GI Flashcards
(39 cards)
A cat has a rectal prolase and the tissue is nonviable. What procedure would you use to fix?
amputate dead tissue and resect (not with any procedure to prevent relapse)
What suture would you use to resect intestine in a 30 kg dog?
3-0, monofilament absorbable suture. Close in an appositional pattern- simple continuous, interrupted, or modified Gambee technique- SINGLE LAYER CLOSURE. 2 mm from edge and 2-3 mm apart. Must be water tight.
Leak Check and then omentalize.
Conditions that predispose to Pica in dogs.
- Hepatic encephalopathy
- pancreatic exocrine encephalopathy
- iron deficiency
What is the layer of strength for the GI?
Submucosa
T/F: The way to enhance formation of fibrin seal is to ensure apposition of submucosa.
False, to enhance formation of fibrin seal, ensure serosa-to-serosa contact.
The “traditional” closure of the stomach is ________ oversewn with _________ pattern.
The “Traditional” closure is Cushing oversewn with Lambert.
A recently weaned puppy comes in to the clinic for intermittent vomiting, upon doing a radiographic contrast study you see an “apple core” or “beak” appearance showing delayed gastric emptying at the pylorus. What diagnostic would you use to differentiate congential pyloric stenosis from neoplasia?
Ultrasound- see the muscular layer hypertrophied
There are two treatments for pyloric stenosis, Fredet - Ramstedt Pyloromyotomy and Heineke- Mikulicz Pyloroplasty. What is the main difference between the two?
The Fredet-Ranstedt Pyloromyotomy involves the serosa and muscular layers. Think F for Fast!. It is quick and easy and doesnt involve any lumen exposure. It is only indicated for congenital cases.
The Heinke-Mikulicz is full thickness and exposes the lumen. Think H for Hole in lumen.
In Acquired Pyloric Stenosis, also called Chronic Hypertrophic Pyloric Gastropathy (CHPG) it commonly affects middle aged, excitable/ agressive, small breed dogs and it most often involves hypertrophy of two layers, the ______ and _______, which is a grade ____.
Acquired stenosis involves Mucosal and Muscular. Think Middle Aged, Mean and Manly Mini dogs get their Mucosal and Musclular layers Messed up.
Called a grade 2.
Describe the grades of CHPG.
Grade 1: Muscular hypertrophy
Grade 2: Muscular and Mucosal Hypertrophy
Grade 3: all layers- Muscular & Mucosal Hypertrophy plus submucosal inflammation.
What are the treatment options for CHPG?
Transverse Pyloroplasty, Y-U Pyloroplasty, Billroth 1 or Biopsy.
The Y-U Pyloroplasty for treatment of CHPG transposes pyloric region to antral wall. Transection of what ligament provides better exposure for this procedure? Which ligament should be avoided bc it can damage the common bile duct?
Transection of Gastrosplenic ligament provides better exposure.
Avoid cutting the Hepatoduodenal ligament. If you cut the Hepatoduodenal Lig, you need Help!
What is indicated if the animal has a grade 3 CHPG?
Billroth 1=
The esophagus does not have what layer?
Serosa
Which surture pattern is full thickness?
a. cushing
b. lambert
c. connell
Connell! Cushing and Connell are similar, except that Cushing is not full thickness.
If you needed to perform a gastrectomy to remove part of the stomach wall that was necrotic or neoplastic, would you use a double layer closure or a single layer closure?
Single Layer bc you don’t want to make the inverting pattern bc it would decrease stomach volume.
What are the two signs that differentiate congenital pyloric stenosis from the acquired form?
- Age- will be young puppies- typically after weaning.
2. Muscular hypertrophy of pylorus
Normal wall thickness of the pyloric region of the stomach is the muscular layer < ______ mm and the pyloric wall is < ____ mm.
muscle < 4 mm
pyloric wall < 9 mm
For a grade 3 acquired pyloric stenosis with severe outflow obstruction, you would use what surgical procedure?
Billroth 1= Pylorectomy with Gastroduodenostomy
Most common stomach cancer in the cat?
Lymphoma- malignant
What is the most common stomach neoplasia in dogs? Breeds/ genders predisposed? Where does it normally metastasize?
Gastric adenocarcinoma
Common in Rough Collie, Staford Terr, Belgian Shepherd
2.5x more common in males.
Spreads to regional LNs and Liver.
You identify gastric adenocarcinoma in a dog. The appearance is rough, thickened- “leather bottle stomach”. What type of adenocarcinoma is this?
a. discrete polypoid
b. Mucosal ulcerated plaques
c. infiltrative
Infiltrative!
To surgically treat a case of gastric adenocarcinoma, aggressive technique is required. This involves wide margins of > ___ cms in the pylorus.
> 5 cm margins.
What is a Billroth II procedure? What are the 3 main complications associated with this surgery?
Billroth II= Gastrectomy with Gastrojejunostomy.
Complications:
1. Alkaline Gastritis- bc of bile and pancreatic secretions that flow into stomach
2. Blind Loop Syndrome: Gastric contents can get stuck in blind sac of jejunum.
3. Marginal Ulceration- ulcerations in jejunum bc not used to acid secretions
