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Smallies 10 Flashcards

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1
Q

What can we use to help exteriorise the stomach during gastric surgery?

A

Stay sutures

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2
Q

How can we prevent contamination during gastric surgery?

A

Pack the area with swabs

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3
Q

How can we prevent cutting blood vessels during gastric surgery?

A

Make a longitudinal incision along the long axis

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4
Q

what are the two obviously visualised layers of the stomach when it is incised?

A

submucosal/mucosal and serosal/muscular

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5
Q

How should you close the stomach?

A

When closing use a two-layer closure

Can do both layers simple interrupted, both layers simple continuous, first as continuous, second inverting etc

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6
Q

If there is an intestinal obstruction why might we need toremove the proximal bowel? What is the risk if we leave it in?

A

Risk of ileus
If left in, this commonly means that the bowel will stay in ileus, so empty the bowel to reduce chance of endotoxaemia and encourage normal functioning post-surgery. Ileus can be as serious as the initial obstruction

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7
Q

How can we prevent contamination of the peritoneum when performing an enterotomy?

A

Exeriorise the bowel
Pack area with swabs
Can use a second drape when removing the ingesta
When you have emptied the bowel you should reglove to continue asepsis

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8
Q

How do you close the intestine?

A

To close you almost invariably use a single layer, full thickness

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9
Q

What is the purpose of using 4 clamps to exteriorise the bowel?

A

The two inner clamps can be crushing as that part of the bowel will be removed. They are there is prevent contamination from the part of the bowel being removed.
The outer clamps are atraumatic and are preventing the ingesta from the bowel proximal and distal to the part being removed from contaminating the abdomen.

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10
Q

Desribe the blood supply to the bowel

A

The blood supply is via the jejunal arteries, then the arcade vessel that comes in on antemesenteric border. Vessels come in at 90o to the long axis of the bowel

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11
Q

Why should you not transect the bowel at 90 degrees?

A

The tips on the antemesenteric border may have poor blood supply

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12
Q

How can you prevent contamination of surgical field of the bowel by the mucosa?

A

The mucosa is often trimmed with curved Metzenbaum scissors down to the submucosa layer so when bowel ends are brought together no mucosa is poking out

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13
Q

What is the best suture pattern to close the bowel?

A

Simple continuous closure of bowel is the most efficient method. Simple interrupted patterns are not wrong, but just means lots of knots need to be tied - can be up to 30 individual knots.

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14
Q

Explain how you close the bowel

A

To close, place one full thickness suture on the mesenteric side and one suture on the antemesenteric border. Work round with one suture and tie the long end to the short end of the second thread, then repeat going up the other side

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15
Q

How should you close the mesentery?

A

Close this with a simple continuous pattern using the mesentery to close it

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16
Q

What are the benefits of omentalisation?

A

this brings in factors to encourage healing e.g. blood supply, oxygen, inflammatory cells etc

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17
Q

When is dehiscence most likely to occur?

A

Most likely to break down in the first week

Most common between day 5 and 7

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18
Q

If you suspect dehiscence of bowel anastomosis and peritonitis what should you do?

A

To investigate complete an ultrasound, run bloods (including electrolytes) and do abdominocentesis.
If you suspect peritonitis, then act proactively

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19
Q

How should you treat dehiscence of bowel anastomosis?

A

Treat aggressively and give antibiotics

Surgery

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20
Q

What antibiotics should you give if you suspect dehiscence of bowel anastomosis?

A

We will want a broad spec antibiotic e.g. Amoxiclav plus fluoroquinolone (enrofloxacin in the dog and marbofloxacin in the cat) until proven otherwise with C+S.

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21
Q

List common conditions of the rectum and anus

A 
Anal sac disease
Anal furunculosis
Anal adenomas
Other peri-anal neoplasia
Rectal prolapse
Rectal stricture
Rectal neoplasia
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22
Q

How can you prevent bacterial contamination when dealing with an anal or rectal condition?

A

Large clip
Evacuate rectum and place purse string suture or pack with swabs
Don’t use enemas – just liquefies the faecal matter, causing more contamination
Pre-op IV antibiotics; e.g., cephalexin/metronidazole

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23
Q

Why is there a high risk of haemorrhage with anal and rectal surgery?

A

Very vascular area

Lots of perineal branches of major vessels

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24
Q

Where are anal sacs located?

