Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
314 Cards in this Set
- Front
- Back
Define celiotomy
|
Surgical incision into the abdomen
|
|
What is the term for a flank approach to the abdominal cavity?
|
Laparotomy
|
|
Which abdominal approach is used most commonly in small animals?
|
Ventral midline
|
|
A ventral midline incision is made along what structure?
|
Linea alba
|
|
What are the benefits to incising through the linea alba?
|
-minimal bleeding
-exposure of all abdominal organs |
|
When would a paramedian incision into the abdomen be used?
|
To increase the exposure of organs on one side of the abdominal cavity
|
|
What are the drawbacks to using a paramedian approach?
|
-increased bleeding
-increased closure time |
|
Which approach would you take to expose one of the kidneys, adrenal gland and one ovary?
|
Flank approach
|
|
What are the landmarks for a flank approach?
|
Lateral incision between the last rib and tuber coxae
|
|
Which abdominal approach gives very limited exposure to the organs and is rarely used alone?
|
Paracostal approach
|
|
Combining a ventral midline approach with a paracostal would give increased visualization to organs such as what?
|
Gall bladder, liver lobes
|
|
When using a ventral midline incision on a male, what strcuture must be severed and later reattached?
|
Preputialias mm.
|
|
Combining a ventral midline with a median sternotomy opens the pleaural cavity. What does this mean for life support for the animal?
|
Assisted ventilation is required
|
|
When using a ventral midline and median sternotomy approach, what is required along with the closing of the sternum?
|
Thoracic drainage
|
|
For an exploratory celiotomy, what is the length of the ventral midline incision?
|
From xiphoid to pubis
|
|
What structure should be included in the field as a landmark?
|
Umbilicus
|
|
Which vessels run parallel to the linea alba cranial to the umbilicus?
|
Superficial epigastrics
|
|
What do you do with the falciform ligament?
|
May be displaced, removed or movd to one side
|
|
What is the holding layer of the fascia in a ventral midline approach?
|
External rectus fascia
|
|
Why is the internal rectus sheath not closed?
|
-doesn't add any strength to the closure
-may increase adhesion formation |
|
Why should suturing the rectus muscle layer be avoided?
|
-doesn't add strength
-increases inflammation |
|
How far apart are sutures placed in a ventral midline closure?
|
5-10mm apart, and incorporate 5-10mm tissue
|
|
What suture pattern is used to close the linea alba?
|
Simple interrupted
|
|
What suture material is used?
|
Monofilament absorbable or non-absorbable
Size 3/0 to 0 in dogs Size 3/0 to 4/0 in cats |
|
Which suture materials are NOT used in closing the linea alba?
|
Chromic gut or stainless steel in a continuous pattern
|
|
In which direction is a ventral midline incision closed?
|
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 |
|
How is the skin closed in a ventral midline approach?
|
3/0 to 4/0 nylon
|
|
What surgical technique is the most efficient path to a definitive diagnsosi?
|
Exploratory celiotomy & biopsy
|
|
What are some of the indications for performing a celiotomy?
|
-fluid accumulation
-non-responsive pain -organ disruption -non-responsive dystocia -abnormal discharge -content evaluation by inspection or palpation -biopsy -microbiological sampling -trauma -neoplasia |
|
How is the table positioned for an exploratory celiotomy?
|
Trendelenburg, dorsal recumbency
|
|
The celiotomy incision is made from where to where?
|
From xyphoid to pubis
|
|
After entering the peritoneal cavity, what samples are collected?
|
Samples of free fluids
|
|
How are the organs evaluated during a celiotomy?
|
Evaluate size, shape, color, location, consistency, surface
|
|
In what manner is the abdomen explored?
|
Begin cranially with the diaphragm, four quadrants, always use the same technique, use anatomical retractors
|
|
If surgical diagnosis is not possible, what is your next step?
