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78 Cards in this Set

  • Front
  • Back
The general principles for the intestines is pretty much similar to__________.
Stomach & GDV
Are peri-op antibiotics commonly used when performing intestinal surgery? Post-op?
Peri-op antibiotics common
Post-op not unless indicated
What do you need to do before exteriorizing/isolating the intestine?
Isolate portion of GI tract of interest with moistened lap sponges
How do you assess the viability of the intestine?
The 4 p's:
-pink
-peristalsis
-pulse
-palpation
what is the holding layer of the intestines?
Same as rest of GI tract: submucosa
What type of suture pattern is used during small animal intestinal surgery?
One layer, appositional patten
-simple interrupted
-simple continuous (if applied incorrectly--> purse string)
Why can't you use inverting or everting sutures in the intestines?
-Inverting bad--> narrows the lumen
-Everting bad--> adhesions
What happens when there's poor apposition of a sutured up intestine?
poor layer apposition ---> more remodeling ---> longer healing period
Compare an omental vs serosa patching.
-Omentum= brings blood supply
-Serosa= provides strength
When can staples be used for intestinal surgery?
When the intestine is healthy otherwise avoid
Is absorbable or non-absorbable generally used during intestinal surgery?
Absorbable
If non-absorbable suture is used on the intestine bc the patient is undergoing chemotherapy and is going to take a long time to heal, what suture pattern does the doctor need to use?
*Simple INTERRUPTED
When should you feed an animal after intestinal surgery?
Control vomiting/nausea and offer food as soon as awake enough
When an intestine is healing from surgery, what provides the initial strength during the healing process?
Fibrin
What percent of initial intestinal strength does the fibrin provide?
~30% of original strength
****How many days post-op are the patients at the greatest risk of intestinal dehiscence?
3-5 days due to a lag phase***
-both bursting and breaking strength decline in the first few days
What type of collagen is laid down in the intestine during day 1 and day 3 post-operation?
Day 1: type III
Day 3: type I
*When does the plateau of collagen SYNTHESIS occur when the intestine is healing from surgery?
By day 6
- max synthesis but not max content!!!!
Why is adequate O2 SOOOO important for intestinal healing?
For hydroxylation of proline & lysine and for cross-linking of collagen
-O2 delivered by blood!
What are the 5 steps of wound repair?
1) Clot formation & resolution (fibrinolysis)
2) Inflammation
-1st PMNs then macs
3) Epithelialization
-coverage then maturation
4) Granulation tissue formation
-fibroblasts
5) Fibroblast secretion products
-Collage type III then type I
-GAGs
Explain the pattern of tensile strength during wound repair?
-Clot= weak
-collagen secretion= little stronger
-Collagen cross linking--< 70-80% original strength
Where and how do you want to make your incision for an enterotomy and/or full thickness biopsy?
Longitudinal incision at anti-mesenteric border (opposite blood supply)
-in healthy bowel if you can
What type of closure can you consider for an enterotomy and/or full thickness biopsy?
Transverse closure- widens the area
What do you need to make sure to do before judging the viability of an intestine after an enterotomy and/or full thickness biopsy?
Time for reperfusion
What are the 3 types of anastomoses you can do on the intestine?
1) End-to-end: garden hose
2) End-to-side: close off blunt pouch on one end and plug one in on the side, do when there's a huge lumen diameter- e.g. plugging duodenum into stomach
3) Side-to-side: do w/ staples
**What do you want to use to clamp off the intestines during surgery?
Doyen's or an assistants fingers do not want to crush the intestine!!
-leave a ~1-2 cm cuff to suture
How do you want to cut the intestine during a resection?
Cut on angle
How do you know what vessels to ligate during a bowel resection?
Look at what blood supply is being taken out and ligate after fenestrating a hole in e.g. mesoduodenum (like w/ OVH)
What is a modified continuous suture pattern?
Where start one continuous suture at 12 o'clock and one at 6 o'clock and each goes ~180 degrees, overlap a couple of throws= doesn't pursestring like a simple continuous
What should you do after suturing the intestine shut?
Omental patch
What is an example of when enteroplication has been suggested as a solution?
When have intussusception and just need to resect this section of intestine can instead tack each side of intestine to each other to prevent future intussusception = controversial, more complications?
Whenever there's essentially anything wrong with the cecum a _______ is recommended. but you have to be very careful during dissection at the ______.
-Typhlectomy
-Ileocecal fold - can destroy blood supply to surrounding area of colon
What type of suture pattern do you want to use during a typhlectomy?
Parker- kerr suture pattern
Why are colopexys rarely performed?
Refractory perineal hernia
-specialists job
How do you perform a rectal "pull-through"?
Evert distal end of terminal colon/ rectum using stay sutures
When do you use a rectal "pull through"?
Only for distal lesions
-limited access
What type of medication needs to be given to an animal undergoing a rectal pull through?
"dirty" surgical site= need antibiotics, not prophylactic because already infected
What are the common clinical signs of an obstructing foreign body?
