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48 Cards in this Set
- Front
- Back
What is included in the pre-op work-up of an animal with stomach problems? (4)
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1) Complete history and PE
2) Minimum database (CBC/ chem/ UA) -electrolytes, acid/base status 3) Abdominal imaging, Rads, aus, CT/MRI 4) Further testing based on initial results |
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What are the 4 general principles to operating on stomach/ GDV cases?
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1) Stabilize patient pre-op
-dehydrated? anemic? 2) Peri-op antibiotics -cefazolin 3) Post-op antibiotics only if indicated (continued source of contamination, gross spillage of ingesta etc.)-do culture! 4) Don't contaminate peritoneum |
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What are 4 ways to prevent contamination of peritoneum during abdominal surgery/ GDV repair?
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1) Stay sutures
2) Lap sponges 3) Lavage 4) Separate instruments |
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Why is it so important to empty out the fluids used for lavage during abdominal surgery?
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Neutrophils can't swim
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What are 4 ways to assess the integrity of the GI tract?
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1) Pink
2) Peristalsis 3) Palpation -thick & edematous= not normal= biopsy -thin=necrotic=perforates 4) Perfusion -can you see pulsation? |
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What type of closure is used in the stomach? (include suture pattern)
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Two layer closure
-simple continuous oversewn with inverting suture (lembert, cushing) |
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Where and how do you want to make your incision to remove a gastric foreign body?
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-Gastrotomy in hypovascular area (pick area w/ less vessels)
-Stab with scalpel and extend w/ metzenbaums |
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What are the 2 layers the stomach separates into?
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Serosal muscularis and mucosa/submucosa
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Is a physical cause of a gastric ulceration very common? What are some examples?
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No, they are very rare and ulceration only results if there's sustained significant trauma
-FB, implants |
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What are 6 examples of more common causes of gastric ulceration?
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1) NSAIDs
2) steroids 3) shock 4) Helicobacter -controversial 5) gastrinomas 6) Mast cell tumor |
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Compare the physical damage that results from a full VS partial thickness gastric ulceration?
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-Full thickness--> expect septic peritonitis & ill patient
-Partial thickness--> anemia due to chronic blood loss (usually treat w/ medical management) |
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What is the treatment for a gastric ulceration that is too severe to treat with proper medical management?
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Partial gastrectomy
-just cut around ulcer and sew together |
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What should always be on your mind when you see a penumoperitoneum on an X-ray? What diagnostic should you perform?
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GI perforation
-Can tap the belly w/ 22g needle and if get gastric contents= diagnosis |
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What are the 4 most common types of neoplasia in the stomach******?
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1) Adenocarcinoma
2) Lymphoma 3) Leiomyo(sarco)ma or fibrosarcoma 4) Mast cell tumors (less likely) |
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*What is the most common type of neoplasia in the canine stomach? Cats?
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Adenocarcinoma= dogs
Lymphoma= cats |
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What do you need to make sure to differentiate a gastric leiomyosarcoma from?
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GIST (gastric interstitial stromal tumor) because look very similar
-can use a stain to differentiate |
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*What is a biliroth 1 procedure?
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a gastroenterostomy with no biliary re-routing (cholecystoenterostomy)
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What is a biliroth II?
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Gastroenterostomy with biliary re-
routing -much more extensive resection -high morbidity & mortality *scares even good surgeon= refer |
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What breeds of dogs most commonly get gastric dilation & volvulus (GDV)?
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Deep chested, large breed dogs
Others: Shar pei, bassets, cocker spaniels |
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What age of dogs are most affected by gastric dilation & volvulus?
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Middled aged dogs (4,5,6+)
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What are 7 common findings in the history of a dog with a GDV?
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1) restlessness
2) retching 3) Non-productive vomiting 4) Hypersalivation 5) Distended abdomen 6) Weakness 7) collapse *history= highly variable, anything from wagging tail to dead |
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What do you normally find on a physical exam of a dog with GDV? (several possibilities..)
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-may be normal (abdomen may not be THAT distended, femoral pulses may be ok, may even be wagging tail)
-collapsed, in shock or dead -or anywhere in b/w |
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What are the 4 standard clinicopathologic diagnostics used when you suspect a GDV?
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1) Right lateral abdominal radiograph
-should also obtain an orthogonal view (VD) 2) CBC/ chem 3) Coagulation profile 5) BP & EKG -consider 3 view thoracic rads |
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What do you see on a radiograph of a dog with GDV?
