E2: Stomach and GDV Flashcards Preview

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Flashcards in E2: Stomach and GDV Deck (79)
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1

What are the gastric layers? Which is strongest? 

From outside to inside: Serosa - Muscle - Submucosa - Mucosa 

Submucosa is the strongest (holdng layer)

2

Pica predisposes animals to gastric foreign bodies. Name some conditions that predispose an animal to pica. 

Iron deficiency 

Hepatic encephalopathy 

Pancreatic exocrine insufficiency 

3

Which of these is not a clinical sign associated with a gastric foreign body?

Vomiting

Fever

Lethargy

Abdominal pain

Anorexia 

Fever

4

Which of these are possible lab findings for an animal with a gastric foreign body?

Anemia

Leukocytosis

Leukopenia

Neutropenia

Renal azotemia

Pre-renal azotemia

Metabolic alkalosis

Metabolic acidosis 

Hyperkalemia

Hypokalemia

Hyperchloremia

Hypochloremia 

Anemia

Leukocytosis

Pre-renal azotemia

Metabolic alkalosis

Metabolic acidosis 

Hypokalemia

Hypochloremia 

5

If you decide to medically manage a foreign body, what do you need to include in your therapy?

If you needed to induce vomiting, what would you use?

Fluid therapy: rehydrate, correct electrolyte imbalances 

Monitor using serial rads

 

Induce vomiting in dog- Apomorphine

Cat- Xylazine

6

T/F: Many gastric foreign bodies can be removed endoscopically.

True 

7

Where should you make your surgical approach for gastric foreign body removal?

Ventral midline celiotomy (from xiphoid to pubis)

Incision in hypovascular aspect of stomach between greater and lesser curvature

8

To reduce contamination during a gastrotomy, isolate the stomach from the remaining abdominal contents with moistened _________. Place _________ to assist in manipulation of the stomach and help prevent spillage of gastric contents. 

Laparotomy sponges 

Stay sutures 

9

How do you close a gastrotomy incision- what pattern(s) could you use in the first layer and what tissue(s) will this layer incorporate? Second layer? 

What alternative method could you use to reduce post-op bleeding?

First layer: Cushing or simple continuous pattern 

                 Tissues: Serosa, muscularis, and submucosa 

Second layer: Lembert/Cushing pattern

                 Tissues: Serosamuscularis and submucosa

 

Alternative: Close mucosa in simple continuous pattern as separate layer followed by inverting pattern including all other tissue layers

 

(Cushing then Cushing/Lembert = Double layer inverting 

Simple then another simple  followed by Cushing/Lembert= Double layer appositional then inverting

10

What clinical signs are associated with gastric outflow obstruction?

Chronic intermittent vomiting of partially digested food hours after feeding

(If congenital signs seen at weaning) 

11

What congenital abnormality causes benign gastric outflow obstruction?

Pyloric stenosis

12

What artery supplies the lesser curvature of the stomach? What is/are the parent artery/arteries?  

Greater curvature? What is/are the parent artery/arteries?  

Lesser- Gastric arteries (left and right)- parent- Celiac artery 

 

Greater- Gastroepiploic arteries (left and right)- parent = Celiac A

Short gastric arteries - parent= Splenic A

 

13

What breeds are predisposed to congenital pyloric stenosis? 

Brachiocephalic dog breeds (Boxers, bulldogs)

Siamese cats

14

What is the suspected etiology for congenital pyloric stenosis?

Excess gastrin production

(trophic for gastric smooth muscle and mucosa)

Also possible cause of Chronic Hypertrophic Pyloric Gastropathy 

15

What are the diagnostic modalities for determining pyloric stenosis?  

Radiographs- to look for gastric distenssion or delayed gastric emptying (evidenced by a not-empty stomach after 8 or more hours of fasting)

Contrast radiography- to look for 'beak' or 'apple core' sign 

Ultrasonography

16

What surgeries can you perform to correct congenital pyloric stenosis?

Pyloromyotomy (Fredet-Ramstedt procedure)

Transverse pyloroplasty (Heineke-Mikulicz procedure)

17

Aquired hypertrophy of which layer or layers of the pyloris causes CHPG (chronic hypertrophic pyloric gastropathy)? Which breeds are predisposed? Is there a sex or age prediliction?

Mucosa and or muscular hypertrophy

Small breed dogs (<10kg) such as Shih-tse, Lhasa apso, Maltese 

Males predisposed 

Middle aged to older 

18

What diagnostic tool can be used to evaluate the middle and pyloric wall thickness to diagnose CHPG? What alernative modality can you use if you also need to take biopsies?

