6 - Small Intestines

Question 1

How long is the intestinal length in dogs compared to their body length?

Answer 1

5x body length

Question 2

What vessels supply the intestines? What drains them?

Answer 2

Celiac artery, cranial and caudal mesenteric arteries;

Drained by portal vein

Question 3

What is the holding layer of the intestines?

Answer 3

submucosa

Question 4

What 3 things does optimal healing of the intestines require?

Answer 4

1. Good blood supply
2. Accurate mucosal apposition
3. Minimal surgical trauma

Question 5

Risk of intestinal dehiscence increases with what 5 factors?

Answer 5

1. Hypovolemia
2. Hypoproteinemia
3. Debilitation
4. Concurrent infection
5. Corticosteroids and NSAIDs

Question 6

What are the 3 phases of intestinal healing and at what days do they occur?

Answer 6

Lag = day 0-4

Proliferative = day 3-14

Maturation = day 10-180

Question 7

In what healing phase is dehiscence most likely?

Answer 7

lag

Question 8

_____ deposition begins in the lag phase.

Answer 8

Collagen

Question 9

In what healing stage does fibrous repair occur?

Answer 9

proliferative

Question 10

Normal strength is regained in the _____ phase of healing, by day _____.

Answer 10

proliferative, 10-17

Question 11

What occurs in the maturation stage of healing?

Answer 11

Collagen reorganizes and remodels

Question 12

What are the 4 indications for intestinal surgery and what is the most common?

Answer 12

1. Obstruction = most common (foreign body)
2. Disruption (blunt/penetrating trauma)
3. Diagnostic procedure (biopsy, culture)
4. Supportive procedure (feeding tube)

Question 13

What should be done first in intestinal surgery?

Answer 13

Isolate intestine and pack off

Question 14

How many layers of the intestine should be involved in closure?

Answer 14

1

Question 15

What layer of the intestine should be engaged in closure?

Answer 15

submucosa

Question 16

What suture patterns should be used in intestinal surgery?

Answer 16

Appositional: simple interrupted and simple continuous

Question 17

What suture material should be used in intestinal surgery?

Answer 17

Monofilament absorbable (Monocryl, PDS, Maxon)

Question 18

How many lavages should be done in intestinal surgery?

Answer 18

Local lavage –> change gloves and instruments –> lavage again (entire abdomen this time)

Question 19

What is an enterotomy?

Answer 19

Incision into the intestinal lumen

Question 20

What is an enterectomy?

Answer 20

Removal of a segment of the intestine

Question 21

What is an intestinal resection and anastomosis?

Answer 21

Enterectomy & reestablished continuity between ends

Question 22

What are 4 ways with which luminal disparity can be dealt?

Answer 22

1. Sutures on larger lumen side spaced farther apart than smaller side
2. Smaller lumen transected at an angle
3. Smaller lumen spatulated
4. Stapler

Question 23

What should always be done to supplement the surgical site/facilitate healing? What else can be done?

Answer 23

Always = omental patching

Can also do = sersal patching for severe serosal/muscularis damage when R&A is not an option

Question 24

How does omental patching help healing?

Answer 24

Helps seal and contributes blood supply

Question 25

When should barium not be used for a GI series?

Answer 25

If perforation is expected

Question 26

How should peritonitis be documented?

Answer 26

Abdominocentesis, peritoneal lavage, exploration

Question 27

What is the benefit of holding off food for intestinal surgery?

Answer 27

It decreases bacterial #s in the stomach and small intestine

Question 28

When would antibiotics be indicated with intestinal surgery?

Answer 28

With bloody diarrhea, fever, leukocytosis, lekopenia, gross spillage, shock

Question 29

What conditions call for emergency intestinal surgery?

Answer 29

Perforation, strangulation, complete obstruction

Question 30

What 6 things increase risk for leakage?

Answer 30

1. Preop peritonitis 2. Hypotension 3. Hypoalbuminemia 4. Blood product transfusion 5. Delayed postop enteral feeding 6. Systemic disease that impairs healing.collagen production

Question 31

Dilatation occurs _____ to an obstruction.

Answer 31

proximal

Question 32

What are the 6 steps to an enterotomy or enterectomy?

Answer 32

1. Pack off/exteriorize bowel segment 2. Incise thru healthy tissue distal to the object for removal 3. Assess bowel viability after removal of object 4. Resect devitalized intestine and anastomosis if necessary 5. Lavage thoroughly 6. Place omentum or create a serosal patch at the site

Question 33

At what age are animals most likely to have intussusception?

Answer 33

young

Question 34

Intussusception is associated with _____ or _____ issues.

Answer 34

enteritis, dysmotility

Question 35

What can intussusception lead to?

Answer 35

Partial to complete obstruction

Question 36

The clinical course of intususcception may span several \_\_\_\_\_.

Answer 36

weeks

Question 37

What is the intussuceptum?

Answer 37

The invaginated portion

Question 38

What is the intussucipiens?

Answer 38

The recipient of the intussusception

Question 39

Most neoplasms of the intestines are \_\_\_\_\_.

Answer 39

malignant

Question 40

Where are dog adenocarcinomas usually found in the intestines?

Answer 40

duodenum and colon

Question 41

Where are cat adenocarcinomas usually found in the intestines?

Answer 41

jejunum and ileum

Question 42

What are the 3 types of neoplasia commonly found in the intestines?

Answer 42

Adenocarcinoma, Lymphosarcoma, Leiomyosarcoma

Question 43

\_\_\_\_\_ or _____ mechanical obstruction can result from intestinal neoplasia.

Answer 43

Intramural, intraluminal

Question 44

How big should margins be for resection of intestinal neoplasia?

Answer 44

3-8 cm

Question 45

Prognosis with neoplasia of the intestines varies with _____ and \_\_\_\_\_.

Answer 45

tumor type, margins

Question 46

What are 4 important considerations for postop care with intestinal surgery?

Answer 46

1. IV crystalloid fluids 2. Pain meds (NOT NSAIDs) 3. **Early enteral nutrition** 4. +/- antibiotics (if contaminated or dirty procedure)