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314 Cards in this Set
- Front
- Back
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Define celiotomy
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Surgical incision into the abdomen
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What is the term for a flank approach to the abdominal cavity?
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Laparotomy
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Which abdominal approach is used most commonly in small animals?
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Ventral midline
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A ventral midline incision is made along what structure?
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Linea alba
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What are the benefits to incising through the linea alba?
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-minimal bleeding
-exposure of all abdominal organs |
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When would a paramedian incision into the abdomen be used?
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To increase the exposure of organs on one side of the abdominal cavity
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What are the drawbacks to using a paramedian approach?
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-increased bleeding
-increased closure time |
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Which approach would you take to expose one of the kidneys, adrenal gland and one ovary?
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Flank approach
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What are the landmarks for a flank approach?
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Lateral incision between the last rib and tuber coxae
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Which abdominal approach gives very limited exposure to the organs and is rarely used alone?
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Paracostal approach
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Combining a ventral midline approach with a paracostal would give increased visualization to organs such as what?
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Gall bladder, liver lobes
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When using a ventral midline incision on a male, what strcuture must be severed and later reattached?
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Preputialias mm.
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Combining a ventral midline with a median sternotomy opens the pleaural cavity. What does this mean for life support for the animal?
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Assisted ventilation is required
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When using a ventral midline and median sternotomy approach, what is required along with the closing of the sternum?
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Thoracic drainage
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For an exploratory celiotomy, what is the length of the ventral midline incision?
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From xiphoid to pubis
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What structure should be included in the field as a landmark?
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Umbilicus
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Which vessels run parallel to the linea alba cranial to the umbilicus?
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Superficial epigastrics
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What do you do with the falciform ligament?
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May be displaced, removed or movd to one side
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What is the holding layer of the fascia in a ventral midline approach?
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External rectus fascia
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Why is the internal rectus sheath not closed?
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-doesn't add any strength to the closure
-may increase adhesion formation |
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Why should suturing the rectus muscle layer be avoided?
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-doesn't add strength
-increases inflammation |
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How far apart are sutures placed in a ventral midline closure?
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5-10mm apart, and incorporate 5-10mm tissue
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What suture pattern is used to close the linea alba?
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Simple interrupted
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What suture material is used?
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Monofilament absorbable or non-absorbable
Size 3/0 to 0 in dogs Size 3/0 to 4/0 in cats |
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Which suture materials are NOT used in closing the linea alba?
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Chromic gut or stainless steel in a continuous pattern
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In which direction is a ventral midline incision closed?
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Start at one end, close at the other or
start at each end and close towards the middle, tie 2 sutures together at the center of incision |
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How is the skin closed in a ventral midline approach?
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3/0 to 4/0 nylon
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What surgical technique is the most efficient path to a definitive diagnsosi?
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Exploratory celiotomy & biopsy
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What are some of the indications for performing a celiotomy?
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-fluid accumulation
-non-responsive pain -organ disruption -non-responsive dystocia -abnormal discharge -content evaluation by inspection or palpation -biopsy -microbiological sampling -trauma -neoplasia |
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How is the table positioned for an exploratory celiotomy?
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Trendelenburg, dorsal recumbency
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The celiotomy incision is made from where to where?
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From xyphoid to pubis
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After entering the peritoneal cavity, what samples are collected?
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Samples of free fluids
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How are the organs evaluated during a celiotomy?
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Evaluate size, shape, color, location, consistency, surface
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In what manner is the abdomen explored?
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Begin cranially with the diaphragm, four quadrants, always use the same technique, use anatomical retractors
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If surgical diagnosis is not possible, what is your next step?
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Obtain multiple samples, begin therapeutic intervention
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Name some techniques for obtaining a liver sample
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-finger crushing
-ligature fracture technique (Guillotine) -instrument fragmentation -wedge resection -biopsy punch -tru-cut |
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How is hemostasis achieved when taking a liver biopsy sample?
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Surigcel, Spongostan, or omentum
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The ligature fracture technique is limited to which portion of the liver?
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Hepatic lobe
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When obtaining a biopsy sample of the intestines, how much of a full thickness sample be taken?
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Not to exceed 20% of the intestinal circumference
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How is the intestinal biopsy site closed?
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Single layer closure, apposition
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What surgical biopsy techniques are used for obtaining samples of lymph nodes?
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-FNA
-wedge -excisional |
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Why is the excisional technique of lymph node biopsy preferred to the FNA technique?
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Provides morphologic data
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A surgical needle aspiration bx of the kidney is performed in what direction?
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Caudal to cranial parallel to the cortex
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What complication can be encountered when performing a wedge resection bx of the kidney?
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Hemorrhage
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To visualize and biopsy the prostate gland, what organ must be exteriorized?