|
Obtain multiple samples, begin therapeutic intervention
|
|
Name some techniques for obtaining a liver sample
|
-finger crushing
-ligature fracture technique (Guillotine) -instrument fragmentation -wedge resection -biopsy punch -tru-cut |
|
How is hemostasis achieved when taking a liver biopsy sample?
|
Surigcel, Spongostan, or omentum
|
|
The ligature fracture technique is limited to which portion of the liver?
|
Hepatic lobe
|
|
When obtaining a biopsy sample of the intestines, how much of a full thickness sample be taken?
|
Not to exceed 20% of the intestinal circumference
|
|
How is the intestinal biopsy site closed?
|
Single layer closure, apposition
|
|
What surgical biopsy techniques are used for obtaining samples of lymph nodes?
|
-FNA
-wedge -excisional |
|
Why is the excisional technique of lymph node biopsy preferred to the FNA technique?
|
Provides morphologic data
|
|
A surgical needle aspiration bx of the kidney is performed in what direction?
|
Caudal to cranial parallel to the cortex
|
|
What complication can be encountered when performing a wedge resection bx of the kidney?
|
Hemorrhage
|
|
To visualize and biopsy the prostate gland, what organ must be exteriorized?
|
Bladder
|
|
What can you do to avoid penetrating the ureter when taking a bx of the prostate gland?
|
Catheterize it to visualize it
|
|
After taking a bx of the urinary bladder and suturing the layers closed, what must you do next?
|
Water test
|
|
What types of therapeutic intervention could you possibly perform during an exploratory?
|
-surgical correction of lesions
-control bleeders -correct source of contamination -correct source of pain -mass removal -correct intestinal obstruction -elimination of abnormal accumulations |
|
Before any surgical intervention can be performed, the surgeon must do what?
|
Plan before the intervention
|
|
What step is performed immediately prior to abdominal closure?
|
Abdominal lavage
|
|
How much lavage fluid is used?
|
Until clear fluid is seen
|
|
What does lavage achieve?
|
-removal of contaminants
-patient warming -isotonic fluid |
|
How is the celiotomy incision closed?
|
Only the external abdominal fascia is closed, avoid the rectus muscle
|
|
What are some of the surgical disorders of the stomach requiring surgery?
|
-foreign body
-pyloric stenosis/hypertrophy -neoplasia -hiatal hernia |
|
What is one of the most common gastric foreign bodies?
|
A bone
|
|
What is a common history for a gastric f.b.?
|
Owners sees animal ingest object or toy or object is missing
|
|
In which species are gastric f.b. more common?
|
Young dogs
|
|
What are the clinical signs of a gastric f.b?
|
-abdominal pain
-vomiting -anorexia/ weight loss |
|
What clinical signs are seen if the f.b. lodges in the pyloric antrum and obstructs the outflow tract?
|
Vomiting- leads to dehydration
Loss of hydrogen and chloride ions leads to metabolic alkalosis and hypochloremia |
|
Infrequently, mucosal erosion, ulceration or necrosis from a b.f. may produce what clinical sign?
|
Melena, hematemesis
|
|
Radiography of a gastric f.b. may require the need for what agent?
|
Contrast
|
|
What other diagnostics are needed in the case of a gastric f.b.?
|
-US
-endoscopy -lab data (metabolic alkalosis, hypochloremia, hypokalemia) |
|
What is the first step in the treatment of a gastric f.b.?
|
Correction of electrolyte ,water and acid-base imbalances
Then removal. |
|
What types of f.b. can be removed by endoscopy?
|
Small, light-weight, soft material
|
|
What is the prognosis for a gastric f.b. case?
|
Excellent in most cases
|
|
What is pyloric hypertrophy/stenosis?
|
Abnormal narrowing of the lumen of the pylorus, causing partial obstruction
|
|
What is the etiology of pyloric hypertrophy/stenosis?
|
Unknown
|
|
The congenital form of pyloric stenosis includes what layer of the pylorus?
|
Muscular layer
|
|
The acquired form of pyloric stensosis is defined as what type?
