Surgery of the ailmentary tract

Question 1

Describe GDV

Answer 1

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

Question 2

What are the early clinical signs of GDV?

Answer 2

Depression

Salivation

Attempting to vomit (unproductive retching)

Distended abdomen

‘Flank’ watching

Collapse

Tachycardia with possible arrhythmias and tachypnoea

Pale mucus membranes and increases CRT

Question 3

Describe the pathogenesis of GDV

Answer 3

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

Question 4

Describe management of GDV

Answer 4

Orogastric intubation

Percutaneous needle

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

Question 5

What equipment is needed for a orogastric intubation?

Answer 5

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

Question 6

Describe patient prep for an orogastric intubation

Answer 6

Sedated if anxious – care hypotension

Right lateral abdominal radiograph

Place on table or trolley to use gravity

Sitting or sternal, right lateral if needed

Question 7

Describe placement of orogastric intubation

Answer 7

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

Question 8

What equipment is needed for a percutaneous needle?

Answer 8

Normal surgical prep equipment

16 or 18G over the needle intravenous catheter.

Question 9

Describe patient prep for a percutaneous needle

Answer 9

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.

Question 10

Describe how to use a percutaneous needle for a GDV

Answer 10

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.

Question 11

What are the goals of surgery for a GDV?

Answer 11

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.

Question 12

What is an gastrotomy?

Answer 12

incision into the stomach

Question 13

When is a gastrotomy required for a GDV?

Answer 13

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

Question 14

What are GDV patients susceptible to?

Answer 14

hypotension, cardiac arrhythmias

Question 15

Why is GDV surgery high risk?

Answer 15

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

Question 16

What is a gastropexy?

Answer 16

Recommended treatment following a GDV

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

Question 17

Describe complications of a gastropexy

Answer 17

Wound infection

Seroma formation

Abdominal wall dehiscence

Gastrotomy dehiscence

Peritonitis

Intestinal Ileus

Vomiting

Question 18

Describe post operative care for GDV surgery

Answer 18

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

Question 19

How can you prevent GDV?

Answer 19

Feed animals at least twice daily

Do not exercise after food

Feed from a height

Question 20

Describe foreign bodies

Answer 20

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

Question 21

What are the clinical signs of a foreign body?

Answer 21

Persistent vomiting

Anorexia

Dehydration

Abdominal discomfort

Question 22

How do you diagnose a foreign body?

Answer 22

Some foreign bodies can be palpated

Confirmation is normally undertaken by radiography

Contrast media may be required

Question 23

What surgery options are available for a foreign body?

Answer 23

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

Question 24

Describe an enterectomy

Answer 24

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

Question 25

Describe a linear foreign body

Answer 25

Result in a partial obstruction only Vague symptoms seen Commonly in cats linear fb’s are anchored around the tongue

Question 26

Why might a linear foreign body be dangerous?

Answer 26

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

Question 27

Describe post operative care for the removal of a foreign body

Answer 27

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

Question 28

What is intussusception?

Answer 28

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.

Question 29

What are the most common animals to get an intussesception?

Answer 29

APPROXIMATELY 80% OF CASES LESS THAN ONE YEAR IN DOGS MOST CASES THREE MONTHS OR YOUNGER.

Question 30

What are the causes of an intussusception?

Answer 30

Bowel hypermobility secondary to diseases such as – Enteritis Intestinal parasites Intestinal Foreign bodies Intestinal masses Previous surgery

Question 31

What are the clinical signs of intussusception?

Answer 31

Vomiting Diarrhoea Dehydration Abdominal pain Tenesmus (ineffectual and painful straining to defecate)

Question 32

Describe surgery for an intussusception

Answer 32

Exploratory laporotomy: - Attempt to manually ‘milk out’ the intussusceptum - Resection of the intussusceptum and anastomosis is often required Intussusceptions can recur. Enteroplication is required to prevent this. This involves suturing loops of intestine together to form adhesions

Question 33

Describe an abdominal lavage

Answer 33

Indicated following many abdominal surgical procedures in an attempt to reduce the level of contamination Large volumes of warmed, sterile, isotonic fluids (Hartmann’s) into the abdomen Suction to remove until they come away clear Repeat lavage as needed. All lavage fluid must be removed as remaining fluid reduces the ability of the immune system to clear remaining bacteria Waterproof surgical drapes should ideally be used to prevent strike through

Question 34

What equipment can you use for an abdominal lavage?

Answer 34

Poole Suction Tip and a Suction machine 50ml catheter tip syringe

Question 35

Define Anastomosis

Answer 35

establishment of communication between two section of bowel (rejoining of two pieces of bowel following an enterectomy)

Question 36

Define an Enterectomy

Answer 36

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

Question 37

Define Enteroplication

Answer 37

Creation of permanent adhesions between loops of bowel

Question 38

Define Enterotomy

Answer 38

Incision into the intestine to create an opening

Question 39

Define Exploratory Laparotomy

Answer 39

Incision into the abdomen to examine the contents

Question 40

Define Intussusception

Answer 40

invagination of one part of the intestine into another

Question 41

Define Gastropexy

Answer 41

surgical fixation of the stomach, most commonly to the abdominal wall

Question 42

Define Gastrotomy

Answer 42

incision into the stomach