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Equine Surgery: QOD > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

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1
Q

The major and minor duodenal papilla are the openings for what?

A

Major: Bile and pancreatic ducts Minor: Accessory pancreatic duct

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2
Q

What provides the blood supply to the ileum? a) Cecocolic artery b) Ileocecal artery c) Caudal mesenteric artery d) Cranial mesenteric artery

A

b) Ileocecal artery NB. It is a branch of the cranial mesenteric artery

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3
Q

Which cell type makes up the majority of small intestinal epithelium? a) Paneth cells b) Goblet cells c) Columnar absorptive cells/enterocytes d) Enteroendocrine cells

A

c) Columnar absorptive cells/enterocytes

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4
Q

What cells are the pacemakers of the intestine?

A

Interstitial cells of Cajal (ICCs)

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5
Q

Which option correctly matches the phase of activity with the type of activity of small intestinal motility? a) I: NSA, II: ISA, III: RSA b) I: ISA, II: NSA, III: RSA c) I: RSA, II: ISA, III: NSA d) I: RSA, II: NSA, III, ISA

A

a) I: NSA, II: ISA, III: RSA

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6
Q

What are the borders of the epiploic foramen

A

Visceral surface of caudate process of liver (dorsal and craniodorsal) Portal vein (cranioventral) Gastropancreatic fold (ventral)

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7
Q

Describe the procedure for a functional end-to-end jejunojejunostomy

A

Bowel ends lined up in antiperistaltic fashion Stoma created with GIA along opposing surfaces Bowel ends closed

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8
Q

Mesenteric rents can be congenital in origin but what structure is the cause

A

Mesodiierticular band

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9
Q

The prognosis for mesenteric rents is lower than for other strangulating lesions. What are the reasons for this

A
  1. Inability to reduce hernia 2. Long segments of bowel involved 3. Haemorrhage from mesentery 4. Failure to close entire mesenteric defect
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10
Q

What is the difference between direct and indirect hernias

A

Indirect: Small intestine passes through naturally occurring ring (eg. vaginal ring) Direct: Small intestine passes through acquired defect in musculature

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11
Q

What are the risk factors for enteroliths

A

1.California, Florida, 2.Arabians, Morgans, American Saddlebreds, donkey and Minis 3. feeding alfalfa hay 4.

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12
Q

For how long should feed be withheld following a jejunocolostomy

A

36-48 hours

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13
Q

What is the mortality rate for large colon volvulus (according to Auer)

A

56-65% (although one study reported 84%

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14
Q

List the complications associated with large colon resection

A
  1. Perstent endotoxemia 2. Peritonitis (contamination or bowel) 3. Continued bowel devitalisation 4. Post-op pain 5. Post- op diarrhoea 6. Weight loss 7. Colon ileus 8. Haemorrhage
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15
Q

How should small colon enterotomy incisions be closed

A

2 layers Full thickness simple continuous Seromuscular inverting pattern 2-0 polyglactin 910 Careful not to invert too much

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16
Q

Describe the post-op care following esophagotomy

A

Withheld feed 48 hours (can be immediate if incision closed and separate esophagostomy tube placed) Small quantities pelleted feed over next 8 days Parenteral electrolytes - can as deficiencies can happen Attention to hydration status Will heal by first intention and intraluminal suture will slough within 60 days

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17
Q

List the options for fixing rectal tears

A

Indwelling rectal liner Loop Colostomy: Single incision - high flank/low flank/ventral midline. Double incision - high flank/ventral midline End Colostomy Direct suturing Medical treatment

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18
Q

Describe the mechanism of action of the following prokinetics: a. metoclopramide b. lidocaine c. erythromycin d. neostigmine

A

a. metoclopramide dopamine 1 (DA1) and 2 (DA2) receptor antagonism and through 5-HT 4-receptor (5-HT4) agonism and 5-HT3 receptor antagonism b. lidocaine - Basically a sodium channel blocker but Auer has a bunch of info: reducing the level of circulating catecholamines through inhibition of the sympathoadrenal response, (2) suppressing activity in the primary afferent neurons involved in re ex inhi- bition of gut motility, (3) stimulating smooth muscles directly, and (4) decreasing in ammation in the bowel wall through inhibition of prostaglandin synthesis, inhibition of granulocyte migration and their release of lysosomal enzymes and cyokines, and inhibition of free radical production. c. erythromycin motilin agonist that in u- ences motility partly by acting on motilin receptors on GI smooth muscles and motilin and/or 5-HT3 receptors to stimulate the release of acetylcholine. d. neostigmine cholinesterase inhibitor

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19
Q

List the grades of rectal tear and describe them. Also give the prognosis for each (based on the two papers mentioned in Auer)

