has Two distinct layers:
1. Serosa & muscularis
2. Submucosa - 32What suture pattern is used to close the stomach?- Two layers
- Inverting or appositional
- continuous - 33What are the different gastric surgeries?- partial gastrectomy
- gastropexy (for GDV)
- Gastrostomy tube
- pyloromyotomy (cut into the muscles of the pylorus)
- pyloroplasty
- billroth I (removal of pylorus) - 34What are surgical diseases of the SI?- FB: simple or linear
- Intussusception
- Neoplasia (mainly older animals)
- Mesenteric volvulus - 35How is an Enterotomy performed?- Pack off intestine using bowel claps/ fingers
- Longitudinal antimesenteric incision distal to FB
- Evaluate for necrosis
- +/- resection and anastomosis
- Close w/ simple interrupted suture: ensure that engaging submucosa therefore can also go full thickness even if sutures entering lumen - 36How is an intestinal biopsy performed?- elliptical incision
- new skin punch biopsy (typically 6mm) - circular defect in a transverse fashion
Need to ensure ligate through the blood vessels in mesentry , can do before or after cutting - 37How is intestinal biopsy closed?- start suturing from mesenteric end
Use simple interrupted suture: one at mesenteric, one opposite and do one side, flip over and do other side.
Simple continuous: one at bottom, use this to suture one side, one at top used to suture otherside - 38What happens after a resection and anastomosis of the SI?- check suture line
- palce additional sutures as necessary
- suture mesentery
- lavage anastomosis
- wrap with omentum - 39How can size disparity when perfomring resection & anastomosis in SI be solved?- cut on an angle to increase surface of small side and place sutures further apart on larger SI section and closer together in smaller SI section.
- Use surgical stapler to make a "trouser leg" connection - 40What suture material can be used to suture SI?- Polydioxanone (PDS)/ Biosyn
1.5 or 2 metric (4/0 or 3/0)
NOTHING PERMANENT or Cat gut! - 41Which suture patterns should be used on SI tissue?- appositional
- continuous or interrupted
- must ensure that Submucosa is engaged! - 42How can the suture line be reinforced?- Omental patch: abdominal policeman, vascular and Lymphatic supply, angiogenic, immunogenic and adhesive properties
- Serosal patch: gastic and duodenal perforation, re-enforce intestinal repairs, anti-mesenteric border of jejunum sutured around site. - 43What are the clinical signs of Intussusception?- Vomiting
- Diarrhoea
- Weight loss/ anorexia
- Abdominal mass
- dehydration
- abdominal pain
- tenesmus
- rectal protusion - 44What are the Surgical tx for Intusussception?- Manual reduction
- Resecton and anastomosis - 45What is Enteroplicationsurgical technique in which the adjoining intestinal segments are laid out, side-by-side in an accordion-type fashion
- used to tx intusussception
- reduced recurrence but other complications - 46How much intestine can be removed?Short bowel syndrome (causes chronic diarrhoea) occurs with extensive resection (70-85%)
May cause maldigestion/ malabsorption: decreased mucosal SA, hypersecretion, bacterial overgrowth, decreased transit time
- Water diarrhoea and weight loss - 47How can Short bowel syndrome be Tx?- Iv fluids/ TPN
- Enteral feeding 6-8x daily
- HIghly digestible diet
- Fibre
- Anti-diarrhoeals
- Antibiotics
- Good outcome in 80% dogs - 48What areas of the GI tract should NOT be considered surgical?- Large intestine has poor healing, therefore avoid colonic sx if possible
- Bile and pancreatic ducts
- proximal duodenum
- pancreas: may cause pancreatitis - 49How can contamination be reduced during GI surgery?- pack off organs with swabs
- Second "dirty" or "GI" kit
- Lavage prior to closure
- Use of suction - 50What is the risk of Dehiscence following GI surgery?- 5-15% risk following intestinal surgery
- Monitor for signs -2-5 days: when fibrin clot is being replaced by collagen
+ vomiting
+depression
+ anorexia
+ abdominal pain
- rapid diagnosis and treatment key success - 51What is the Treatment for Septic Peritonitis?- Challenging
- Rapid and aggressive tx required:
+ rapid stabilisation
+ ex lap for correction of disease process
+ reduction of contamination
+ prevention of on-going infection/ inflammation
+ intensive postoperative care
- High mortality and morbidity - 52What are the goals of surgery to tx septic peritonitis?- Explore abdomen
- Diagnose & control source of contamination
- lavage
- on-going drainage
- nutritional support
- requires closed suction drain e.g. Jacson Pratt drain following sx
- Should place feeding tube if not feeding by self - 53What post-op care is necessary for septic peritonitis?- intensive care necessary
- removal of drain
- some animals may have on-going sepsis and require repeat surgery
- Very expensive ~£4,000
- varying prognosis depending on underlying cause
- Mortality 20-70%
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- 2 Clinical Veterinary Science (Small Animal Gastrointestinal Medicine) Flashcards on Gastrointestinal surgery , created by Rebecca Hitchman on 10/01/2019.
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- Rebecca Hitchman
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