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Bladder
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What can you do to avoid penetrating the ureter when taking a bx of the prostate gland?
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Catheterize it to visualize it
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After taking a bx of the urinary bladder and suturing the layers closed, what must you do next?
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Water test
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What types of therapeutic intervention could you possibly perform during an exploratory?
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-surgical correction of lesions
-control bleeders -correct source of contamination -correct source of pain -mass removal -correct intestinal obstruction -elimination of abnormal accumulations |
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Before any surgical intervention can be performed, the surgeon must do what?
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Plan before the intervention
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What step is performed immediately prior to abdominal closure?
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Abdominal lavage
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How much lavage fluid is used?
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Until clear fluid is seen
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What does lavage achieve?
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-removal of contaminants
-patient warming -isotonic fluid |
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How is the celiotomy incision closed?
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Only the external abdominal fascia is closed, avoid the rectus muscle
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What are some of the surgical disorders of the stomach requiring surgery?
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-foreign body
-pyloric stenosis/hypertrophy -neoplasia -hiatal hernia |
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What is one of the most common gastric foreign bodies?
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A bone
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What is a common history for a gastric f.b.?
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Owners sees animal ingest object or toy or object is missing
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In which species are gastric f.b. more common?
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Young dogs
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What are the clinical signs of a gastric f.b?
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-abdominal pain
-vomiting -anorexia/ weight loss |
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What clinical signs are seen if the f.b. lodges in the pyloric antrum and obstructs the outflow tract?
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Vomiting- leads to dehydration
Loss of hydrogen and chloride ions leads to metabolic alkalosis and hypochloremia |
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Infrequently, mucosal erosion, ulceration or necrosis from a b.f. may produce what clinical sign?
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Melena, hematemesis
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Radiography of a gastric f.b. may require the need for what agent?
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Contrast
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What other diagnostics are needed in the case of a gastric f.b.?
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-US
-endoscopy -lab data (metabolic alkalosis, hypochloremia, hypokalemia) |
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What is the first step in the treatment of a gastric f.b.?
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Correction of electrolyte ,water and acid-base imbalances
Then removal. |
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What types of f.b. can be removed by endoscopy?
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Small, light-weight, soft material
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What is the prognosis for a gastric f.b. case?
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Excellent in most cases
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What is pyloric hypertrophy/stenosis?
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Abnormal narrowing of the lumen of the pylorus, causing partial obstruction
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What is the etiology of pyloric hypertrophy/stenosis?
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Unknown
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The congenital form of pyloric stenosis includes what layer of the pylorus?
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Muscular layer
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The acquired form of pyloric stensosis is defined as what type?
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Hypertrophy of muscosal or muscular layer of pylorus and sometimes antrum
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When does pyloric stenosis manifest in puppies?
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Following ingestion of solid food, at weaning
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What other history might the owner provide?
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May have ravenous appetite
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What information is needed to make a clinical diagnosis of pyloric stenosis?
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-hx and signalment, esp age at onset
-clinical signs -lab data -rads |
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Which breeds have a higher incidence of pyloric stenosis?
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-brachcephalic dogs
-siamese cats |
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What other clinical signs might be seen with congenital pyloric stenosis?
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-emaciation, stunted growth
-dehydration -occasionally fever and increased lung sounds secondary to aspiration of vomitus |
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What would you expect to see on radiographs of a case of congenital pyloric stenosis?
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Plain rads: enlarged stomach filled with fluids and food
Contrast: delayed gastric emptying, presence of barium in the stomach 8-12 hours is abnormal |
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What lab results indicating congenital pyloric stenosis would you expect?
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Malnutrition: hypoproteinemia, anemia, low BUN, hypoglycemia
-dehydration, hypochloremic metabolic alkalosis -eleveated WBC count if aspiration pneumonia occurs |
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What difference in the history might be given with acquired pyloric hypertrophy/stenosis?
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Intermittent vomiting, not always associated with feeding, increases in frequency over months
-weight loss -occasionally anemia, depression, decreased activity |
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Acquired pyloric stenosis/hypertrophy is common in which breeds?
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Middle aged, excitable small breeds, esp, Lhasa apso and Shih-tzu
rare in cats |
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Radiographically, what would you see in a case of acquired pyloric hypertrophy/stenosis?
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Filling defect in pylorus
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What surgical techniques are used to correct pyloric stenosis?
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-pyloromyotomy
-pyloroplasties -gastroduodenostomy/gastrojejunostomy |
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Name the 3 common surgical procedures used for correcting pyloric hypertrophy/stenosis.
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-Fredet-Ramstedt pyloromyotomy
-heinke-Mikulicz pylroplasty -Y-U antral advancement flap pyloroplasty |
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What radical surgical may be used for pyloric hypretrophy/stenosis?