Ultrasound 

Endoscopy 

19

In addition to a Heineke-Mikulicz pyloroplasty, which 2 other surgical techniques can you use to manage CHPG?  What are advantages and disadvantages of each?

Y- U Pyroplasty 

Advantages:Increase diameter of pylorus, access to excise hypertrophied mucosa

Disadvantages: Potential flap tip necrosis, possible side effect of rapid gastric emptying 

 

Pylorectomy w/Gastroduedenostomy (Bilroth I) 

Advantages: All diseased tissue can be removed

Disadvantages: technically more demanding, increased risk of "dumping" syndrome and reflux gastritis (due to direct connection between duodenum and stomach)

20

_________ tumors are commonly found near the cardia.

_________ tumors are commonly found in the pyloric antrum or the lesser cuvature of the stomach. 

Leiomyoma, LSA 

Adenocarcinoma

21

What are the sigalment, physical finding, treatment options and prognosis for gastric adenocarcinoma?

Signalment: Male, 8-10yo, Staffies, Belgian shepherds 

Physical findings: plaque-like mucosal lesions with ulcers, raised sessile or polypoid lesions, diffuse infiltration (linitis plastic, scirrhous stomach wall), on US see mural thickeing and loss of normal gastric wall

Treatment options: aggresive sx exision via gastrectomy, 5cm margins

             Pallitative tx: By-pass procedure (Bilroth I or II), chemotherapy?

Prognosis: Guarded to poor, no sx= 2-4mo, aggressive therapy= 10mo

22

What are the sigalment, physical finding, treatment options and prognosis for gastric leiomyosarcoma?

Signalment: 7-8 yo

Physical findings: ulceration, mass near cardia protruding into the gastric lumen

Treatment options: submucosal resection, Partial gastrectomy (if extensive or ulcerated)

Prognosis: median survival 21 mo, good to guarded, recurrence possible 

23

What are the sigalment, physical finding, treatment options and prognosis for gastric leiomyoma?

Signalment:older dogs, INCIDENTAL finding

Physical findings: mass near cardia protruding into the gastric lumen

Treatment options: submucosal resection, Partial gastrectomy (if extensive)

 Prognosis: Good to guarded 

24

How would you describe this stomach wall that has been affected by a gastric adenocarcinoma?

Scirrhous

25

What are the sigalment, physical finding, treatment options and prognosis for Pythiosis?

Signalment: Young dogs, Labrador Retrievers, Cavalier King Charles Spaniels and German Shepherd Dogs predisposed (highest incidence in Gulf Coast States in fall or early winter and usually after a summer of flooding and large amounts of precipitation)

Physical findings: severe inflammation and infiltration (submucosa and muscularis affected), intense fibrotic reaction, transmural thickening (esp gastric outflow area), vomiting, inappetence, weight loss, diarrhea 

Treatment options: Wide surgical excision (antifungals INEFFECTIVE)

 Prognosis:Guarded to poor, MST 26.5 days

26

What type of suture should be avoided in gastric surgery?

Chromic gut

27

What is a Bilroth II and what are the indications to perform it?

What are some disadvantages of using this procedure?

Gastroenterostomy- partial gastectomy followed by gastroenterostomy 

 

Indications: Extensive gastric resection making gastroduodenostomy impossible

Disadvantages: A LOT of complications - Alkaline gastritis (bile and pancreatic secretions flow into stomach), "Blind loop" syndrome (gastric contens move orally and putrefy), Marginal ulceration (of jejunal mucosa due to acid)

28

What is a Bilroth I and what are the indications to perform it?

What are some advantages and disadvantages of using this procedure?

Pylorectomy Gastroduodenostomy

 

Indications: neoplasia, outflow obstruction caused by muscular hypertrophy, ulceration of gastric outflowtract

Advantage: All dieased tissue can be removed 

Disadvantages: difficulty, risk for "dumping" syndrome and reflux gastritis (must use extreme care when incising in pyloric area to avoid damaging COMMON BILE DUCT where it traverses lesser omentum)

29

How does a Bilroth I differ from a Bilroth II? 

In Bilroth II the distal stomach and proximal duodenum are closed after pylorectomy, and the jejunum is attached with a side-to-side anastomosis to the diaphragmatic surface of the stomach

In Bilroth I stomach and duodenum are connected where the pylorus has been removed

30

 _________ is the distension of the stomach with fluid, food, and/or gas. Treatment is _______ (medical/surgical). 

 

 _________ is the enlargement of the stomach associated with rotation on its medenteric axis. Treatment is _______ (medical/surgical). 

Dilation/ dilatation - Medical

Dilation-Volvulus - Surgical