A

I - mucosa and submucosa only 93% (medical) 100% (medical) II - muscular only (mucosa intact) 100% (medical) IIIa - mucosa, submucosa, muscular (serosa remaining) 70% (medical) 38% (medical) 81% (suturing) IIIb - tear into mesorectum or retroperitoneal tissues 69% (medical) IV - everything (communicates with abdomen) 6% (medical) 2% (medical) 50% (suturing)

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20
Q

Name the methods for repairing chronic incising hernias

A

Subperitoneal Mesh Placement with Fascial Overlay Subperitoneal Meach Placement with Hernial Ring Apposition Subcutaneous Mesh Placement with Hernial Ring Apposition Laparoscopic Intraperitoneal Mesh Onlay

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21
Q

What mesh materials are available for repairing incisional hernias

A

Knit polypropylene mesh (Marlex): Strong, elastic, inert, resists infection Coated polyester (Mersilene) Polyglactin 910 Absorbable mesh; may not need to be removed, even if infection

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22
Q

What suture size, type and patterns would be used to close umbilical hernias in foals

A

Simple continuous appositional pattern recommended using appropriate size (USP 1,2,3) absorbable, monofilament suture

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23
Q

What are the predisposing factors for prepubic tendon rupture

A

Hydrops allantois Hydrops amnions Trauma Twins Fetal gaints Normal pregnancy Draft breeds Older mares

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24
Q

What material, patter, bite size, etc is used to repair acute total dehiscence of an abdominal incision

A

Monofilament stainless steel wire Through and through interrupted vertical mattress pattern Sutures 2-3cm apart Suture through skin, fascia, rectum abdominal muscle 5cm from wound edge Hard rubber tubing used as stents Second bite 2.5cm from wound edge Preplace sutures and close by applying tension on all sutures Wires twisted Cut ends bent back into lumen of tubing Leave skin unsutured if infected