A

Located at 4 and 8 o’clock in between external and internal anal sphincters

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25
Why do we see anal sac disease?
Disease occurs due to a change in consistency of secretion or interference with normal duct emptying; e.g. diarrhoea, diet, tapeworm, seborrhoea, oestrus, scar tissue
26
What is the typical clinical presentation of a patient with anal sac disease?
Perineal irritation | Scooting
27
What is a differential for anal sac disease?
Fleas
28
How can anal sac disease be diagnosed?
Palpation
29
If you express blood from the anal sacs, what is this an indication of and what is an important consideration?
Blood is an indication of an abscess, this will be painful for the patient if you try to express
30
If you express blood from the anal sacs, what action and treatment is required?
Blood tinged material/pus requires lavage and packing with local antibiotic
31
What are indications for anal sacculectomy?
Recurrent impaction Neoplasia – most common reason for anal gland removal On occasion, an additional component of the treatment for to perianal fistula (anal furunculosis)
32
What is the difference between an open and closed anal sacculectomy?
In a closed, we remove the anal glands by not cutting the wall of the sac and in the open procedure we do cut the wall of the sac (risk of contamination to surgery site)
33
How can we highlight the anal gland for a closed anal sacculectomy? And why?
Fill the anal sac with a resin which hardens and highlights the gland This prevents accidntally cutting the wall
34
What are complications fo anal sacculectomy?
Draining sinus formation leaving to persistent draining fistula (some gland left behind) Infection (can lead to dehiscence) Dehiscence Tenesmus – improper analgesia peri-operatively can lead to the patient continuing to scoot and causing trauma to surgery site Faecal incontinence
35
What is anal furunculosis?
Suppurative, progressive, deep ulcerating tracts in the perianal tissues
36
What breed is predisposed to anal furunculosis?
GSD
37
What are signs fo anal furunculosis?
Low tail carriage | Reluctence to pass faeces
38
Why are GSDs predisposed to anal furunculosis?
Increased density of apocrine glands in perineum
39
What is the treatment for anal furunculosis?
Cyclosporin (Atopica) for 12 weeks will resolve 60% but 70% of these will recur in 4 to 17 months Hypoallergenic diet and immunosuppressive doses of prednisolone If a failure to respond to cyclosporin then check no anal sac involvement. If there is, then the dog will require an anal sacculectomy whilst you remove the tracts
40
What are adverse affects fo long term cyclosporin use?
v+/d+, coat changes, nephrotoxicity or hepatotoxicity, gingival hyperplasia
41
Where are perianal adenomas most commonly found?
Hairless area of anal ring most common location, can see at tail base, prepuce and ventrum
42
How can we differentiate between a perianal sebaceous gland adenoma and a malginant adenocarcinoma?
Biopsy
43
What are clinical signs of anal adenocarcinomas?
Dyschezia and pain | Some have sublumbar LN enlargement
44
What is the treatment for anal adenocarcinomas?
Aggressive surgical removal with adequate margins is indicated – not curative alone Adjunctive radiotherapy but rarely curative
45
What is the prognosis for anal adenocarcinomas?
Poor prognosis due to local recurrence and metastasis
46
Which dogs commonly get anal sac adenocarcinoma?
Older (>10yrs) female dogs
47
What are anal sac adenocarcinomas?
Small discrete nodules in the wall of the ansl sac that secretes PTH-like substance
48
What are clinical signs of anal sac adenocarcinoma?
PU/PD, depression, weakness, weight loss
49
What are neoplastic differentials of anal sac adenocarcinoma?
lymphoma and mammary carcinoma
50
What is diagnosis of anal sac adenocarcinoma based on?
``` Palpation – there is an obvious nodule felt, will often just be a small nodule but will have a characteristic feel Biochemical findings Abdominal/thoracic radiographs Abdominal/thoracic CT scans Ultrasound of sublumbar lymph nodes ```
51
What should you do if a patient with anal sac adenocarcinoma is hypercalcaemic?
Treat hypercalcaemia first - don’t anaesthetise a patient with hypercalcaemia
52
What is the treatment for anal sac adenocarcinoma?
Excision of primary mass Metastectomy Adjunctive chemotherapy
53
What is rectal prolapse often associated with?
Endoparasites/enteritis in young animals (straining for a long period of time) and tumours or perineal hernias in middle aged/older animals
54
What is an incomplete prolapse?
Just mucosa prolapsed
55
What is a complete prolapse?
All layers of rectal wall in entire circumference
56
What can you do with an acute presentation of a rectal prolapse?
Lavage Lubricate Reduce and place purse string suture
57
How do you treat a non-reducible or severely traumatised rectal prolapse?
Amputation
58
How can you treat a recurrent but reducible rectal prolapse?
Colopexy
59
What is a colopexy?
Surgery to suture the colon to the wall of the peritoneum
60
What is a rectal stricture often secondary to?
To proctatitis chronic anal sacculitis, penetrating foreign bodies or as complication of anorectal surgery
61
What are clinical signs of rectal stricture?
dyschezia, constipation and tenesmus
62
How is a rectal stricture diagnosed?
Diagnosed by digital rectal exam – will be a tough palpable structure that will be hard to get your finger passed
63
How can you differentiate a rectal stricture from neoplasia?
Deep biopsy
64
What is the treatment for superficial rectal stricture?