|
Hypertrophy of muscosal or muscular layer of pylorus and sometimes antrum
|
|
When does pyloric stenosis manifest in puppies?
|
Following ingestion of solid food, at weaning
|
|
What other history might the owner provide?
|
May have ravenous appetite
|
|
What information is needed to make a clinical diagnosis of pyloric stenosis?
|
-hx and signalment, esp age at onset
-clinical signs -lab data -rads |
|
Which breeds have a higher incidence of pyloric stenosis?
|
-brachcephalic dogs
-siamese cats |
|
What other clinical signs might be seen with congenital pyloric stenosis?
|
-emaciation, stunted growth
-dehydration -occasionally fever and increased lung sounds secondary to aspiration of vomitus |
|
What would you expect to see on radiographs of a case of congenital pyloric stenosis?
|
Plain rads: enlarged stomach filled with fluids and food
Contrast: delayed gastric emptying, presence of barium in the stomach 8-12 hours is abnormal |
|
What lab results indicating congenital pyloric stenosis would you expect?
|
Malnutrition: hypoproteinemia, anemia, low BUN, hypoglycemia
-dehydration, hypochloremic metabolic alkalosis -eleveated WBC count if aspiration pneumonia occurs |
|
What difference in the history might be given with acquired pyloric hypertrophy/stenosis?
|
Intermittent vomiting, not always associated with feeding, increases in frequency over months
-weight loss -occasionally anemia, depression, decreased activity |
|
Acquired pyloric stenosis/hypertrophy is common in which breeds?
|
Middle aged, excitable small breeds, esp, Lhasa apso and Shih-tzu
rare in cats |
|
Radiographically, what would you see in a case of acquired pyloric hypertrophy/stenosis?
|
Filling defect in pylorus
|
|
What surgical techniques are used to correct pyloric stenosis?
|
-pyloromyotomy
-pyloroplasties -gastroduodenostomy/gastrojejunostomy |
|
Name the 3 common surgical procedures used for correcting pyloric hypertrophy/stenosis.
|
-Fredet-Ramstedt pyloromyotomy
-heinke-Mikulicz pylroplasty -Y-U antral advancement flap pyloroplasty |
|
What radical surgical may be used for pyloric hypretrophy/stenosis?
|
Bilroth I gastroduodenostomy
|
|
What is the indication for using the
Fredet-Ramstedt pyloromyotomy procedure? |
Congenital pyloric stenosis
|
|
What is the goal of the pyloromyotomy technique?
|
To incise the seromuscular layer and allow the mucosa to bulge into the incision and expand the pylorus
|
|
Where is the pyloromyotomy incision made?
|
Partial thickness longitudinal incision from antrum to duodenum across pylorus.
|
|
What are the advantages of using the Fredet-Ramstedt pyloromyotomy technique?
|
-quick and easy to perform
-lumen of pylorus not opened |
|
What are the disadvantages of using the Fredet-Ramstedt pyloromyotomy technique?
|
-effective ONLY in congenital stenosis
-effect may be temporary, stenosis my recur as seromuscular incision heals |
|
What are the indications for using the Heineke-Milkulicz pyloroplasty technique?
|
Congenital or acquired pyloric hypertrophy/stenosis, biopsy
|
|
How is the Heineke-Milkulicz pyloroplasty performed?
|
A full thickness longitudinal incision crosses the ventral surface of the pylorus. The incision is closed transversely in 1 layer of simple interrupted sutures
|
|
What are the advantages of the
Heineke-Milkulicz pyloroplasty ? |
-exposure of muscosa for biospy
-less likelyhood of recurrance than pyloromyotomy |
|
What are the disadvanatges of the Heineke-Milkulicz pyloroplasty ?
|
-lumen is opened
-not usually effective with acquired pyloric hypertrophy |
|
What are the indications for using the Y-U pyloroplasty technique?
|
For acquired pyloric hypertrophy, resection of mucosa/submucosa
|
|
What is the surgical approach of the Y-U pyloroplasty?
|
-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 |
|
What are the advantages of the Y-U pyloroplasty?