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Bilroth I gastroduodenostomy
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What is the indication for using the
Fredet-Ramstedt pyloromyotomy procedure? |
Congenital pyloric stenosis
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What is the goal of the pyloromyotomy technique?
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To incise the seromuscular layer and allow the mucosa to bulge into the incision and expand the pylorus
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Where is the pyloromyotomy incision made?
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Partial thickness longitudinal incision from antrum to duodenum across pylorus.
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What are the advantages of using the Fredet-Ramstedt pyloromyotomy technique?
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-quick and easy to perform
-lumen of pylorus not opened |
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What are the disadvantages of using the Fredet-Ramstedt pyloromyotomy technique?
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-effective ONLY in congenital stenosis
-effect may be temporary, stenosis my recur as seromuscular incision heals |
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What are the indications for using the Heineke-Milkulicz pyloroplasty technique?
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Congenital or acquired pyloric hypertrophy/stenosis, biopsy
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How is the Heineke-Milkulicz pyloroplasty performed?
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A full thickness longitudinal incision crosses the ventral surface of the pylorus. The incision is closed transversely in 1 layer of simple interrupted sutures
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What are the advantages of the
Heineke-Milkulicz pyloroplasty ? |
-exposure of muscosa for biospy
-less likelyhood of recurrance than pyloromyotomy |
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What are the disadvanatges of the Heineke-Milkulicz pyloroplasty ?
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-lumen is opened
-not usually effective with acquired pyloric hypertrophy |
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What are the indications for using the Y-U pyloroplasty technique?
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For acquired pyloric hypertrophy, resection of mucosa/submucosa
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What is the surgical approach of the Y-U pyloroplasty?
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-make longitudinal full thickness pyloric incision
-extend it to the pyloric antrum making 2 diverging incisions (Y) -the incised gastric wall is closed by suturing into a U shape |
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What are the advantages of the Y-U pyloroplasty?
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-good exposure of mucosa
-redundant mucosa/submucosa can be resected (2 layer closure) -greater expansion of the pylorus |
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What are the disadvantages of the Y-U pyloroplasty?
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-lumen is opened
-more lengthy procedure |
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Which surgical procedure to correct pyloric hypertrophy/stenosis is no longer performed?
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Billlroth I
Pylorectomy & Gastroduodenostomy |
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Which type of gastric neoplasia occurs (rare) in older dogs as a large, pedunculated mass?
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Benign adenoma, adematous polyp
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Leiomyosarcomas occur in dogs of what age?
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very old dogs...15 years.
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What is the most common gastric cancer found in dogs?
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Adenocarcinoma
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What is the average age of a dog with adenocarcinoma?
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8 years
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Which sex has the higher prevalence of adenocarcinoma?
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males (2.5:1)
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What is the most common gastric tumor found in cats?
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Lymphosarcoma
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Clinical signs of gastric neoplasia include what?
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-hematemesis
-abdominal pain -anemia -melena -signs of pyloric obstruction -icterus |
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Contrast radiology or ultrasound may demonstrate a gastric malignant neoplasia usually located where?
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On the lesser curvature or pyloric antrum
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Benign neoplasia are seen as what?
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Pedunculated/circumscribed
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Radiographically, a tumor in the pyloric antrum will have what appearance (with contrast)?
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Apple core- filling defect
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Tumors in this area may cause icterus due to what?
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Obstruction of biliary outflow
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Differential diagnoses for gastric neoplasia can include what?
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-pyloric hypertrophy
-Pythiosis |
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Where is pythiosis most common?
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Gulf states- hunting dogs
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What are the primary sites of metastisis of adenocarcinoma?
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-regional lymph nodes
-liver -lung |
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Other site of adeoncarcinoma metastesis include what?
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-omentum
-peritoneal surface -diaphragm |
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When describing the appearance of an adenocarcinoma, what does the term scirrhous mean?
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Firm and white on serosal surface
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An adenocarcinoma may also appear expansile with a central crater and ulceration on the muscosal surface. This appearance is termed what?
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Infiltrative (cobblestone)
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What surgical procedures may be indicated for treatment of gastric neoplasia?
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-partial gastrectomy
(Billroth I or II) |
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What additional procedure might be required with pyloric tumors?
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Cholecystoenterostomy
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Indications for a partial gastrectomy include....
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-neoplasia
-ischemic injury (GDV) -penetrating injury (ulcer or trauma) |
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Ischemic injury to the stomach usually occurs where?
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At the greater curvature
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Which surgical procedure is used when ischemic injury involves both curvatures?
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Not suitable for surgery
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With the incisional technique of partial gastrectomy, which vessels to the affected area are ligated?
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Gastroepiploic
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What other technique can be used for performing a partial gastrectomy?
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TA stapler technique
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The Billroth II pylorectomy & gastrojejunostomy is indicated for which conditions?
