lecture 3: Surgery of the Stomach Flashcards
(48 cards)
1
Q
Gastrotomy
A
an incision through the stomach wall
into the gastric lumen
2
Q
Partial Gastrectomy
A
resection of a portion of the
stomach
3
Q
Gastropexy
A
Procedure that permanently adheres
the stomach to the body wall
4
Q
Pyloroplasty
A
– Full-thickness incision and tissue
reorientation to increase the diameter of the gastric
outflow tract
5
Q
- Pylorectomy
A
Removal of the pylorus
6
Q
Gastroduodenostomy
A
Attachment of the stomach to
the duodenum
7
Q
Billroth I Procedure
A
= pylorectomy +
gastroduodenostomy
8
Q
- Billroth II Procedure
A
gastrojejunostomy + after
partial gastrectomy (including pylorectomy)
9
Q
Pyloromyotomy
A
an incision through the serosa and
muscularis layers of the pylorus only
10
Q
common reasons for gastric surgery
A
- Foreign Body Removal (most common)
- Correction of Gastric Dilatation and Volvulus (GDV)
- Prophylactic Gastropexy (Before or after GDV)
11
Q
less common reasons for gastric surgery
A
- Treat Gastric Ulceration or Erosion
- Treat Neoplasia
- Treat Benign Gastric Outflow Obstruction
12
Q
4 pre-op concerns for gastric surgery
A
- Vomiting Animals
- Alkalosis
- Hematemesis
- Peritonitis
13
Q
why would we worry about the 4 pre op concerns?
A
- Vomiting Animals (Dehydration, Hypokalemia, Aspiration pneumonia, Esophagitis)
- Alkalosis – secondary to gastric fluid loss (may see
metabolic acidosis) - Hematemesis – may indicate gastric erosion or
ulceration, but may also indicate a coagulopathy - Peritonitis from gastric perforation/rupture
14
Q
- Withholding Food:
Normally ______hours prior to surgery
*______ hours (preferably 24) prior to gastroscopy - 4 to 6 hours in pediatrics when _______ is a
concern
A
≥ 8 to 12
≥ 18
hypoglycemia
15
Q
- Perioperative antibiotics may be used if the gastric
lumen is to be ______ however, this may not be
necessary if ________ or ________-
A
entered
Normal immune function or Simple gastrotomy
16
Q
- Gastric Mucosa accounts for ______ of the stomachs weight.
A
½
17
Q
gastric surgery is safer than what two other surgeries
A
esophagotomy
enterotomy
18
Q
what three things are uncommon/ rare compared to gastric surgery
A
- Peritonitis is uncommon (with good technique)
- Stricture is rare
- Obstruction is rare
19
Q
_________ procedures are more difficult and may be
associated with severe complications
A
- Billroth
20
Q
Gastroscopy
A
- Preferred over surgical removal for foreign bodies
- More sensitive when looking for erosions, Physaloptera, and small lesions, Physaloptera rara, Physaloptera preputialis
21
Q
Gastrotomy
A
- Ventral midline approach (exploratory celiotomy)
- Use Balfour retractors
- Perform exploratory before incising the stomach
- Isolate the stomach with moistened laparotomy pads
- Place stay sutures
22
Q
most common reason for gastrotomy in dogs and
cats is removal of a _________-
A
foreign body
23
Q
Make the gastric incision in a _________ area of the ventral aspect of the stomach, between the greater and lesser curvatures
A
hypovascular
24
Q
steps in gastronomy:
A
- Make a stab incision into the gastric lumen
- Enlarge the incision with Metzenbaum scissors
- Use suction to aspirate gastric content (spillage)
- Close stomach with 2-0 or 3-0 absorbable
monofilament suture
25
suturing up a gastronomy
* Close stomach with 2-0 or 3-0 absorbable
monofilament suture in a 2-layer inverting seromuscular pattern
e.g., polydioxanone,
polyglyconate)
* 1st Layer: Serosa, muscularis, & submucosa with a Cushing or simple continuous
* 2nd Layer: Lembert or Cushing that incorporates serosal and muscularis layers
26
label the following
D. Lembert
E. Connel
F. Cushing
27
Cushing
* The beginning and the end make a “box” around the end of the incision to bury the knot
* Bites #1 and #11 are back handed
* Bite 3 and possibly bite 4 should be situated back toward the beginning of the incision to help bury the knot
* Bites should be either directly across from each other or taken slightly back toward the beginning of the incision to make a ti
28
lembert
* Think of this pattern like an intradermal pattern with deep being close to your incision and superficial being away.