Superficial strictures treated by bougienage (well lubricated finger/blunt instrument used to gently stretch the tissue) This may need to be repeated at regular intervals for many days Corticosteroids then for 2-3 weeks
65
What is the treatment for extensive rectal strictures?
Require resection by, for example, rectal pull-through If the stricture is right at the end of the rectum, by the anus, you can evert the tissue and do the surgery externally Several surgical approaches – dependent on location of stricture
66
What is the mean age for rectal polyps to develop?
7yrs
67
What are clinical signs of rectal polyps?
Blood/mucus in faeces Tenesmus can occur Polyp can occasionally prolapse from anus Secondary rectal prolapse can occur
68
What is the treatment for rectal polyps?
Small pedunculated masses can be removed from distal rectum with electrocautery, or excision and suture placement Larger polyps may need intestinal resection
69
What do rectal adenocarcinomas do?
Invades rectal wall causing fibrosis and stricture
70
What are clinical signs of rectal adenocarcinomas?
Tenesmus, dyschezia, weight loss and lethargy with advanced malignancy
71
How are rectal adenocarcinomas diagnosed?
Palpation, (contrast) radiography, ultrasound, endoscopy/proctoscopy
72
What are the 3 common sites of rectal adenocarcinomas?
Colorectal junction and cranial 1/3 rectum Middle 1/3 rectum Caudal 1/3 rectum and anal canal
73
What is atresia ani?
Neonate with absent anus
74
What are the signs of atresia ani?
Tenesemus and buldging perineum
75
How is a diagnosis of atresia ani confirmed?
Radiogrphy
76
What is the trreatment for atresia ani?
Involves creation of an anus by excision of skin and terminal rectal mucosa and careful suturing
77
What is a hernia?
A protrusion of an organ or part of an organ through a defect in the wall of the anatomical area in which it normally lies
78
WHat is the difference between a hernia and a rupture?
A hernia consists of a hernial ring and sac. By comparison, a rupture normally has no ring or sac
79
What are common hernia locations?
``` Umbilical Inguinal Incisional Diaphragmatic Perineal Pericardio-peritoneal Hiatal ```
80
What are aims of hernia surgery?
Return hernia content to normal location Secure closure of neck of sac Obliterate redundant tissue in the sac Try to use the patients own tissues for repair
81
How can you surgically reduce a hernia?
Directly incise over site Ensure adequate exposure Try to use atraumatic technique Breakdown adhesions Check viability of herniated tissues especially if strangulated hernia Resect non-viable tissue before returning to abdominal cavity
82
Why should you use monofilament when closing a hernia?
To avoid sinus formation
83
Why do we see umbilical hernias?
Usually congenital due to failed embryogenesis | Thought to be inherited
84
What will you see with an umbilical hernia?
Clinically soft, painless swelling at umbilicus
85
What should you suspect if an umbilical hernia is not soft and painless?
That there is a piece of strangulated bowel within the hernia
86
How can you diagnose an umbilical hernia?
Palpation is usually sufficient
87
How can you treat umbilical hernias?
Can resolve spontaneously if small (just left with fibrous scar at the umbilicus), or be corrected at neutering (unless you have a strangulating hernia, or it is especially large) Repair by reducing, incise over hernia, excise sac and repair muscle edges
88
What should you close an umbilical hernia repair with?
Close with synthetic, absorbable, monofilament suture; e.g., polydioxanone, using a single interrupted or continuous pattern to close the linea alba
89
What is the most common cause of an incisional hernia?
Failure of the linea alba | Due to incorrect technique or suture material
90
What are clinical signs of an incisional hernia?
Oedema, inflammation and serosanguinous fluid often pre-empt Soft painless swelling Palpable defect Exposed viscera
91
Why does an incisional hernia need to be repaired asap?
high risk of peritonitis, especially if there is exposed viscera
92
What is the treatment for an incisional hernia?
Tell owner to keep area moist and wrap the bowel in a towel Lavage and resect nonviable tissues/anastomose bowel if necessary Re-open and repair entire wound Only debride edges if infection or are non-viable Suture external sheath of rectus abdominis (strongest holding layer)
93
What is a traumatic abdominal rupture caused by?
Blunt trauma | Bite
94
What are inguial hernias associated with?
Due to congenital inguinal ring abnormality or trauma | Can be associated with obesity/pregnancy – spotaneous development
95
What dogs are non-traumatic inguinal hernias normally seen in?
In intact female middle aged dogs or under 2-year-old male dogs Small breeds e.g. Cairn/WHWT
96
What is the most common content of an inguinal hernia?
Omentum
97
When do diaphragmatic hernias occur?
Occurs commonly during inspiration (increased pressure) when there is a large traumatic force applied
98
What part of the diaphragm is most commonly affected by a hernia?
Muscular portion of diaphragm most commonly affected as weakest point
99
What are clinical signs of a diaphragmatic hernia?
Normally present shortly after trauma shocked Pale/cyanotic Tachypnoeic/dyspnoeic Tachycardic Occasional cardiac arrhythmias – pericardium irritated Hydrothorax – fluid in the thorax so hard to hear the heart
100
What will you see on radiography in a patient with a diaphragmatic hernia?
Loss of diaphragmatic line Loss of cardiac silhouette Presence of gas filled structure in thorax Atelectasis – collapse or closure of a lung resulting in reduced or absent gas exchange Displaced abdominal organs

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