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-neoplasia
-necrosis of pylorus or antral region of stomach |
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With the Billroth II technique, the stomach is side to side anastomosed with what organ?
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Loop of proximal jejunum
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What are the advantages to using Billroth II?
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-abnormal tissue is removed
-compared to Billroth I, reduces tension on suture line when extensive resection is required |
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What are the disadvantages of Billroth II?
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-difficult, lengthy procedure
-marginal ulceration od jejunal limb from exposure to gastric fluid |
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Do adenocarcinoma and gastric lymposarcoma respond well to chemotherapy?
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No
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Why isn't radiation therapy used for these cancers?
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Sensitivity of surrounding tissues
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What is the prognosis for excision of a adenoma?
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Curative
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What is the survival time for a pt. with leiomyoma/leiomyosarcoma?
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1 year
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What is the survival rate of gastic adenocarcinoma?
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6 months (surgery is palliative)
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What is the definition of a hiatal hernia?
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Protrusion of the abdominal esophagus, gastro-esophageal junction and sometimes a portion of gastric funduc throuhg the esophgeal hiatus of the diaphragm into the caudal mediastinum
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What are the possible etiologies of a hiatal hernia?
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-usually congenital, associated with abnormalities of hiatus, esp phrenicoesophageal ligament
-possibly traumatic -maybe associated with upper airway obstruction |
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Which breeds (usually males) are pre-disposed to hiatal hernia?
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Shar-pei, Bulldog
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History for a hiatal hernia may be asymptomatic, or might include what clinical signs?
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-regurgitation, vomiting, dysphagia
-hematemesis -anorexia, weight loss |
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What diagnostic procedures can be used to confirm a hiatal hernia?
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-radiography/fluoroscopy
-endoscopy |
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What are the surgical treatments of hiatal hernia in symptomatic patients?
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-gastropexy. left sided fundus to body wall
-hiatal reduction and esophagopexy -gastrostomy tube -Nissen fundoplication (only is reflux and esophagitis are present |
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When performing a gastrotomy, how is the stomach elevated to the cranial midline position?
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Stay sutures, or Babcock forceps
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Once the stomach is packed off with lap sponges, a stab incision (for the gastrotomy) is made where?
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Through a hypovascular area on the ventral body of the stomach between into the gastric lumen between greater and lesser curvatures, far from the pyloric antrum as possible
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With which instrument is the gastrotomy incision lengthened?
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Metzenbaum scissors
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How is the gastrotomy incision closed?
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- two inverting layers (Conell followed by Cushing or Lembert
-Simple continuous in mucosa/submucosa, followed by Cushing or Lembert |
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What type of suture material is used in closing the gastrotomy?
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Absorbable
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Post op, the gastrotomy patient should remain NPO for how long?
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12-24 hours, offer small amount of water at 12-24 hours
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How is GDV characterized?
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Accumulation of gas in the stomach and malpositioning of the stomach with obstruction of eructation and pyloric outflow
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Which breeds are prone to GDV?
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GSD
Doberman |
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GDV is considered a clinical-surgical emergency. Why isn't the saphenous vein a good location for giving fluids?
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Return to heart can be slowed or blocked to fluids coming caudal areas
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What are the clinical signs of GDV?
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-cranial abdominal distension
-anxious face -tachypnea -tympanic abdomen -MM ingurgitated, pale -splenomegaly/altered position -altered cardiac and respiratory parameters |
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Even with treatment, death from GDV can be as high as what?
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25-30%
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What is gastric torsion?
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When the stomach twists abruptly on the long axis
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Why can this stage of GDV be overlooked?
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No complete closure of the GE junction
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What is the definition of gastric volvulus?
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Twisting takes place over the long axis of the stomach
Rotation of the GE junction is greater than 180 degrees, with esophageal and pyloric obstruction |
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Clockwise rotation can be as far as how much?
Counter clockwise? |
CW: 180-270 degrees
CCW: 90 degrees |
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Volvulus is a twist along the long axis greater than....
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180 degrees
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When do most GDV's occur?
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Night time
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By what 3 mehtods can gastric decompression be attempted?
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-orogastric intubation
-ganstrocentesis -gastrostomy |
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Patient at risk with GDV show what clinical signs?
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-dyspnea with abdominal component
-debilitated -decreased consciousness -decreased HR -increased RR, reduction -back coat "erection" |
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What is the appearance of GDV on radiographs?
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Double bubble, compartmentilization
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What are the 3 objectives to the surgical correction of GDV?
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-reposition the stomach
-assess severity of ischemia and resect any devitilized tissue -perform a permanent gastropexy to prevent recurrence |
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If repositioning the stomach is correct, where should the pylorus be?
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On the right, GE junction should not be twisted
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How is the stomach assessed in terms of viable tissue?
