SOFT TISSUE SX 6 &7 : stomach & SI

Question 1

What is a gastrotomy?

Answer 1

Incising the stomach

Question 2

What does a gastrectomy involve?

Answer 2

Excising a portion of the stomach

Question 3

Define gastrostomy.

Answer 3

Creating a stoma usually using a tube in the stomach

Question 4

What is a gastropexy?

Answer 4

Fixing stomach to body wall

Question 5

What are 4 significant risks during gastrointestinal surgery?

Answer 5

-Intra-operative contamination
-post-operative dehiscence and leakage
-septic peritonitis
-iatrogenic obstruction

Question 6

What are 2 items that can be used to exteriorise and isolate contamination from the rest of the abdomen?

Answer 6

swabs
laparotomy pad

Question 7

What are 5 ways that the stomach can be isolated in cases of contmaination?

Answer 7

stay sutures
babcock forceps
packing around the site
occlude stomach on either sides of incision
stay suture to tent stomach

Question 8

What are 3 techniques/strategies to reduce risk of dehiscence in surgery?

Answer 8

atraumatic tissue handling

omental wrap [good for blood supply, immune response…]

serosal patch [serosa from different region of intestine sutured on incision]

Question 9

What is the percentage of degiscence?

Answer 9

5-10%

Question 10

To reduce risk of dehisence, what type of suture material should be used?

mono or multi?
synthetic or natural?
absorbable or non-absorbable?

Answer 10

monofilament, synthetic, absorbable

Question 11

What are the two main indications for gastrotomy

Answer 11

foreign body removal
biopsy

Question 12

What are the steps to a gastrotomy?

Answer 12

expose stomach

pick avascular area away form pylorus

place stay sutures on either side

tent stomach and isolate with swabs

stab with no.11 scalpel

extend incision

Question 13

Does the stomach have a large or small collateral blood supply?

Answer 13

large

Question 14

How many layers are included in the closure of a gastrotomy? (just stomach, not wall/skin etc)

What are the layers?

Answer 14

1-2

1:mucosa & submucosa
2: muscularis & serosa

Question 15

Should patients be fasted after gastrotomy surgery?

Answer 15

no

Question 16

List some clinical signs of gastric disease.

Answer 16

• Vomiting
• Haematemesis
• Melena [black feces]
• Dehydration
• Loss of appetite
• Weight loss

Question 17

What can gastric foreign bodies cause?

Answer 17

Pyloric/intestinal obstruction and rapid deterioration
[can also be incidental]

Question 18

What diagnostic tool is used to detect radio-opaque foreign bodies?

Answer 18

Radiography

Question 19

What is the size of a normal fundus? [in relation to # of intercostal spaces]

Answer 19

normal fundus < 3 icsp
if >6 icsp, suspect pathology

Question 20

How can gastric foreign bodies be treated? (3 ways)

Answer 20

• Induce emesis
• Endoscopic removal
• Gastrotomy

Question 21

Define primary peritonitis.

Answer 21

Spontaneous, inflammation with no primary cause. less common

Question 22

What is an example of a condition causing secondary peritonitis?

Answer 22

FIP

Question 23

What substances is secondary peritonitis commonly caused by?

Answer 23

urine
bile
pyometra
pancreatitis

Question 24

What are clinical indicators of peritonitis?

Answer 24

• History of GI surgery/foreign body sx
• Dullness/lethargy
• Abdominal distension
• Abdominal pain

Question 25

What clinical signs may indicate septic peritonitis?

Answer 25

* Signs of shock * Signs of sepsis * Pyrexia

Question 26

What can be seen on radiographs for diagnosing peritonitis?

Answer 26

* Loss of serosal detail in radiograph due to free fluid * Free abdominal gas

Question 27

Which is preffered for diagnosing perotinitis: ultrasound or radiographs?

Answer 27

US [free abdominal fluid present in front of bladder]

Question 28

What is abdominocentesis?

Answer 28

4 quadrant tap or ultrasound guided tap to analyze fluid

Question 29

What is the treatment for septic peritonitis?

Answer 29

Surgical emergency requiring oxygen, fluid resuscitation, antimicrobials, control of the source, nutrition, management of organ damage

Question 30

True or False: Septic peritonitis is most common in cats.

