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Flashcards in Surgery of the ailmentary tract Deck (42)
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1

Describe GDV

A condition normally seen in deep chested animals e.g. Greyhounds, German Shepherds, Pointers etc

Usually the animal has been fed, normally on dry food, and then exercised

2

What are the early clinical signs of GDV?

Depression

Salivation

Attempting to vomit (unproductive retching)

Distended abdomen

‘Flank’ watching

Collapse

Tachycardia with possible arrhythmias and tachypnoea

Pale mucus membranes and increases CRT

3

Describe the pathogenesis of GDV

Stomach dilates due to accumulation of gas or fluid

The dilation can progress to a torsion if the stomach starts to rotate

The rotation twists the distal oesophagus and the duodenum stopping anything leaving the stomach in either direction

Stomach continues to extend putting pressure on the hepatic portal vein and caudal vena cava – reducing venous return

Hypovolaemic shock occurs due to the reduced blood flow back to the heart

Blood flow to the stomach is compromised resulting in necrosis of the stomach wall

4

Describe management of GDV

Orogastric intubation

Percutaneous needle

One or both methods used in an attempt to stabilise the patient prior to surgery

5

What equipment is needed for a orogastric intubation?

Wide-bore stomach tube

7.5cm wide roll of adhesive bandage with a hollow plastic core

Funnel

Bucket

Warmed normal (0.9%) saline, lactated Ringer’s (Hartmann’s) solution or tap water

6

Describe patient prep for an orogastric intubation

Sedated if anxious – care hypotension

Right lateral abdominal radiograph

Place on table or trolley to use gravity

Sitting or sternal, right lateral if needed

7

Describe placement of orogastric intubation

Mark stomach tube – level of dogs nose to 11th rib

Insert the bandage into the dogs mouth.

Hold closed or apply tape as a muzzle

Insert stomach tube through bandage core.

Rotation of the tube can help passage

8

What equipment is needed for a percutaneous needle?

Normal surgical prep equipment

16 or 18G over the needle intravenous catheter.

9

Describe patient prep for a percutaneous needle

Sedation and radiography as above

Position patient in left lateral or sternal recumbency

Aseptic skin preparation over the most distended part of the right abdominal wall.

10

Describe how to use a percutaneous needle for a GDV

Define the site of greatest tympany

Insert the catheter though the abdominal wall directly into the stomach

Remove the stylet of the catheter and allow air to escape freely from the stomach.

11

What are the goals of surgery for a GDV?

To decompress the stomach

Return the stomach to its normal anatomical position. Normally the stomach rotates in a clockwise direction

Evaluate organs such as the stomach, spleen and pancreas for viability

Perform a gastropexy to prevent recurrence.

12

What is an gastrotomy?

incision into the stomach

13

When is a gastrotomy required for a GDV?

indicated to remove any large food particles still in the stomach and unreleased gas

14

What are GDV patients susceptible to?

hypotension, cardiac arrhythmias

15

Why is GDV surgery high risk?

Immediately after the stomach is returned to its normal position due to the release of toxins into the blood stream

16

What is a gastropexy?

Recommended treatment following a GDV

Surgical fixation of the stomach. Most commonly to the abdominal wall

17

Describe complications of a gastropexy

Wound infection

Seroma formation

Abdominal wall dehiscence

Gastrotomy dehiscence

Peritonitis

Intestinal Ileus

Vomiting

18

Describe post operative care for GDV surgery

Close patient monitoring is essential in the first 48 hours

The prognosis should always be guarded – endotoxic shock

Intravenous fluids should continue until the animal is eating well

Reintroduction of food gradually of a bland nature. Timing is dependant on the vets management

19

How can you prevent GDV?

Feed animals at least twice daily

Do not exercise after food

Feed from a height

20

Describe foreign bodies

Normally caused by the ingestion of non digestible materials

The location of the object will depend on its size, larger items tend to stay within the stomach

21

What are the clinical signs of a foreign body?

Persistent vomiting

Anorexia

Dehydration

Abdominal discomfort

22

How do you diagnose a foreign body?

Some foreign bodies can be palpated

Confirmation is normally undertaken by radiography

Contrast media may be required

23

What surgery options are available for a foreign body?

Exploratory Laparotomy to determine (confirm) needed procedure

Gastrotomy:

Incision into the stomach to create an opening

Use of ‘stay sutures’ to ease the procedure

Enterotomy:

Incision into the intestine to create an opening

Use of Doyle's Intestinal forceps or assistants fingers to clamp bowel

24

Describe an enterectomy

Removal of a section of bowel if the tissue has been compromised

Use of Doyle's forceps or assistants fingers to clamp to bowel

Anastomosis to reconnect the intestine

Following surgery Omentum is wrapped around the operation site

25

Describe a linear foreign body

Result in a partial obstruction only

Vague symptoms seen

Commonly in cats linear fb’s are anchored around the tongue

26

Why might a linear foreign body be dangerous?

Intestines ‘bunch up’ around FB

FB may cut through mesenteric border and result in multiple perforations

Removal involves multiple enterotomies and careful inspection of GI tract

27

Describe post operative care for the removal of a foreign body

Intravenous fluids until the animal is eating well

Introduction of small, bland meals

Observation for vomiting and diarrhoea

Monitor for signs of peritonitis –
- Pyrexia

Gradual reintroduction of normal diet

28

What is intussusception?

Invagination of one part of the intestine into another.

Classified according to the site at which they occur. Commonly - ileocaecocolic

Increased motility in a segment of intestine (hyper motility) adjacent to a segment that has lack of motility (ileus) can cause the hyper motile segment to telescope into the segment with ileus, resulting in an intussusception.

29

What are the most common animals to get an intussesception?

APPROXIMATELY 80% OF CASES LESS THAN ONE YEAR

IN DOGS MOST CASES THREE MONTHS OR YOUNGER.

30

What are the causes of an intussusception?

Bowel hypermobility secondary to diseases such as –

Enteritis

Intestinal parasites

Intestinal Foreign bodies

Intestinal masses

Previous surgery