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By color, presence of pulsating vessels, peristalsis and bleeding from cut surface
-palpate thickness of wall (devitilized areas are thinner |
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In performing a tube gastropexy, the tube incision is placed where?
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Behind last rib, lateral to nipple line, must not obstruct pylorus
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When is the tube removed?
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5-7 days
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What is the advantage to using the tube gastropexy?
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-can continue to decompress
-easy access to feeding and meds |
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Which layer of tissue is incised for the incisional gastropexy?
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Seromuscularis only
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Which pexy technique is the strongest?
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Circumcostal
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Briefly, how is the circumcostal pexy performed?
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Flap is made and passed around a rib, sutured back into place
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The belt loop gastropexy is similar to the circumcostal, but passes around what structure?
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The transversus abdominis
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A prophylactic gastropexy can be performed by what method?
|
Laporoscope
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What is the recurrence of GDV in patients that have had gastropexy?
|
Less than 6.9%
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Post op care includes enteral nutrition that includes glutamine....why?
|
To maintain intestinal surface
|
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How often should a post GDV dog be feed?
|
Several small meals in a day, high protein
|
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If gastropexy is not performed, how likely is it that GDV will reoccur?
|
75-80% chance
|
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What are the indications for surgery of the small intestines?
|
-obstruction
-perforation -diagnosis (bx) |
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Intestinal obstruction can be caused by what?
|
-F.B.
-intussusception -ileus -neoplasia -pythosis -trauma -mesenteric torsion -herniation |
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Severity of signs of intestinal obstruction are dependent on what?
|
-completeness (complete or partial)
-location (high vs low) -blood supply (strangulated vs non-stangulated) |
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More severe clinical signs are seen in which type of obstruction?
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Complete, high and strangulated
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Linear f.b. are more common in which species?
|
Cats
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Which type of intestinal obstruction is more common in young dogs?
|
Intussusception
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Mesenteric torsion is seen in adult dogs, esp which breed?
|
GSD
|
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Neoplasia of the small intestine is usually seen in which age/species?
|
Older dogs and cats
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Intestinal obstruction can lead to infarction in what time frame?
|
8 hours
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Intestinal necrosis can lead to what disastrous condition?
|
Perforation
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Without treatment, death from a small intestine obstruction can occur in 3-4 days due to what?
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Hypovolemia
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Gross necrosis of the intestine, from hypoxia, is evident in what timeframe?
|
20 hrs
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A pyloric/proximal duodenal obstruction can lead to metabolic alkalosis or acidosis?
|
Alkalosis from vomiting
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A mid-duodenal to ileal obstruction could lead to a metabolic alkalosis or acidosis?
|
Acidosis from diarrhea
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Fluid loss from an intestinal obstruction can be due to what?
|
-vomiting
-sequestration in intestinal lumen (incr secretion, decreased absorption) -edema of intestinal walls (esp venous occlusion) |
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What is a strangulating obstruction?
|
Occlusion of the blood supply
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Strangulation can lead to what complications in the bowel?
|
-bacterial overgrowth
-increased bowel permeability -perforation and escape of bowel contents -peritonitis |
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What are the causes of strangulating obstructions?
|
-intussusception
-mesenteric torsion -strangulated hernias -some f.b. obstructions -abhesions/bands |
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Clinical signs of intestinal obstruction include what?
|
-vomiting
-dehydration, electrolyte imbalance, acid base abnormalities -abdominal pain -distended loops of intestine -palpable abdominal mass |
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Overall the treatment of intestinal obstruction includes what?
|
-stabilize patient (correct acid-base, fluid and electrolytes)
-IV antibiotics -Tx for shock -correct underlying condition surgically |
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What happens to F.B. that pass into the colon?
|
Usually pass out with feces
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Linear F.B.'s in cats are often anchored where?
|
Under the tongue (needle and thread)
|
|
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What radiographic signs can be seen in a case of a linear F.B.?
|
-intestines plicated in cranial direction
-teardrop shape of gas bubbles in intestine |
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What procedure(s) may be required to remove a linear F.B.?
|
Multiple enterotomies
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What is the term for the segment of intestinf that telescopes into another segment in an intussuception?
|
Intussusceptum
(adjacent segment is intussuscipiens) |
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Intussusception is more common in puppies and is associated with what condition of the gut?
|
Hypermotility
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|
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Intussusception can progress to what other grave conditions?
|
-venous occlusion may progress to perforation and peritonitis
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|
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What clinical signs are seen in a case of intussusception?
|
-bloody diarrhea may accompany vomiting and abdominal pain
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|
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If the intussusception can be manually corrected, what do you do next?
|
Wait to see if it occurs again
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|
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If the intussusception cant be reduced, what approach do you take?