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Backwards smurf
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Why does the stomach get bruising (discoloration) when they have a GDV?
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Because there are a bunch of vessels that are connected to the stomach and spleen and these tear---> spleen becomes hypovascular, thrombosis
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What are the 4 primary ways that a GDV effects the body?
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1) Thoracic and diaphragm impingement
-everything is distended--> decreased tidal flow --> V/Q mismatch 2) Decreased blood flow through caudal vena cava and portal vein (--> decreased CO) 3) Gastric ischemia --> perforation--> peritonitis 4) Intestinal ileus, atony --> fluid sequestration & electrolyte imbalance |
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What treatment should be done pre-op in a serious GDV case?
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Stabilization--> IV CRYSTALLOIDS AND COLLOIDS
-antibiotics? -anti-arrhythmics? -analgesia/ premeds |
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What is the shock dose of crystalloids? Colloids?
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Crystalloids: 60-90 mL/kg
Colloids: 20-30 mL/kg |
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Either before or after you open up the abdomen, what do you do need to do before entering the stomach?
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Decompress the stomach
-either use a needle or stomach tubing to release air |
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What are the 3 main steps to surgically treating a GDV?
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1) Gastric repositioning
2) Evaluate abdominal viscera -if indicated perform splenectomy -if indicated, perform partial gastrectomy *when stomach twists it cuts off blood supply to spleen and stomach 3) Perform right sided gastropexy |
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If you pass a stomach tube before operating on a GDV patient, then the stomach is in the right position, should you still perform a gastropexy?
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YES!
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**When surgically treating a GD you should maintain vigilant monitoring of what?
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Response to treatment and adjust fluid therapy as needed by monitoring BP and EKG monitoring are essential
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What should you think if you open up the abdomen and all you see is a bunch of omentum?
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Omentum should not be covering stomach, think of GDV bc stomach twisted
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How is repositioning of the stomach performed in most cases of gastric dilation & volvulus?
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Standing on the dog's right side and:
-pushing the fundus (which is nearest to you) dorsally and to the dog's left -Pulling the pylorus (which is away from you, near the dog's left side) ventrally and towards you -use a gentle but confident application of force -often helpful if stomach is decompressed |
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How do you verify that you have correct positioning of the stomach after repositioning in cases of GDV?
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By carefully palpating the esophageal hiatus
-some may have experienced a counter clockwise volvulus |
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When should you perform a splenectomy during repair of a GDV?
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If spleen is thrombosed or vascularly devitalized
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When should a partial gastrectomy performed during a GDV repair?
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If stomach wall palpates thin, is excessively dark/black/ or white/grey = partial gastrectomy
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Why doesn't Dr. Milovancev recommend a gastric invagination instead of a partial gastrectomy?
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bc associated with chronic recurrent bleeding gastric ulcers and clinical anemia
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What is the most common method of performing a right sided gastropexy?
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Incisional
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Should you avoid when performing an incisional ride sided gastropexy?
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White fat line bc can cut into diaphragm
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How do you perform an incisional right sided gastropexy?
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Make incision through transverse abdominis and suture the serosa muscularis to the transverse abdominis muscle
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What treatments should be occurring during the continuum of care from pre-op to intra-op to post-op in a GDV patient?
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Aggressive volume expansio
-crystalloids at 90 ml/kg/day -Hetastarch 30 ml/kg/day -+/- plasma or other blood products |
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What type of monitoring needs to be performed post-op for a GDV patient?
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-EKG, BP, emesis
-Bloodwork and lytes -consider coags (DIC) |
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What analgesics should be used post-op in a GDV patient?
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Opioids
-AVOID NSAIDS |
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What medication other than analgesics should be considered for a GDV patient post-op?
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-Gastroprotectants (sucralfate +/- famotidine and/or omeprazole)
-antibiotics if suspect risk of bacterial translocation (if perforation otherwise not worth it bc causes vomiting) -anti-emetics |
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What should be your post-op suggestions for feeding a post-op patient?
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Encourage small frequent meals as soon as they can tolerate it
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What is the prognosis for GDV?
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Guarded to fair
-~30% mortality |
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What are 4 considerations of performing a prophylactic gastropexy?
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1) Previous episode of GD?
-likelihood of GDV after episode is ~85% 2) Familial history of GDV? 3) At risk breed? 4) Working/ valuable dog? |