* You will tie to a “deep” loop and a “deep” single suture strand
* You can take bites straight across the incision (ex: bites 3&4) without coming out first, but don’t loose track of your serosal edg
29
t/f: you should Change gloves prior to closing the abdominal wall and use sterile instruments
true
30
Invagination of Necrotic Stomach
* Obstruction is possible from excessive
intraluminal tissue
* Excessive hemorrhage is possible
31
indications for billroth I procedure : * Neoplasia
* 1- to 2-cm margins of normal tissue should be
removed with the abnormal tissue
* margins of the resected tissue should be evaluated
histologically
32
Indications for billroth I procedure
-Outflow obstruction caused by pyloric muscular
hypertrophy
* Ulceration of the gastric outflow tract
33
Complications of a Billroth I
Procedure
* If the common bile duct has been damaged, a
cholecystoduodenostomy or cholecystojejunostomy may be required.
* If the pancreatic ducts are inadvertently ligated,
supplementation with pancreatic enzymes may
be necessary postoperatively.
34
Billroth I Procedure
pylorectomy + gastroduodenostomy
35
Billroth II Procedure
gastrojejunostomy + after partial gastrectomy (including pylorectomy)
36
difference between billiroth I and II
the distal stomach andproximal duodenum are closed after pylorectomy, and the jejunum is
attached with a side-toside anastomosis to the
diaphragmatic surface ofthe stomach.
37
in comparison, If the extent of the lesion precludes end-to-end anastomosis of the pyloric antrum to the duodenum, consider a _______ procedure
Billroth II
38
Pyloromyotomy & Pyloroplasty
* Increase diameter of the pylorus
* Used to correct gastric outflow obstruction
* Difficult or impossible to reverse
* Not for routine use without evidence of pyloric
dysfunction
39
Fredet-Ramstedt Pyloromyotomy
* Simplest and easiestprocedure
* Does not allow inspection or biopsy of pyloric mucosa
* Probably only temporary benefit (healing may reduce lumen size)
40
Heineke-Mikulicz Pyloroplasty
Allows limited exposure of the pyloric mucosa for inspection & biopsy
41
Y-U Pyloroplasty
Allows greater accessibility for resection of the pyloric mucosa in dogs with mucosal hypertrophy
* Increases the luminal diameter of the
outflow tract
*****To reduce necrosis at the pointed tip of the gastric tissue flap, you may wish to excise the point of the Y before suturing it.
42
Gastric Foreign Bodies usually cause vomiting due to
* Gastric outflow obstruction
* Gastric distension
* Gastric mucosal irritation
43
Important Considerations for Gastric Foreign
Bodies
* Initial clinical signs may not alert the owner to seriousness of condition.
* Linear foreign objects must be removed as soon as possible to avoid intestinal perforation and peritonitis.
* Not all animals with gastric foreign objects vomit.
* Finding a foreign object in the stomach does not
guarantee that it is the cause of vomiting.
44
Which type of foreign body is more common in cats?
Linear foreign bodies are more common in cats
45
Where should you always check for foreign bodies in cats?
lways check under the tongue, as linear foreign bodies often get lodged there. This may require sedation
46
Don’t do barium contrast studies within _______ of endoscopy, perforation is likely
24 hours
46
What should you do before surgery for a gastric foreign body?
Always repeat the radiographs immediately before surgery to ensure that the foreign object has not moved.
47
t/f Opening the colon is always justified
false, Colonoscopy is the preferred technique