|
Resection and anastomosis
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|
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In which adult male dog breeds does mesenteric torsion occur more often?
|
GSD, Pointers
|
|
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What are the pre-disposing factors of mesenteric torsion?
|
-vigorous activity
-dietary indiscretion -trauma -recent GI surgery -enteritis -parasitism -fb -obstruction -exocrine pancreas deficiency -GDV |
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What clinical signs might be seen with mesenteric torsion?
|
-acute pain
-shock -mild abd enlargement -depression -recumbency -nausea, retching, vomiting -hematochezia |
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The differential diagnsoses of mesenteric torsion include what?
|
-GDV
-acute splenic torsion -enteritis -Gi obstruction -ileus -trauma -peritonitis |
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Radiographically, what would be seen in a case of mesenteric torsion?
|
Entire small intestines distended with gas
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|
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Surgical treatment of mesenteric torsion includes what objectives?
|
-untwist and reposition the intestines
-allow for reperfusion, then evaluate viability -resect devitilized tissue if possible -lavage, peritoneal drainage |
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Mortality in cases of mesenteric torsion can be how high?
|
Up to 100%
|
|
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What are the indications for an enterotomy?
|
-removal of interluminal F.B.
-full thickness bx sample of intestines -evaluation of intestinal mucosa to determine viability |
|
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How is the enterotomy performed?
|
-atraumatically occlude intestine proximal and distal to prevent leakage (Doyne clamps or fingers)
-make a stb incision into lumen, extend with Metzenbaums |
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Where should the enterotomy incision be made?
|
In healthy tissue, usually distal to F.B.
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|
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How should the enterotomy be closed?
|
Simple continuous or simple interrupted, sutures 2-3mm from edge of tissue, 2-3 mm apart
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After the lumen is closed, how do you check for leaks?
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Inject saline
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After the completion of closing the intesttines what do you do with the omentum?
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Wrap it around the intestines
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|
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What are the indications for an enterectomy?
|
-removal of non-viable intestines
-removal of irreducible intussusception -removal of traumatized intestine -removal of solitary neoplasms and fungal lesions |
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What are the criteria for evaluating intestinal viability?
|
-color
-wall texture and thickness -motility -pulsation and mesenteric arteries -bleeding of mucosa when incised |
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What other methods can be used to determine intestinal viability?
|
-pulse ox (within 1cm of normal peripheral O2 saturation
-fluorescein dye (accurate in detecting non-viable bowel) |
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The standard surgical closing technique for enterectomy uses what approach?
|
End to end
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When performing the enterectomy, the mesenteric side is shorter or longer than the anti-mesenteric side?
|
Shorter
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When performing the end to end anastomosis, how do you handle the disparity in lumen size?
|
Fish mouth the smaller segment
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When closing the enterectomy, which surface is sutured first?
|
Mesenteric border
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The indications for a serosal patch include what?
|
-questionable area of suturing after enterotomy or anastomosis
-tension at suture line -damage to serosa -repair of dehiscence -Superficial trauma to intestinal wall |
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What are some of the methods of serosal patching?
|
-placement of anitmesenteric border of small intestine over suture line or organ defect
-adjacent loop of intestine sutures over damaged area -sutures engage submucosa but don't penetrate mucosa -avoid twisting, stretching or kinking the intestine and mesenteric vessels |
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What procedure was developed to prevent recurrence of intussusception?
|
Intestinal plication
small intestines placed in gentle loops and seromuscular layers are sutured with small interrupted sutures |
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When is a colopexy indicated?
|
In animals with recurrent rectal prolapse
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How long post op intestinal surgery can you offer water?
|
8-12 hours
|
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Bland food can be offered how long after intestinal surgery?
|
12-24 hours
|
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When are antibiotics indicated in intestinal surgery?
|
Not indicated unless peritonitis is present
|
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What is the cause of dehiscence in intestinal surgery?
|
-poor suturing technique, non-viable bowel, use of chromic gut, delayed healing
|
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When does dehiscence occur?
|
between 3rd and 5th day post op
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Why is dehiscence treated aggressively?
|
75% of patients die
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How can the severity of post op ileus be reduced?
|
-feeding frequent small meals
-early ambulation |
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What other post op complication might be seen in intestinal surgery cases?
|
-adhesions
-stricture |
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What condition results when more then 70-80% of the small intestine is removed?
|
Short bowel syndrome
|
|
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What are the clinical signs of short bowel syndrome?
|
-weight loss
-diarrhea -malnutrition -anemia secondary to folic acid deficiency |
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How long should supportive therapy be given in the case of short bowel syndrome?
|
1-2 months until remaining intestines adapt
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Neoplasms of the intestine are most common where in the dog?
