Sx Dz Of Gi Tract

Front 1

What portion of the small intestine is most fixed

Back 1

Duodenum

Front 2

What portion of the small intestine is intimately associated with the pancreas

Back 2

Duodenum

Front 3

What portion of the small intestine extends from the pylorus to the duodenal colic ligament

Back 3

Duodenum

Front 4

What is associated with the major duodenal papilla? what about the minor?

Back 4

Major - common bile duct and pancreatic duct
Minor - Accessory pancreatic duct

Front 5

What portion of the small intestine is the largest?

Back 5

Jejunum

Front 6

What portion of the small intestine is the most mobile?

Back 6

Jejunum

Front 7

What is the smallest segment of the small intestine and between what is it located?

Back 7

Illeum
between the jejunum and the colon

Front 8

What is the blood supply to the small intestine?

Back 8

Branches of the celiac and cranial mesenteric arteries
Root of the mesentery attaches jejunum and ileum to dorsal body wall

Front 9

What is an enterotomy and what are some indications

Back 9

Incision into small intestine

foreign body removal
Biopsy for chronic GI disease such as IBD, lymphoma, lymphangetasia

Front 10

What are some indications for an intestinal biopsy

Back 10

Chronic vomiting, wt loss, hypoproteimemia, diarrhea, non diagnostic samples by less invasive biopsy

Front 11

What are some advantages and disadvantages of intestinal biopsy

Back 11

Advantage - allows access to entire GI tract, obtain full thickness biopsies, can explore abdomen

Disadvantages - expensive, invasive, cannot evaluate mucosal lesions, may take non-diagnostic samples, risk of problems with healing

Front 12

When should you perform a transfusion

Back 12

If PCV is <20%

Front 13

T/F with an intestinal biopsy you should obtain biopsies from the duodenum, jejunum, ileum +/- stomach

Back 13

True

Front 14

If you have a patient that needs surgery and has hypoproteinemia what kind of fluid should be administered?

Back 14

Give plasma or synthetic colloids

Front 15

T/F when performing intestinal surgery don't worry about the instruments you used where.

Back 15

FALSE
should keep instruments used with biopsies separate from other instruments - are considered dirty

Front 16

With IBD which portion of the SI are you most likely to get your diagnosis from?

Back 16

Ileum

Front 17

How do you perform an intestinal biopsy?

Back 17

Use fingers as clamps or doyens, occlude intestinal segment cranial and caudal to the biopsy site
Use an 11blade, make 2 parallel incisions ~1mm apart and 1 cm long
Close with 4/0 monofilament, swaged taper needle, simple interrupted suture pattern
Can close transverse if lumen size is a concern

Front 18

What are some signs of dehiscence with SI biopsy?

Back 18

Increased temperature
decreased appetite
deteriorating attitude
abdominal pain
discharge from incision
abdominal fluid
usually evident with in 3-5 days post op

Front 19

T/F you have to wait 10 days before you can pull an esophagotomy tube

Back 19

FALSE

Front 20

What are some causes of intestinal obstruction

Back 20

Intestinal FB
Intestinal Mass
Intussusception
Peritonitis - potential secondary problem

Front 21

What are some clinical signs of intestinal obstruction

Back 21

Vomiting
Diarrhea
Abdominal pain
Abdominal distention
Anorexia

Front 22

What diagnostic tests should be run if an intestinal FB is suspected?

Back 22

CBC, serum chem, plasma lactate, abdominal rads, abd us, abdominocentesis, diagnostic peritoneal lavage

Front 23

What will you see on radiographs with a SI obstruction?

Back 23

Local distention of SI
hair pin turns
Plicated intestine
Free air - if ruptured

Front 24

Should you immediately go to surgery for a patient with SI obstruction? why or why not?

Back 24

No should stabilize first
but if you see free abdominal air on rads, abdominal effusion with intracellular bacteria, or animal deteriorates despite aggressive medical therapy you should go right to surgery

Front 25

If you have a foreign body in the intestines where should you make your incision?

Back 25

Clamp cranial and caudal
Perform enterotomy in healthy tissue distal to the foreign body - all parts cranial were already affected by the FB moving and could have been damaged

Front 26

What are some good colors to see on enterotomy?
What are some bad colors to see on enterotomy?