|
-good exposure of mucosa
-redundant mucosa/submucosa can be resected (2 layer closure) -greater expansion of the pylorus |
|
What are the disadvantages of the Y-U pyloroplasty?
|
-lumen is opened
-more lengthy procedure |
|
Which surgical procedure to correct pyloric hypertrophy/stenosis is no longer performed?
|
Billlroth I
Pylorectomy & Gastroduodenostomy |
|
Which type of gastric neoplasia occurs (rare) in older dogs as a large, pedunculated mass?
|
Benign adenoma, adematous polyp
|
|
Leiomyosarcomas occur in dogs of what age?
|
very old dogs...15 years.
|
|
What is the most common gastric cancer found in dogs?
|
Adenocarcinoma
|
|
What is the average age of a dog with adenocarcinoma?
|
8 years
|
|
Which sex has the higher prevalence of adenocarcinoma?
|
males (2.5:1)
|
|
What is the most common gastric tumor found in cats?
|
Lymphosarcoma
|
|
Clinical signs of gastric neoplasia include what?
|
-hematemesis
-abdominal pain -anemia -melena -signs of pyloric obstruction -icterus |
|
Contrast radiology or ultrasound may demonstrate a gastric malignant neoplasia usually located where?
|
On the lesser curvature or pyloric antrum
|
|
Benign neoplasia are seen as what?
|
Pedunculated/circumscribed
|
|
Radiographically, a tumor in the pyloric antrum will have what appearance (with contrast)?
|
Apple core- filling defect
|
|
Tumors in this area may cause icterus due to what?
|
Obstruction of biliary outflow
|
|
Differential diagnoses for gastric neoplasia can include what?
|
-pyloric hypertrophy
-Pythiosis |
|
Where is pythiosis most common?
|
Gulf states- hunting dogs
|
|
What are the primary sites of metastisis of adenocarcinoma?
|
-regional lymph nodes
-liver -lung |
|
Other site of adeoncarcinoma metastesis include what?
|
-omentum
-peritoneal surface -diaphragm |
|
When describing the appearance of an adenocarcinoma, what does the term scirrhous mean?
|
Firm and white on serosal surface
|
|
An adenocarcinoma may also appear expansile with a central crater and ulceration on the muscosal surface. This appearance is termed what?
|
Infiltrative (cobblestone)
|
|
What surgical procedures may be indicated for treatment of gastric neoplasia?
|
-partial gastrectomy
(Billroth I or II) |
|
What additional procedure might be required with pyloric tumors?
|
Cholecystoenterostomy
|
|
Indications for a partial gastrectomy include....
|
-neoplasia
-ischemic injury (GDV) -penetrating injury (ulcer or trauma) |
|
Ischemic injury to the stomach usually occurs where?
|
At the greater curvature
|
|
Which surgical procedure is used when ischemic injury involves both curvatures?
|
Not suitable for surgery
|
|
With the incisional technique of partial gastrectomy, which vessels to the affected area are ligated?
|
Gastroepiploic
|
|
What other technique can be used for performing a partial gastrectomy?
|
TA stapler technique
|
|
The Billroth II pylorectomy & gastrojejunostomy is indicated for which conditions?
|
-neoplasia
-necrosis of pylorus or antral region of stomach |
|
With the Billroth II technique, the stomach is side to side anastomosed with what organ?
|
Loop of proximal jejunum
|
|
What are the advantages to using Billroth II?
|
-abnormal tissue is removed
-compared to Billroth I, reduces tension on suture line when extensive resection is required |
|
What are the disadvantages of Billroth II?
|
-difficult, lengthy procedure
-marginal ulceration od jejunal limb from exposure to gastric fluid |
|
Do adenocarcinoma and gastric lymposarcoma respond well to chemotherapy?
|
No
|
|
Why isn't radiation therapy used for these cancers?
|
Sensitivity of surrounding tissues
|
|
What is the prognosis for excision of a adenoma?