In the cat? |
Dog: colon and rectum
Cat: small intestines |
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|
True or False
Most intestinal tumors are malignant in both dogs and cats. |
True
|
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What neoplasm is the most common in dogs?
In cats? |
Dogs: adenocarcinoma
Cats: adenomatous polyp (rectal tumor), lymphosarcoma or intestines |
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Which breeds have a higher incidence of adenocarcinoma of the intestines?
|
Boxers, Collies, GSD, Siamese
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Clinical signs/Hx of small intestine neoplasia include.....
|
-weight loss
-anorexia -depression -diarrhea -signs of obstruction, vomiting |
|
|
Clinical signs/history of large intestine neoplasia include ...
|
-tenesmus
-hematochezia -Dyschezia -Weight loss |
|
|
What might you find on a physical exam for intestinal neoplasia?
|
-palpable abdominal or rectal mass
-dilated loops or intestines -anemia -signs of peritonitis |
|
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What might be seen radiographically in a case of intestinal neoplasia?
|
-abdominal mass
-dilated intestinal loops -contrast rads- intramural or annular lesion, diffuse filling defect |
|
|
Ultrsaound might show what in a case of intestinal neoplasia?
|
Enlarged lymph nodes or hepatic masses
|
|
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When would intestinal resection and anastomosis be indicated for intestinal neoplasia?
|
In the case of a single mass with no mets present
|
|
|
Rectal polyps are resected how?
|
Submucosal resection per anus
|
|
|
Annular or more cranial tumors of the rectum are treated how?
|
-dorsal approach to rectum
-rectal pull-through approach -ventral approach to rectum |
|
|
How can rectal polyps usually be treated?
|
Manual reduction
-may need purse string sutures |
|
|
What is the prognosis of colorectal tumors?
|
Usually euthanasia because of failure to control dyschezia or hematochezia
|
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|
What acquired disease of cats is characterized by colonic dilation and ineffective transport of feces, resulting in chronic constipation?
|
Feline idiopathic megacolon
|
|
|
How can dogs get megacolon?
|
pelvic fx, poor healing blocks colon
|
|
|
The etiology is unknown but may have to due with what part of the neuro muscular system?
|
Neuromuscular junction
|
|
|
Which age are cats typically at onset?
|
Any sex, any breed any age
|
|
|
What are the clinical signs of megacolon?
|
-constipation
-depression -tenesmus -weight loss -inappetance -poor hair coat |
|
|
What procedures help to diagnose megacolon?
|
-palpation of feces filled colon
-rads to rul eout narrowing of bony pelvic canal -US, barium enema, procto to r/o sticture, pelvic mass |
|
|
How is megacolon managed medically?
|
-warm water enemas
-lubrication and digital breakdown of feces -Gen anest often required -provides only short term relief |
|
|
How is megacolon treated surgically?
|
Colectomy- removal of colon plus ileocecal valve and cecum..ileorectal end to end anastomosis
Subtotal Colectomy-removal of colon only |
|
|
Which surgical technique is not recommended?
|
Colotomy
|
|
|
Why are prophylactic antibiotics given for a colectomy?
|
High bacterial content of colon
|
|
|
Where is the location of the distal resection of the colon?
|
2-3 cm cranial to the pubis
|
|
|
What suture type is used when doing the anastomosis of a colectomy?
|
3.0 4.0 monofiliment, PDS, Nylon
non-absorbable ok |
|
|
What post op signs might you see with a colectomy?
|
-tarry feces 2-3 days
-tenesmus 5-7 days -anorexia |
|
|
What type of changes in fluid, electrolyte and vitamin absorption are seen?
|
None clinically significant...remaining bowel increases absorption
|
|
|
What is the prognosis of a cat with a colectomy?
|
Good to excellent
|
|
|
Define the term mesial.
|
Towards the lateral incisors
|
|
|
What is the term that means away from the lateral incisors>
|
Distal
|
|
|
How many teeth does the adult dog have? Cat?
|
Dog: 42
Cat: 30 |
|
|
How many roots does a dog's 2nd premolar have?
|
2 roots
|
|
|
A dog's 4th molar has how many roots?
|
3 roots
|
|
|
The pulp of the tooth is comprised of what structures?
|
Nerves, lymph, blood supply
|
|
|
Moderate periodontal disease (stage 3) show how much tooth support loss?
|
<50% at the cemento-enamel junction
|
|
|
What type of bone loss is seen with periodontal disease?
|
Horizontal bone loss
|
|
|
Using the tooth charting number system, K-9 teeth all have what number?
|
4 (104,204,304,404)
|
|
|
Using the tooth charting number system, 1st molar teeth all have what number?
|
9
|
|
|
What is a through and through furcation?
|
Periodontal disease in which the probe passes from one side to the other
|
|
|
Is gingival recession a pocketing or non-pocketing disease?