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25
Name 2 drugs, their function and their doses that can be used to treat gastric ulcers
Histamine (H2) antagonists: Ranitidine (6.6mg/kg PO q8hrs or 1.5-2mg/kg IV q6-8hrs) Proton pump inhibitors: Omeprazole (2-4mg/kg PO q24hrs)
26
What is the fancy term for migration of epithelium across gastric ulcers
Epithelial restitution
27
What methods can be used to treat gastric impactions
Medical:Nasogastric intubation: Water Reflux contents Carbonated cola Surgery:Infusion/Massage Massage Infuse impaction via insertion of needle adjacent to greater curvature Infusion of balanced polytonic fluid Gastronomy: Pack of abdomen with towels Incision parallel and caudal to attachment of omentum on greater curvature Evacuate contents Double layer inverting closure Rarely necessary to open stomach
28
Describe the arterial supply and venous drainage of the spleen
Arterial supply: Splenic artery (branch of celiac artery) Within hilus Branches to supply spleen and greater curvature of stomach Venous drainage: Affluent of portal vein
29
List the possible approaches for splenectomy
Left side. Standing or right lateral recumbency Incision caudal to 18th rib in left paralumbar fossa: Difficult to assess primary vessels Between ribs 17-18 Resection of 18th/17th/16th rib Removal of distal aspect of last 3 ribs Removal of 17th and transecting of 16th and 18th ribs Laparoscopic-assisted
30
Describe the ventrolateral approach to the oesophagus
GA, right lateral or dorsal recumbency or standing Place feeding tube 5cm skin incision just ventral to jugular vein Sternocephalicus and brachiocephalicus muscles separated Deep cervical fascia incised to expose oesophagus May be necessary to incise cutaneous colli muscles in distal cervical area
31
List the methods of treating oesophageal stricture
First 60 days: Bougienage - not useful Pneumostatic/hydrostatic dilators - no useful Balloon dilation Initially low-bulk diet, NSAIDs and antibiotics for first 60 days Then surgical options: Esophagomyotomy Partial or complete resection and anastomosis Patch grafting
32
What suture material/patterns should be used in an oesophageal resection and anastomosis
Submucosal layers apposed with 3-0 simple interrupted monofilament non absorbable polypropylene placed 3cm from cut edge, 2-3mm apart, with knots tied in lumen Oesophageal muscle apposed with interrupted horizontal mattress sutures, 2-0 polydioxanone or monofilament non absorbable suture material (relief incision - circular myotome 4-5cm proximal or distal to anastomosis may help)
33
List the complications of oesophageal surgery
Dehiscence and stricture Acid-base electrolyte alterations Laryngeal hemiplegia Carotid artery rupture
34
What are the 4 layers of the oesophagus
Tunica adventitia (fibrous layer) Tunic muscular (muscular layers) Tela submucosa (submucosal layer) Tunica mucosa (mucous membrane)
35
How can you treat diastemata
Cleaning out periodontal pockets with diastema forceps, dental picks, long forceps or high pressure-pneumatic or water instruments and filling periodontal defects with antibiotics in plastic impression material Use diastema burr to wide to 4-6mm (clear periodontal pockets and diastema for feed first). Stop burr at 5 second intervals. Spray water continuously. Remove more from rostral aspect of caudal tooth as pulp horns located towards caudal aspect of tooth May require extraction of a displaced cheer tooth Do not widen diastema in young horses
36
Name lots of methods of removing cheek teeth and which teeth they are appropriate for
Oral (anything) Minimally invasive transbuccal (anything but more difficult caudally as may not be able to get sufficient angle) Repulsion (any) Lateral buccotomy (Upper 6,7,8; can also be used for lower 6,7,8)
37
How do you close a partial (decent size that needs repair but not needing partial glossecomy) thickness tongue laceration
GA/Standing and local Debride Lavage Multi layer closure Vertical mattress sutures replaced deep in muscular body of tongue with absorbable or non-absorbable size 0 or 1 monofilament suture Buried rows of simple interrupted 2-0 to 0 monofilamter absorbable suture subsequently used to appose muscles, obliterating dead space Vertical mattress sutures tied and lingual mucosa apposed with simple continuous or interrupted vertical matters sutures
38
What are sialoliths made of
Calcium carbonate and organic matter that develops within salivary duct (or a gland)
39
How do you treat a laceration of the parotid duct
Most close spontaneously in 1-3 weeks Anastomosis techniques: Suture over intraluminal tube Three sutures opposing two cut ends as a triangle and suturing between apices (Size 2 nylon threaded normograde through distal laceration; guide tubing over nylon to cannulate duct before suturing) Use 4-0 to 7-0 absorbable or non-absorbable suture in simple interrupted pattern Leave tube in place while duct heals If only one side lacerated, do not need to leave tube in place after closing defect If anastomosis not possible, interposition polytetrafluoroethylene tube graft may restore duct continuity Can create fistula from duct to oral cavity proximal to injury Duct translocation Surgical removal of gland, duct ligation or chemical ablation of gland
40
What are the normal peritoneal fluid values day 6 post-op?
40,000 WBC/ml; 6g/dL TP
41
What are the normal peritoneal fluid values day 4 post-op?
200,000WBC/ml
42
What are the most common organisms found in septic peritonitis?
Streptococcus Rhodococcus equi Esherichia coli Staphylococcus Bacteriodes (anerobic) Clostridium (anerobic) Fusobacterium (anerobic)
43
In what percentage of cases does recurrences of a right dorsal displacement of the large colon occur?
15%
44
What are the predisposing and protective factors for incisional complication?
Predisposing factors: Repeat laparotomy Increased duration of surgery Use of near-far-far-near Chromic catgut Leukopenia Incisional edema Post-operative pain \>300kg weight \>1 year age Staple Closure by less experienced surgeons Protective factors: Abdominal bandage Short surgery time Adequate draping Isolating enterotomy incision Minimize trauma to incision during exploration Minimally reactive suture material Do not take overly large bites Avoid excessive force when tightening sutures
