Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
70 Cards in this Set
- Front
- Back
|
What are important considerations with regards to small intestinal surgery
|
Fluid therapy
Antibiotic prophylaxis Assessment of viability Suture material and pattern Suture line reinforcement |
|
|
Why is fluid therapy so important for small intestinal therapy
|
Corrects dehydration
Improves cardiac output Improves tissue perfusion Improves organ function Corrects electrolyte imbalances |
|
|
What are the three major components of fluid therapy
|
1. Rehydration or replacement
2. Maintainence 3. Ongoing losses |
|
|
What are characteristics of maintainence crytalloids
|
decrease Na
Increase K |
|
|
What are examples of maintainence crystalloids
|
Normosol-M
Plasmalyte-M |
|
|
What are characteristics of replacement crystalloid fluids
|
Increase Na
Decrese K resembles ECF |
|
|
What are examples of alkalizing replacement fluids
|
Plasmalyte
LRS Normosol-R |
|
|
When would you use an alkalyzing replacement fluid
|
Fluid losses due to GI disease
Shock Metabolic disease |
|
|
What are examples of acidifying replacement fluids
|
Saline
Ringers |
|
|
When wouold you want to use an acidifying replacement fluid
|
Metabolic alkalosis
|
|
|
When would you want to use a dextrose solution
|
To correct hypernatremia
To decrease hypoglycemia |
|
|
When would you use hypertonic salt solutions (5%, 7%)
|
When you wanted rapid expansion of intravascular volume
|
|
|
How long will the effect of hypertonic salt solutions last for increasing the intravascular fluid volume
|
30 minutes
|
|
|
What conditions would require hypertonic salt solutions
|
Hemorrhagic shock
GDV Shock associated with blunt trauma |
|
|
What are examples of colloids
|
Plasma
Synthetics - hetastarch, pentastarch |
|
|
What are colloid fluids useful for
|
To hold or draw water into the intravascular space
For rapid correction of hypovolemia |
|
|
what is the definaition of a clean contaminated wound
|
Hollow organs entered under controlled conditions
Clean wound with a drain |
|
|
What is the definition of a contaminated wound
|
Open, fresh wounds
Gastrointestinal contents or urine spilled Major break in aseptic technique |
|
|
What is the definition of a dirty wound
|
Old traumatic wounds
Purulent discharge Viscus is perforated or fecal contamination |
|
|
What is the definition of a clean wound
|
Non-traumatic
Non-inflammed No hollow organ entered |
|
|
True or False gastrointestinal surgery is considered clean-contaminated
|
TRUE
|
|
|
What bacteria are of concern in the stomach
|
Few if any
|
|
|
What bacteria are of concern in the small intestine
|
Gram+ and Gram-
|
|
|
What bacteria are of concern in the colon
|
Gram- and anaerobes
|
|
|
What antibiotics are appropiate for surgery in the proximal small intestine
|
1G cephalosporin
|
|
|
What antibiotica are appropiate for distan small intestine surgery
|
2G cephalosporin
|
|
|
When should antibiotics be administered for gastrointestinal surgery
|
20 minute before the start of surgery to ensure they are present in the tissues at time of surgery
|
|
|
True or False antibiotic therapy for gastrointestinal surgery should be continued for at least the first 72 hours
|
FALSE do not continue passt the first 24 hours unless ongoing infection is present
|
|
|
What type of suture material should be used for GI surgery and why
|
Monofilament synthetic absorbable suture with a taper or taper cut needle
decreased bacterial adhesion decreased drag |
|
|
Why wouldn't you use a mutifilament synthetic absorbable suture material for GI surgery
|
because it hass increased surface area for bacteria to colonize
It has increased drag It has increased healing time and increased inflammation |
|
|
True or False gastrointestinal surgeries should be closed with a two layer closure
|
FALSE a single layer closure should be used the only exception would be a two layer closure of the stomach wall
|
|
|
What is the strongest layer of the intestinal wall
|
Submucosa
|
|
|
What surgical procedures are done on the stomach
|
Gastrotomy
Gastropexy Gastrectomy Gastrotomy tube placement |
|
|
What is a gastrotomy
|
An incision into the lumen of the stomach
|
|
|
What are indications for performing a gastrotomy
|
Foreign body
Biopsy |
|
|
What are the clinical signs of a gastric foreign body
|
Vomiting
+/- anorexia +/- dehydration +/- shock |
|
|
What diagnostics are performed with a gastric foreign body
|
CBC?biochem
Abdominal rads +/- contrast U/S |