|
Curative
|
|
What is the survival time for a pt. with leiomyoma/leiomyosarcoma?
|
1 year
|
|
What is the survival rate of gastic adenocarcinoma?
|
6 months (surgery is palliative)
|
|
What is the definition of a hiatal hernia?
|
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
|
|
What are the possible etiologies of a hiatal hernia?
|
-usually congenital, associated with abnormalities of hiatus, esp phrenicoesophageal ligament
-possibly traumatic -maybe associated with upper airway obstruction |
|
Which breeds (usually males) are pre-disposed to hiatal hernia?
|
Shar-pei, Bulldog
|
|
History for a hiatal hernia may be asymptomatic, or might include what clinical signs?
|
-regurgitation, vomiting, dysphagia
-hematemesis -anorexia, weight loss |
|
What diagnostic procedures can be used to confirm a hiatal hernia?
|
-radiography/fluoroscopy
-endoscopy |
|
What are the surgical treatments of hiatal hernia in symptomatic patients?
|
-gastropexy. left sided fundus to body wall
-hiatal reduction and esophagopexy -gastrostomy tube -Nissen fundoplication (only is reflux and esophagitis are present |
|
When performing a gastrotomy, how is the stomach elevated to the cranial midline position?
|
Stay sutures, or Babcock forceps
|
|
Once the stomach is packed off with lap sponges, a stab incision (for the gastrotomy) is made where?
|
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
|
|
With which instrument is the gastrotomy incision lengthened?
|
Metzenbaum scissors
|
|
How is the gastrotomy incision closed?
|
- two inverting layers (Conell followed by Cushing or Lembert
-Simple continuous in mucosa/submucosa, followed by Cushing or Lembert |
|
What type of suture material is used in closing the gastrotomy?
|
Absorbable
|
|
Post op, the gastrotomy patient should remain NPO for how long?
|
12-24 hours, offer small amount of water at 12-24 hours
|
|
How is GDV characterized?
|
Accumulation of gas in the stomach and malpositioning of the stomach with obstruction of eructation and pyloric outflow
|
|
Which breeds are prone to GDV?
|
GSD
Doberman |
|
GDV is considered a clinical-surgical emergency. Why isn't the saphenous vein a good location for giving fluids?
|
Return to heart can be slowed or blocked to fluids coming caudal areas
|
|
What are the clinical signs of GDV?
|
-cranial abdominal distension
-anxious face -tachypnea -tympanic abdomen -MM ingurgitated, pale -splenomegaly/altered position -altered cardiac and respiratory parameters |
|
Even with treatment, death from GDV can be as high as what?
|
25-30%
|
|
What is gastric torsion?
|
When the stomach twists abruptly on the long axis
|
|
Why can this stage of GDV be overlooked?
|
No complete closure of the GE junction
|
|
What is the definition of gastric volvulus?
|
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 |
|
Clockwise rotation can be as far as how much?
Counter clockwise? |
CW: 180-270 degrees
CCW: 90 degrees |
|
Volvulus is a twist along the long axis greater than....
|
180 degrees
|
|
When do most GDV's occur?
|
Night time
|
|
By what 3 mehtods can gastric decompression be attempted?
|
-orogastric intubation
-ganstrocentesis -gastrostomy |
|
Patient at risk with GDV show what clinical signs?
|
-dyspnea with abdominal component
-debilitated -decreased consciousness -decreased HR -increased RR, reduction -back coat "erection" |
|
What is the appearance of GDV on radiographs?
|
Double bubble, compartmentilization
|
|
What are the 3 objectives to the surgical correction of GDV?
|
-reposition the stomach
-assess severity of ischemia and resect any devitilized tissue -perform a permanent gastropexy to prevent recurrence |
|
If repositioning the stomach is correct, where should the pylorus be?
|
On the right, GE junction should not be twisted
|
|
How is the stomach assessed in terms of viable tissue?
|
By color, presence of pulsating vessels, peristalsis and bleeding from cut surface
-palpate thickness of wall (devitilized areas are thinner |
|
In performing a tube gastropexy, the tube incision is placed where?
