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year 3 GIT > small animal GI surgery > Flashcards

Flashcards in small animal GI surgery Deck (38):
1

problems with gastric and high int. vomiting and how to correct prior to surgery

- loss of HCl
-dehydration
-insufficient food intake
correct: IV isotonic crystalloids, IV K+ supplement

2

problems with lower int. vomiting and how to correct prior to surgery

Loss of pancreatic Na, HCO3
dehydration
insufficient food intake
correct: IV isotonic crystalloids, IV K+ supplement

3

How to correct before surgery if have GI bleeding

blood tansfusion, iron supplement

4

What do gastric surgical diseases cause?

Gastric vomiting

5

What do S.int complete obstruction cause?

Acute vomiting

6

What do S.int partial obstruction cuase?

chronic vom, diah, weight loss

7

What does GI bleeding cause?

haematemesis (vom blood)
melaena

8

Stomach surgery risks and precautions?

-Acid kills most bacteria
-antibiotics not necessary if young,healthy and under 90 min surgery
- single broad spectrum antibi. with anaerobic cover (2nd gen cephalosporin / amoxycillin-clavulante)

9

Small intestine surgery risk and precautions?

10^2 - 10^6 CFU/ml 50%anaerobe
- use antibiotics if compromised
- broad spectrum with anaerobic cover

10

Large intestine surgery risk and precautions?

10^9 - 10^11 CFU/ml 79%anaerobe
-always use antibiotics
- broad spectrum and anaerobic only (metronidazole)

11

Methods to decrease contamination?

- isolate site of entry
- pack abdomen with moist swabs
- change instruments and gloves for contaminated part
- lavage wound after closure

12

GI wound healing - 2 phases

Lag phase (1-4 d)
Proliferative phase (3-14 d)

13

Different organ healing abilities

stomach - rapid and uncomplicated
s.int - 75-80% of tensile strength by d 14
l.int - 50% of tensile strength by d 14

Traumatic surgical techniques and electrocautery can affect healing

14

Suture material and why?

Monofilament so no crevices for bacteria, absorbable, retains strength >5 d

E.g PDS II

15

What is an exploratory laparotomy?

direct visual and tactile exam of the abdominal organs at surgery via and incision into the abdomen.

incision from xiphisternum to pubis

16

Gastrotomy

between greater and lesser curvature

repair in 2 layers - mucosa + submucosa and serosa + muscularis

17

Enterotomy

milk contents away
incise along along anti-mesenteric border

18

Liver biopsy

first try fine needle aspirate and trucut biopsy

take from periphery as less blood

19

Pancreas biopsy

Tighten suture ligature around area before cutting

20

Check viability of intestines

pulsations in arterial BV
peristalsis
colour
wall thickness

21

What is luminal disparity and how to get around it?

different opening sizes when resecting the int.
- space sutures further apart on large size
- transect small side at an angle to match diameter
- reduce big side with sutures
- spatulate small side

22

How to do an end - to - end anastomosis

Simple interrupted suture
1st - on mesenteric border as harder to apposition
2nd on anti-mesenteric border

23

Two ways of supporting a wound

omentalisation

serosal patch - tack adjacent healthy int. to wound

24

Signs and how to deal with a string like foreign body?

on radiograph : concertina int., stacking of int

cut string up...multiple enterotomies

25

What is intussusception? Signs? How to reduce?

invagination of one portion of the GI tract into the lumen of an adjoining segment

Signs: abdo pain/mass, parallel lines on ultrasounds, gas distension on radiograph

push to reduce and resect if needed

can prevent hapenning again by entroplication - suturing loops of int together

26

What is the main complication of GI surgery?

Septic peritonitis - bacterial inf of peritoneum
wound dehiscence

27

What are the results of septic peritonitis?

Hypovolaemic shock, systemic infl response, DIC, 50% die

28

Signs and treatment of septic peritonitis?

Signs - vomiting, anorexia, depression, abd pain, hypovolaemia, pyrexia, wound discharge, dia, haematochezia, melaena, haematemesis

3-5 d post surgery

Treat - pre-op stabilisation, exp lap to correct leak, peritoneal lavage and drainage, extensive post op care

29

4 approaches to colorectal surgery

- ventral midline laparotomy
- pelvic split
- dorsal perianal approach
- transanal

30

complication of resecting too much colon?

reduce resevoir and absorptive capacities ( increased faecal frequency and wateryness)

31

How much rectum can be resected out?

no more than 6 cm

32

Surgical diseases of the colon and rectum? (3)

megacolon
colorectal neoplasia
rectal prolapse

33

secondary megacolon causes

pelvic fracture
intrapelvic space occupying lesion
colorectal neoplasia / abcess
perineal hernia
inappropriate diet

34

How to diagnose megacolon?

chronic constipation, tenesmus, vom, anorexia, weight loss, dehydration

35

Signs of colorectal neoplasia

tenesmus, haematochezia, increased defecation frequency, ribbon - like faeces, rectal prolapse, weight loss

36

2 ways to treat colorectal neoplasia

submucosal resection
colorectal resection and anastomosis

37

how to repare a rectal prolaps

resect if needed, push in and put a stitch in anus to decrease diameter.
give faecal softners, anthelmintics, low residue diet

38

treatment of anal sac disease

- mannual expression
- sedate and catheterise them (sample and cytology)
- anal sacculectomy (open or closed removal)