|
|
When would antibiotics be indicated for a gastric foreign body
|
When there is perforation do a C&S use a 1G cephalosporin
|
|
|
True or False ileus is common after a gastric foreign body
|
TRUE treat with metocloprimide CRI 2mg/kg/day
|
|
|
What is bloat
|
over distended food filled stomach
|
|
|
What is bloat associated with
|
Known or presumed consumption of large quantities of food
|
|
|
What are clinical signs of chronic gastric volvulus
|
Intermittant weight loss
Borborgymus Flatulence Eructation Vomiting |
|
|
How does the acute syndrome of gastric dilation (volvulus) typically present
|
Rapid and significant gaseous distention of the stomach
Concomitant cardiovascular dysfunction +/- volvulus |
|
|
What are the risk factors for GD/GDV
|
Large and giant breed dogs
Deep chested dogs First degree relative with a Hx of GD/GDV Dogs fed one meal a day Dogs under increased stress Poor body condition Increasing age Behaviours that promote aerophagia Eating from a raised food dish Unhappy dogs |
|
|
What breed is the posterchild for GD/GDV
|
Great Danes (in North America)
|
|
|
What are the secondary effects of GDV
|
Cardiovascular effects
Hemolymphatic effects Renal effects CNS effects Metabolic effects |
|
|
True or False GD/GDV has been reported in cats
|
TRUE
|
|
|
How is GD/GDV diagnosed
|
Signalment
History Physical findings Initial Lab findings Radiographic findings |
|
|
What kind of history is indicitive for GD/GDV
|
Anxious
Uncomfortable Retching Salivating Breathing rapidly Abdominal distention |
|
|
What will you see on physical exam with GD/GDV
|
Distended painful abdomen
Retching Hypersalivation Shock (compensatory, endotoxic, noncompensatory) |
|
|
What is the medical management for GD/GDV
|
IV fluids
2 large bore cathaters one in the jugular and one in the cephalic |
|
|
What radiographs do you want to take for a suspected GDV
|
A right lateral
|
|
|
True or False successful passage of a gastric tube will rule out a GDV
|
FALSE
|
|
|
What are negative prognostic indicators for GDV
|
Pre-op VPC's
Plasma lactate > 9 mmol/L Free gas in the abdomen |
|
|
What are the surgical goals for a GDV in order
|
Reposition stomach
Evaluate for devitalization Evaluate other organs Reevaluate stomach (resection or invagination if necessary) Gastropexy |
|
|
What are indicators that the stomach is still viable (post GDV)
|
Red
Purple Thickened |
|
|
What are negative indicators of viability (GDV)
|
Tissue is green, grey or black
There is thinning of stomach wall |
|
|
Surgical correction of splenic torsion includes derotating and splenopexy to abdominal wall
|
FALSE do NOT derotate the spleen perfor a splenectomy
|
|
|
True or False current literature suggests that there is a posiive relationship between GDV and splenic torsion
|
FALSE current literature suggests that the two are not related
|
|
|
What are the techniques used for gastropexy
|
Incisional
Belt loop Circumcostal Tube gastropexy Ventral midline Laparoscopic assited |
|
|
Why should a ventral midline gastropexy not be performed
|
Because of an increased risk of gastrotomy if ever needed to enter the abdomen again
|
|
|
What are the advantages to an incisional gastropexy
|
Quick
Does not enter the gastric lumen Forms fibrous tissue adhesion Easy to perform Can be done unassisted |
|
|
What are the advantages of a belt loop/circumcostal gastropexy
|
Biomechanically stronger
Can be done unassisted Gastric lumen not entered |
|
|
What are the disadvantages of a belt loop/circumcostal gastropexy
|
Longer surgery time
Higher risk of flap dehiscence Increased complications - (rib fracture, pneumothorax) |
|
|
What are the advantages of a tube gastropexy
|
Rapid to perform
\allows for continued decompression post op Can feed through tube |
|
|
Ideally when should patients be fed post gastropexy
|
Patients should be feed within 24 hours
important for gut health |
|
|
What are post op complications of gastropexy
|
Peritonitis - from gastric necrosis or dehiscence
Aspiration pneumonia - from retching or gastric tube lavage Incisional infection/seroma |
|
|
What are the advantages of prophylactic gastropexy
|
Decreased risk of morbidity and mortality
Decreased lifetime costs in high risk breeds Decreased worry for owners |
|
|
What are indications for a gastric tube
|
Esophageal injury/irritation/surgery
Anorexia |
|
|
What are the potential complications of gastric tube placement
|
Leakage into abdominal cavity
Peritonitis Death |