|
Behind last rib, lateral to nipple line, must not obstruct pylorus
|
|
When is the tube removed?
|
5-7 days
|
|
What is the advantage to using the tube gastropexy?
|
-can continue to decompress
-easy access to feeding and meds |
|
Which layer of tissue is incised for the incisional gastropexy?
|
Seromuscularis only
|
|
Which pexy technique is the strongest?
|
Circumcostal
|
|
Briefly, how is the circumcostal pexy performed?
|
Flap is made and passed around a rib, sutured back into place
|
|
The belt loop gastropexy is similar to the circumcostal, but passes around what structure?
|
The transversus abdominis
|
|
A prophylactic gastropexy can be performed by what method?
|
Laporoscope
|
|
What is the recurrence of GDV in patients that have had gastropexy?
|
Less than 6.9%
|
|
Post op care includes enteral nutrition that includes glutamine....why?
|
To maintain intestinal surface
|
|
How often should a post GDV dog be feed?
|
Several small meals in a day, high protein
|
|
If gastropexy is not performed, how likely is it that GDV will reoccur?
|
75-80% chance
|
|
What are the indications for surgery of the small intestines?
|
-obstruction
-perforation -diagnosis (bx) |
|
Intestinal obstruction can be caused by what?
|
-F.B.
-intussusception -ileus -neoplasia -pythosis -trauma -mesenteric torsion -herniation |
|
Severity of signs of intestinal obstruction are dependent on what?
|
-completeness (complete or partial)
-location (high vs low) -blood supply (strangulated vs non-stangulated) |
|
More severe clinical signs are seen in which type of obstruction?
|
Complete, high and strangulated
|
|
Linear f.b. are more common in which species?
|
Cats
|
|
Which type of intestinal obstruction is more common in young dogs?
|
Intussusception
|
|
Mesenteric torsion is seen in adult dogs, esp which breed?
|
GSD
|
|
Neoplasia of the small intestine is usually seen in which age/species?
|
Older dogs and cats
|
|
Intestinal obstruction can lead to infarction in what time frame?
|
8 hours
|
|
Intestinal necrosis can lead to what disastrous condition?
|
Perforation
|
|
Without treatment, death from a small intestine obstruction can occur in 3-4 days due to what?
|
Hypovolemia
|
|
Gross necrosis of the intestine, from hypoxia, is evident in what timeframe?
|
20 hrs
|
|
A pyloric/proximal duodenal obstruction can lead to metabolic alkalosis or acidosis?
|
Alkalosis from vomiting
|
|
A mid-duodenal to ileal obstruction could lead to a metabolic alkalosis or acidosis?
|
Acidosis from diarrhea
|
|
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) |
|
What is a strangulating obstruction?
|
Occlusion of the blood supply
|
|
Strangulation can lead to what complications in the bowel?
|
-bacterial overgrowth
-increased bowel permeability -perforation and escape of bowel contents -peritonitis |
|
What are the causes of strangulating obstructions?
|
-intussusception
-mesenteric torsion -strangulated hernias -some f.b. obstructions -abhesions/bands |
|
Clinical signs of intestinal obstruction include what?
|
-vomiting
-dehydration, electrolyte imbalance, acid base abnormalities -abdominal pain -distended loops of intestine -palpable abdominal mass |
|
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 |
|
What happens to F.B. that pass into the colon?
|
Usually pass out with feces
|
|
Linear F.B.'s in cats are often anchored where?
|
Under the tongue (needle and thread)
|
|
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 |
|
What procedure(s) may be required to remove a linear F.B.?
|
Multiple enterotomies
|
|
What is the term for the segment of intestinf that telescopes into another segment in an intussuception?
|
Intussusceptum
(adjacent segment is intussuscipiens) |
|
Intussusception is more common in puppies and is associated with what condition of the gut?
|
Hypermotility
|
|
Intussusception can progress to what other grave conditions?