|
Non-pocketing
|
|
|
In which breed is an oro-nasal fistula common?
|
Dachshund
|
|
|
What is CUPS?
|
Canine Ulcerative Periodontal Stomatitis
|
|
|
What cauases feline stomatitis?
|
Allergic to teeth
|
|
|
What treatment is followed is a traumatized tooth has pulp exposed?
|
Root canal or extraction
|
|
|
What causes a purple tooth?
|
Pulpitis- ischemic necrosis
|
|
|
A tooth pushed to the side of the socket, with a slight socket fracture is termes what?
|
Luxation
|
|
|
What is meant by tooth avulsion?
|
Out of the socket (usually in owner's hand)
|
|
|
What term is used to describe the mandibular teeth being caudal in relation to the maxillary teeth?
|
Mandibular distoclusion
|
|
|
What term is used to describe the mandibular teeth being cranial in relation to the maxillary teeth?
|
mandibular mesoclusion
|
|
|
What is meant by dental malocclusion?
|
Jaws are ok, teeth are crooked
|
|
|
What is an epulis?
|
Abnormal, oral mass
|
|
|
Up to what age can an operculectomy be performed?
|
Before 9 months
|
|
|
When is Doxirboe used?
|
For treatment of pockets with less than 25% support loss
|
|
|
What are some of the conditions that warrant esophageal surgery?
|
-FB
-stricture -cricpharyngeal achalasia -perforation/fistula -vascular ring anomaly (PRRA) -hiatal hernia -neoplasia -intussusception |
|
|
What are the clinical signs of esophageal disease?
|
-regurgitation
-dysphagia -coughing -dyspnea -salivation |
|
|
Diagnosis of esophageal disease includes Hx and PE as well as what?
|
-edoscopy
-radiographs -US |
|
|
Compared to other organs, what layer is the esophagus missing?
|
No serosal layer
|
|
|
Which layer of the esophagus is the holding layer?
|
Submucosa
|
|
|
What is the vascular supply to the esophagus?
|
Submucosal plexus & segmented extrinsic vasculature
|
|
|
If the esophageal incision is closed in a single layer, on which surface on the knots placed?
|
Extraluminal surface
|
|
|
In a 2 layer closure of the esophagus, the first layer knots are tied where?
|
In the lumen
|
|
|
How is he surgical approach to the cervical esophagus made?
|
Ventral midline
|
|
|
What is the surgical approach to the thoracic esophagus, cranial to the heart?
|
Right lateral thoracotomy, at 3rd ,4th or 5th interspace
|
|
|
The surgical approach to the thoracic esophagus, caudal to the heart is made where?
|
Right or left lateral thorcotomy, at 10th, 11th or 12th interspace
|
|
|
How should the esophagus be handled during surgery?
|
With stay sutures
|
|
|
How could alarge bone be removed during an esopagotomy?
|
With rongeurs
|
|
|
What are the indications for performing an esophageal resection and anastomosis?
|
-sever trauma or necrosis
-stricture > 3-5 cm that is not successfully treated by bouginage -neoplasia (rare in cat and dog) |
|
|
How much of the thoracic esophagus can be resected?
|
Up to 1/3
|
|
|
Describe the tension relieving technique that may be needed on a resection and anastomosis of the esophagus.
|
Partial myotomy- cicumferential incision through longitudinal muscle layers 2-3 cm cranial and caudal to site of anastomosis
-cranial mobilization of stomach |
|
|
What structures can be used for esophageal patching m(reinforcement of esophagotomy or esophagectomy)?
|
-muscled pedicle graft (sternohyoid, sternothyroid or diaphragm)
-omentum -pericardium or gastric wall used on occasion |
|
|
How long should the patient be kept NPO post surgery?
|
24 hours to 10 days
bypass esophagus with gastrostomy |
|
|
What are the potential complication of esophageal sugery?
|
-leakage or rupture at suture line
-stricture |
|
|
What factors predispose the esophagus to rupture?
|
-lack of serosa
-pressure gradient across esophageal wall caused by changes in pleural pressure w/breathing -rapid dilation associated w/swallowing |
|
|
Clinical signs of a FB of the esophagus include what?
|
-dysphagia
-choking -coughing -regurgitation -refusal to eat -depression -pyrexia |
|
|
What are the 2 most common sites of esophageal obstruction?
|
-base of heart
-esophageal hiatus |
|
|
What diagnostics are used to r/o a FB?
|
-Hx
-clinical signs -radiography -endoscopy |
|
|
What are the 2 common FB's found in the esophagus?
|
-fish hooks
-bones |
|
|
What is the appearance of a FB on plain film radiographs?
|
-abnormal interluminal density
-esophageal distension -tracheal displacement -abnormalities of mediastinum -abnormalities of lungs fields +- pleura |