-vomiting**
-abdominal pain
-anorexia
-lethargy
What is the most common used diagnostic technique for obstructing foreign bodies?
Abdominal rads and/ or ultrasound
How can you determine if an intestine is distended (obstructed) by an abdominal radiograph?
if the diameter of the intestine is > 2 times the body of L5 on a lateral view
What is the prognosis for an obstructing foreign body?
Generally good
What is the most common location for linear foreign bodies to get stuck? What animal?
cats> dogs
base of tongue
What does a linear foreign body in the intestines look like on an abdominal radiograph?
Eccentric, small gas pockets
What is commonly the necessary treatment for linear foreign bodies?
Multiple enterotomies (usually not more than 2) +/- gastrotomy
What is the prognosis of linear foreign body obstructions?
Generally good, worse in dogs than cats
What should you do if you're removing a linear foreign object from the intestines and there's resistance?
Stop pulling! and find where resistance is coming from
What is the definition of an intussusception?
Invagination of one portion of GI tract (intussusceptum) into an adjoining section (untussuscipiens)
What age of animals are most commonly affected by intussusception?
Usually under 1 year old
What diagnostic technique is very helpful in diagnosing an intussusception?
Abdominal ultrasound
- see concentric rings in transverse plane
What is the surgical treatment for intussusception?
Try reduction, but usually requires resection & anastomosis
If an animal has an intussusception what should you test the animal for (what could be an underlying cause)?
Parvo
Parasites
What is the prognosis of intussusception?
Generally good if uncomplicated
How often do intussusceptions reoccur? (what's the recurrence rate) When do they usually recur?
Recurrence rate of 6-27%
Usually b/w 3 days- 3 wks post-op if it will recur
Incarceration/ strangulation of the intestine is rare, but what can strangle the intestines?
Through a hernia they can be strangulated
Whenever there's trauma (bite wounds, gun shot, HBC) to the intestine what should be your first step in working up the animal?
Look for pneumoperitoneum on radiographs
-if suspect peritonitis then do tap
Why are mesenteric volvuli so fatal compared to gastric dilation and volvulus?
GDV injures blood supply to stomach, but not entire intestine; mesenteric volvulus wipes out blood supply to everything
-mesenteric volvulus= very poor prognosis
How do you diagnose a mesenteric volvulus?
Radiographs- look for severe diffuse gas dilatation
What is the treatment for a colonic foreign body?
if its made it that far it will pass on its own
What are 3 types of diseases of the LI?
1) Colonic entrapment
-rare but reported
2) Colonic neoplasia
3) Cecal diseases
What is very useful pre-op when you're operating on a colonic neoplasia?
Colonoscopy
What is the treatment for colonic neoplasia most often?
Resection and anastomosis
-intra-pelvic location challenging
What are 3 examples of cecal disease?
Neoplasia, inversion, impaction
What is the treatment for cecal diseases?
Typhlectomy!!!!!!
-no matter what it is take it out
Idiopathic megacolon is relatively common in ______.
cats
Idiopathic megacolon is the end result of ______.
Chronic obstipation
Idiopathic (primary) megacolon accounts for ~62% of cases, but are some secondary causes of megacolon?
Pelvic canal stenosis (6 month rule), nerve injury, or manx sacral spinal cord deformity
What is the treatment for idiopathic megacolon?
Almost always fail medical management--> resection and anastomosis (aka subtotal colectomy)
Should you try to preserve the ileocecocolic valve when performing a resection an anastomosis due to idiopathic megacolon?
more recent studies imply that preserving it doesn't result in higher incidence of occurrence and so most try to preserve when possible, but earlier on they were taken out and the cats had diarrhea for a few extra weeks but were fine
How long does it take for feces to normalize after a resection and anastomosis to correct idiopathic megacolon?
~3 months
A local _____ can help during intestinal surgery?
lavage
What are 3 potential post-op complications of bowel resection & anastomosis to correct idiopathic megacolon?
1) Ileus
2) Septic peritonitis
3) Short bowel syndrome
Septic peritonitis as a post-op complication of correcting an idiopathic megacolon is associated with ______.
Dehiscence
What are the clinical signs of septic peritonitis as a post-op complication of intestinal surgery?
Nonspecific signs
-anorexia, depression, abdominal pain, vomiting
How long does it normally take septic peritonitis to develop as a post-op complication of surgery for idiopathic megacolon?
Usually occurs w/in 3-5 days after surgery
What diagnostics can be done to confirm septic peritonitis?
-Check CBC
-Abdominal tap: look for bands, intracellular bacteria, toxic changes (degenerative neutrophils in abdominal fluid, toxic in blood)
What is the prognosis of idiopathic megacolon?
Generally guarded
How much of the jejunum can be removed (e.g. when correcting short bowel syndrome)?
70-85% of the jejunum
What is the treatment of short bowel syndrome?
-Increase fiber and fat in diet while they're still adapting
-may need injections of fat soluble vitamins
-intestinal adaptation may take weeks to months