45
List the uses of buscopan
Anti-spasmodic for colic Choke Rectal exam Uterine movement during pregnancy
46
What side effect of buscopan may affect monitoring for colic/pain
Increases heart rate
47
Which laxative is anionic?
DSS
48
Which laxative can form an oil embolus when administered with mineral oil?
DSS
49
On incision, the oesophagus separates into 2 layers, what is in each layer?
Mucosa and submucosa: Inner Elastic Muscular layer and adventitia: Outer Inelastic
50
Describe the arterial blood supply to the oesophagus
Cervial part: Carotid arteries Thoracic/abdominal part: Bronchoesophageal and gastric arteries Vascular pattern arcuate but segmental Minimal collateral circulation (preservation of vessels important)
51
Describe the ventral approach to the oesophagus
GA, dorsal recumbency 10cm skin incision exposes 6cm esophagus Skin and subQ fascia divided used scalpel blade Paired steronothyroid, sternohyoid and omohyoid muscles are separated along midline to expose trachea Blunt separation of fascia on left side of trachea permits identification of esophagus containing NG tube Retract trachea to right Gentle sharp dissection of overlying loose adnentitia to expose ventral wall of esophagus
52
List the possible diagnostic tests for choke (even the funky tests)
Clinical exam Palpation Ultrasound Radiography Contrast radiography Negative/double positive contrast radiography Bloodwork: WBC, electrolytes, hydration Cineradiogrpahy Electromyography Manometric evaluation Functionally distinct regions: Cranial esophageal sphincter Caudal esophageal sphincter Fast (cranial 2/3) Slow (caudal 1/3)
53
What drugs does Auer like to use for choke?
Atropinization (0.02mg/kg) Acepromazine Oxytocin (0.11 and 0.2IU/kg) Xylazine
54
The left carotid sheath is super close to the oesophagus - what structures does it contain?
Carotid artery, vagus and recurrent largngeal nerves
55
Describe the procedure for a cervical esophagostomy
Lateral recumbency and GA or standing and local anesthesia Pass NG tube Skin over left jugular furrow prepped (can occasioanlly be right) 5cm skin incision ventral to jugular vein Esophagus sharply incised lonitudinally for 3cm down to indwelling NG tube NG tube removed and polyethylene NG tube (outer diameter 14-24mm) placed into stomach (make sure placed through both layers of esophagus) Place sutures in mucosa to form a seal around tube (likely unncessary as saliva will still leak) Secure tube firmly with butterfly tape bandages sutured to skin, then elastic tape bandages Large diameter tubes preferred Cap tube between feedings; flush with water at end of each feeding Tube should remain in place for minimum of 7-10 days to allow stoma to form (longer if in area of rupture or perforation) Can feed normally when tube removed Large portion of swallowed feed lost through stoma when fed from ground (feed a withers height) Stoma heals spontaneously Fistula formation rare Complications:Fatal infection: Drain and infection early ABs for 7-10 days, until mature stoma develops
56
What do I cells release and what does it do?
Cholecystokinin (CCK): Released in response to protein and fat in duodenum. Stimulates pancreas to secrete amylase, lipase, trypsin, chymotrypsin, carboxypeptidase, elastase and colipase.
57
What is the effect of high Mg on Ca absorption?
Decreases Ca absorption
58
Describe the neural stimulation of motility of the small intestine
Vagus nerve, components of sympathetic NS, enteric NS Enteric NS: ganglia in myenteric (Auerbach) plexus and submucosal (Meissner) plexus - independent of CNS Myenteric neurone: innervate longitudinal muscle and outer lamella of circular muscle Submucosal neurons innervate inner lamella of circular muscle
59
Apart from WBC and TP, which 6 factors in peritoneal fluid have a strong correlation with a strangulating lesion?
Gross appearance Peritoneal chloride pH Lactate (peritoneal better than blood; also good for prognosis) Myeloperoxidase (MPO) - potentially useful to indicate neutrophil activation D-dimer concentration - potentially for fibrinolytic activity
60
What 4 issues in the GI tract can Parascaris equorum lead to?
Obstruction Intussusception Abscesation Rupture
61
What is a Littre hernia?
Protrusion of a Meckel diverticulum through a potential abdominal opening
62
What is a Richter hernia?
Antimesenteric wall of intestine protrudes through defect in abdominal wall
63
Between which bands (for the cecum and colon) do you perform a cecocolic anastomosis
CCA between dorsal and lateral bands of cecum and lateral and medial free bands of RVC
64
List the causes of cecocecal or cecocolic intussusception
Dietary changes Cecal wall abscess Salmonella Eimeria leuckarti Strongulus vulgaris arteritis Organophosphate exposure Parasympathomimetic drugs, Tapeworm
65
What type of laxative is Polyethylene glycol 3350?
Osmotic laxative
66
What is DCAB? What is the equation to calculate it and what is the target in horses?
Dietary cation anion balance (DCAB) Target DCAB +200-300 mEq/kg Grass hay/cereal grains ok Not alfalfa - important in enterolith formation ![]()
67
List the Ddx for meconium impaction
Bladder rupture Atresia colic Ileocolonic aganglionosis Enteritis
68
List the factors that predispose to post-op ileus
Intestinal ischemia Distention Peritonitis Electrolyte imbalances Endotoxemia Traumatic handling of intestine R&A Anesthesia \>10yrs Arabian PCV\>45% High serum protein and albumin Elevated serum glucose \>8L reflux at admission Anesthesia \>2.5hrs Surgery \>2yrs High pulse rate Strangulating lesions of SI and ascending colon Length of SI resection Obstruciton of SI Ischemic SI
69
List 2 factors that protect against post-op ileus (presuming the horse had SI surgery)
Pelvic flexure enterotomy Intra-operative lidocaine
70
What is the mechanism of action of bethanecol
Muscarinic cholinergic agonist Stimulate Ach (M3 and M2) recetors at level of myenteric plexus Affects duodenum, jejunum, cecum emptying, pelvic flexure, gastric emptying
71
List the complications that can occur with abdominal drain placement
Partial obstruction of drain (26%) Leakage of fluid around drain (16%) Subcutaneous fluid accumulation (12%) I guess peritonitis too but not listed in Auer

Equine Surgery: QOD (13 decks)

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