Answer 30

False

Question 31

What is an enterotomy?

Answer 31

Incision into the intestine

Question 32

Define enterectomy.

Answer 32

Removal of a segment of the intestine

Question 33

What is intestinal resection and anastomosis?

Answer 33

Enterectomy with re-establishment of the cut ends

Question 34

What does enteroplication refer to?

Answer 34

Surgical fixation of one intestinal segment to another, in parallel

Question 35

What two structures can be used to find/ identify the duodenum in surgery?

Answer 35

pancreas Duodeno-colic ligament

Question 36

What can be used to find /identify the jejunumin surgery

Answer 36

Arcading blood supply

Question 37

What can be used to find /identify the ileum in surgery

Answer 37

Antimesenteric vessels and connection to the cecum

Question 38

What is the main strength holding layer of the intestine?

Answer 38

Submucosa

Question 39

What are the common clinical signs of intestinal foreign body ingestion?

Answer 39

Vomiting, loss of appetite, abdominal discomfort, diarrhoea, melaena

Question 40

What are extra considerations in linear foreign bodies?

Answer 40

causes intestinal plication [due to peristalsis trying to move it down]

Question 41

What are two types of surgeries to treat a foreign body?

Answer 41

enterotomy enterectomy

Question 42

Describe how to perform a leak test in an enterotomy

Answer 42

To check for leaks after closure

Question 43

Does omentalisation need to be sutured into place?

Answer 43

no

Question 44

True or False: It is acceptable to incise directly over a foreign body or injured site.

Answer 44

False

Question 45

What should be done to isolate the intestine during surgery?

Answer 45

Exteriorize, use swabs to isolate, hold away from abdomen, milk contents away, occlude the lumen

Question 46

What are the systemic effects of intestinal foreign bodies? local effects?

Answer 46

S: Dehydration, electrolyte loss, weight loss L: pressure necrosis, perforation, peritonitis

Question 47

What is a common site for luminal disparity in animals?

Answer 47

Ileocaecocolic junction

Question 48

What are ways to reduce contamination in intestinal sx?

Answer 48

isolate intestine lavage & suction atraumatic handling

Question 49

what is the name of these long clamps?

Answer 49

doyen clamps

Question 50

to assist with atraumatic tissue hadnling, wht are two types of foreceps that can be used? and one type tht should not be used

Answer 50

2 good: plain forceps, debakey forceps do not use: rat toothed forceps

Question 51

what is the post common primary care intestinal pathology?

Answer 51

foreign body

Question 52

what are 4 common intestinal apthologies?

Answer 52

Question 53

What could be seen in bloodwork results of a patient with a foreign body obstruction?

Answer 53

hypochloremia: losing chloride through vomiting

Question 54

describe the pathophysiology/local effects of foreign body

Answer 54

Question 55

describe the systemic effects of a foreign body

Answer 55

Question 56

Other than seeing the foreign bdoy itself, what can be seen in radiology to diagnose a foreign body?

Answer 56

distended loops of small intestine peritonitis plications arounds the foreign body

Question 57

Other than seeing the foreign bdoy itself, what can be seen in ultrasounds to diagnose a foreign body?

Answer 57

distended loops with fluid or gas

Question 58

describe the steps to a intestional foreign body enterotomy

Answer 58

ADD MORE

Question 59

When would an enterecotmy be performed (Rather than an enterotomy?)

Answer 59

when intestine is not viable

Question 60

What are the steps to an intestinal resection (not anastamosis)

Answer 60

ADD MROE

Question 61

What are the steps to an anastamosis?

Answer 61

ADD MORE

Question 62

what is the msot common site of iatrogenic leakage post anastamosis?

Answer 62

mesenteric border

Question 63

What is the solution to a luminal disparity during anastamosis? [luminal disparity=one diameter is larger than another]

Answer 63

Question 64

What are common causes of intussusception in young animals?

Answer 64

Question 65

INTESTINAL BIOPSY

Answer 65

ADD MORE

Question 66

What are some options for fixing and preventing recurrence in an intussusception lesion?

Answer 66

1. reduce intussusception (manually pull it apart) 2. intestinal resection and anastamosis 3. enteroplication [rare n usually not indicated]