|
-venous occlusion may progress to perforation and peritonitis
|
|
What clinical signs are seen in a case of intussusception?
|
-bloody diarrhea may accompany vomiting and abdominal pain
|
|
If the intussusception can be manually corrected, what do you do next?
|
Wait to see if it occurs again
|
|
If the intussusception cant be reduced, what approach do you take?
|
Resection and anastomosis
|
|
In which adult male dog breeds does mesenteric torsion occur more often?
|
GSD, Pointers
|
|
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 |
|
What clinical signs might be seen with mesenteric torsion?
|
-acute pain
-shock -mild abd enlargement -depression -recumbency -nausea, retching, vomiting -hematochezia |
|
The differential diagnsoses of mesenteric torsion include what?
|
-GDV
-acute splenic torsion -enteritis -Gi obstruction -ileus -trauma -peritonitis |
|
Radiographically, what would be seen in a case of mesenteric torsion?
|
Entire small intestines distended with gas
|
|
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 |
|
Mortality in cases of mesenteric torsion can be how high?
|
Up to 100%
|
|
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 |
|
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 |
|
Where should the enterotomy incision be made?
|
In healthy tissue, usually distal to F.B.
|
|
How should the enterotomy be closed?
|
Simple continuous or simple interrupted, sutures 2-3mm from edge of tissue, 2-3 mm apart
|
|
After the lumen is closed, how do you check for leaks?
|
Inject saline
|
|
After the completion of closing the intesttines what do you do with the omentum?
|
Wrap it around the intestines
|
|
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 |
|
What are the criteria for evaluating intestinal viability?
|
-color
-wall texture and thickness -motility -pulsation and mesenteric arteries -bleeding of mucosa when incised |
|
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) |
|
The standard surgical closing technique for enterectomy uses what approach?
|
End to end
|
|
When performing the enterectomy, the mesenteric side is shorter or longer than the anti-mesenteric side?
|
Shorter
|
|
When performing the end to end anastomosis, how do you handle the disparity in lumen size?
|
Fish mouth the smaller segment
|
|
When closing the enterectomy, which surface is sutured first?
|
Mesenteric border
|
|
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 |
|
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 |
|
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 |
|
When is a colopexy indicated?
|
In animals with recurrent rectal prolapse
|
|
How long post op intestinal surgery can you offer water?
|
8-12 hours
|
|
Bland food can be offered how long after intestinal surgery?
|
12-24 hours
|
|
When are antibiotics indicated in intestinal surgery?
|
Not indicated unless peritonitis is present
|
|
What is the cause of dehiscence in intestinal surgery?
|
-poor suturing technique, non-viable bowel, use of chromic gut, delayed healing
|
|
When does dehiscence occur?
|
between 3rd and 5th day post op
|
|
Why is dehiscence treated aggressively?
|
75% of patients die
|
|
How can the severity of post op ileus be reduced?
|
-feeding frequent small meals
-early ambulation |
|
What other post op complication might be seen in intestinal surgery cases?
|
-adhesions
-stricture |
|
What condition results when more then 70-80% of the small intestine is removed?
|
Short bowel syndrome
|
|
What are the clinical signs of short bowel syndrome?
|
-weight loss
-diarrhea -malnutrition -anemia secondary to folic acid deficiency |
|
How long should supportive therapy be given in the case of short bowel syndrome?
|
1-2 months until remaining intestines adapt
|
|
Neoplasms of the intestine are most common where in the dog?
In the cat? |
Dog: colon and rectum
Cat: small intestines |
|
True or False
Most intestinal tumors are malignant in both dogs and cats. |
True
|
|
What neoplasm is the most common in dogs?
In cats? |
Dogs: adenocarcinoma
Cats: adenomatous polyp (rectal tumor), lymphosarcoma or intestines |
|
Which breeds have a higher incidence of adenocarcinoma of the intestines?
|
Boxers, Collies, GSD, Siamese
|
|
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 |
|
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
|
|
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
|
|
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 |