Back 26

Bad - black, green ,gray
Good - pink, red, possibly purple

Front 27

When should you feed a patient after an enterotomy or intestinal biopsy

Back 27

feed within 12-24hrs

Front 28

what drug should be administered to patients after enterotomy or intestinal biopsy until they are eating or stop vomiting?

Back 28

Metoclopramide CRI
2mg/kg/day

Front 29

What are two places that linear foreign bodies often become tethered causing bunching of intestine?

Back 29

Underneath the tongue
Caught in the stomach

Front 30

How do you remove a linear foreign body?

Back 30

Often requires multiple enterotomy incisions, release at the most proximal part
may require resection and anastomosis

Front 31

If a linear foreign body was to cut through the piece of intestine it was in what side of the intestine would this occur at?

Back 31

Can cut through mesenteric border and compromise the blood supply

Front 32

What are some situations where you would need to do a resection and anastomosis?

Back 32

Intestinal foreign body with ischemic necrosis
Intestinal mass
Non-reducible intestinal intussusception

Front 33

What is the only kind of intestinal forcep that should be placed on healthy tissue?

Back 33

Doyens

Front 34

How do you perform a resection and anastomosis

Back 34

Exteriorize isolate affected intestinal segment, ligate blood supply, clamp proximal and distal at least 2cm beyond affected tissue, resect and close

Front 35

How do you close an anastomosis? what do you use? pattern?

Back 35

Start at the mesenteric border - divide in half and place simple interrupted sutures, 4/0 monofilament 2-3mm apart

Front 36

Why should you always start to suture at the mesenteric border for intestinal anastomosis?

Back 36

Hard to see wall in this area due to the amount of fat that can accumulate. Most surgeries that have complications are caused by a suture problem at this point

Front 37

What is the holding layer for the intestine?

Back 37

The submucosa

Front 38

how do you check if your intestinal anastomosis worked?

Back 38

Occlude cranial and caudal, use 25g needle syringe and saline, inject small amount of fluid - do not want to distend the intestine (is not natural)

Front 39

What is an omental patch used for

Back 39

If there is peritonitis in the abdomen and want to protect the incision from it can make an omental patch

Front 40

Do you have to close the rent in the mesentery after anastomosis?

Back 40

Yes!
to decrease the risk of SI entrapement

Front 41

If there is a size disparity between the resected bowel segments what should you do?

Back 41

try to make the smaller opening bigger DO NOT make the bigger opening smaller
Do this by cutting the smaller side at an angle to increase the size of the lumen

Front 42

What % of intestine can be removed?

Back 42

don't recommend removing more than 70-80% of the SI
short bowel syndrome involves diarrhea, wt loss, malnutrition, requires intense medical support wile waiting for the body to adapt if it does adapt, may take several months to see a response

Front 43

How will an intussusception present?

Back 43

With clinical signs of intestinal obstruction

Front 44

What are the most common causes of intestinal intussusception?

Back 44

Parasites
Diarrhea and vomiting
Older animals - intestinal masses

Front 45

What will you see on Ultrasound with an intussusception?

Back 45

a target sign

Front 46

What do you do surgically with an intussusception?

Back 46

Try to reduce
if not possible resection and anastomosis
Asses for viability, intestinal hypermotility and for recurrence

Front 47

How can intussusception be prevented?

Back 47

Perform a bowel plication
Suture small intestine side by side causing gentle curves, will prevent kinking and later obstruction

Front 48

What do you do post op with intussusception patients

Back 48

Treat the underlying cause if possible
-Parasites, parvovirus
Other wise treat as with other SI sx

Front 49

What breeds are typically affected by torsion of the mesenteric root?

Back 49

Uncommon
Jejunum most commonly involved
medium to large working or sporting breed dogs (german shepherds, english pointers)

Front 50

What are some clinical signs of mesenteric volvulus

Back 50

Peracute to acute
associated with obstruction and ischemia
Shock, abdominal pain and dilated loops of intestine

Front 51

How do you make a diagnosis of mesenteric volvulus?

Back 51

PE
Rads - uniform gas distended loops of bowel

Front 52

How do you treat mesenteric volvulus

Back 52

Aggressive treatment for shock
emergency surgery to derotate and decompress intestines

Front 53

What is the mortality with mesenteric volvulus?

Back 53

Almost 100%