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Module 16 > Decision Making in GI Obstruction > Flashcards

Decision Making in GI Obstruction Flashcards

1
Q

what is a gastronomy

A

incision in stomach

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2
Q

what is enterotomy

A

incision into intestine

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3
Q

what is enterectomy

A

removal or portion of intestine

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4
Q

how do you limit contamination in GI surgery (8)

A
  1. isolate using moistened swabs
  2. exteriorize intestine when possible
  3. dirty area of trolley
  4. change gloves + intruments after closed GI tract
  5. perform local lavage
  6. perform general lavage
  7. milk contents away from incision lines
  8. occlude intestines: doyen intestinal clamps, assistants hands
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5
Q

what forceps should you use to hand the intestines

A

atraumatic forceps

plain thumb forceps

debakey vascular forceps

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6
Q

what do you need to do when you are suturing the intestines

A

engage the submucosa

fibrous suture holding strong layer

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7
Q

what suture materials are appropriate

A
  1. monofilament
  2. synthetic
  3. absorbable

must be synthetic material

cat gut matieral is not acceptable –> it will be digested by proteases

poliglecaprone 25 (monocril)

glycomer 631 (biosin)

polydioxanone (PDS 2)

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8
Q

what suture patterns can be used

A

appostitional patterns

simple interrupted or continuous

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9
Q

how far apart should simple interrupted sutures be

A

3mm bites 3mm apart

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10
Q

what is the cushing pattern be used for

A

invert seromuscular layer in the stomach

produces early serosal seal

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11
Q

what are the benefits of serosal seal (5)

A
  1. reduce leakage
  2. increase blood supply
  3. speed up healing
  4. increase drainage
  5. increase local host defences
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12
Q

what is an omental wrap

A

wrap omentum around intestine

adhere to incision line and bring in a good blood supply and drain material away

don’t necessarily need to suture into position but you can put a tacking suture proximally and distally

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13
Q

when should you feed postoperatively

A

early feeding recommended

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14
Q

why is early feeding recommended

A
  1. little distention of intestine with feeding
  2. water tight seat
  3. enteral feeding crucial for mucosal health
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15
Q

what are common presentations of gastric foreign bodies

A
  1. incidental finding
  2. obstruction: intermittent or persistent vomiting
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16
Q

what are the treatment options for gastric foreign bodies (3)

A
  1. induce emesis
  2. endoscopic retrieval
  3. gastronomy
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17
Q

where is a gastronomy done

A

between the lesser and greater curvature

in the body of the stomach

18
Q

how do you begin your incision into the stomach

A

stay sutures to lift the area you want to incise up

the liquid sits at bottom and gas at the top

easier to control contamination

19
Q

what scissors should you use to extend your incision in a gastronomy

A

metzenbaum

mayo scissors are too blunt and will crush tissue

20
Q

how do you close a gastronomy (2)

A
  1. first layer: simple continuous mucosa and submucosa
  2. second layer: cushing in seromuscular layer
21
Q

what is a non viable area of intestine

A

wall thinning

green

grey

black

22
Q

what is a compromised area of intestine

A

avulsed vessels

red

hemorrhagic

23
Q

what is viable intestine

A

active hemorrhage from nick

pulse

peristalsis

24
Q

what are key things to remember when performing an enterotomy

A
  1. do not incise over the foreign body as this area is compromised
  2. extend incision to avoid stretching and tearing as foreign body is removed
  3. use instruments to handle foreign body
  4. sutures must engage the submucosa
25
Q

describe how to perform an enterotomy (5)

A
  1. pick site proximal or distal to foreign body
  2. linear incision
  3. antimesenteric surface
  4. no 11 blade
  5. extend with scapel or metzenbaum scissors
26
Q

how is an enteronomy closed

A

submucosa is holding layer

simple, full thickness appositional pattern (interrupted or continuous)

27
Q

how do you perform a leak test in enterotomy

A

occlude intestine

25 guage needle

5ml saline

gentle pressure

28
Q

how do you perform an enterectomy (5)

A
  1. identify areas to resect including healthy margin –> make incision between two arcuate vessels
  2. ligate vessels
  3. incise mesentery
  4. curshing clamps on portion to excise
  5. non crushing clamps on portion to suture
29
Q

how do you close an enterectomy

A

suture 1: mesenteric border

suture 2: anti-mesenteric border

fill in between: 3mm apart

close mesentery

30
Q

how do you deal with luminal disparity

A

adapt narrower end of intestine so it matches the larger loop

extend incision on anit mesenteric surface

so length along the intestine matches the loop

get a triangular edges and can help to trim those off

31
Q

what is an intussesception

A

proximal telescoping inside the distal loop

causes obstruction, adhesion and pressure buildup and vascular comrpomise leading to necrosis

32
Q

when are intussusceptions common

A

in puppies and kittens

spontaneous

possibly secondary to worms or enteritis

33
Q

where is the most common location for intussusceptions

A

jejunocolic at ileocecocolic junction

34
Q

how do you diagnose an intussusception (3)

A
  1. clinical signs in young animal
  2. palpable sausage in abdomen
  3. ultrasound distinctive
35
Q

how do you treat an intussusception (2)

A
  1. reduce intussusception +/- enteroplication in young patients
  2. enterctomy if there is non viable tissue or in old patients
36
Q

how do you reduce the intussusception

A

squeeze base of intussusception distally whilst applying cranial traction

37
Q

when should you perform an enterectomy with an intussusception (4)

A
  1. adhesions prevent reduction
  2. tissue non-viable
  3. tissue tears
  4. neoplasia
38
Q

what is an enteroplication and what are the risks

A

suture adjacent loops of small intestine together on antimeseteric surface

prevents recurrce but there is risk of perforation and death

reserve for reccurent cases

39
Q

how do linear foriegn bodies travel through intestines

A

usually gets trapped at base of tongue

string becomes taught in intestine

intestines bunch up around FB

string cuts into mesenteric border

40
Q

what can linear foreign bodies cause

A

perforation

peritonitis

death common

Module 16 (26 decks)

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