surgical disorders of the stomach Flashcards
(53 cards)
1
Q
list the possible surgical disorder of the stomach
A
- fb
- pyloric stenosis
- neoplasia
- hiatal hernia
*
2
Q
cs of gastric fb
A
- abdominal pain
- vomiting
- anorexia and wt loss
- gastric fb are seldomly palpable
- incomplete or intermittent obstruction causes less frequent vomiting
- mucosal erosions,ulceration or necrosis occurs naturally and may cause melena or hematemesis
3
Q
diagnosis for gastric fb
A
- radiography
- ultrasonography
- endoscopy
- laboratory data: metabolic alkalosis, hypochloremia,hypokalemia
4
Q
treatment for gastric fb
A
- correction of electrolytes,water and acid-base imbalances.
- foreign body removal :endoscopy for small light wt ,soft material ie fabric,.gastroctomy for smooth or heavy objects,sharp or heavy objects,sharp bojects
5
Q
prognosis for gastric fb removal
A
- excellent in most cases
- good even if mucosal damage is present
6
Q
abnormal narrowing of the lumen of the pylorus causing partial obstruction
A
- pyloric hypertrophy/stenosis
- occurs predominantly in dogs and less in cats
- etiology is unknown
7
Q
discuss the etiolgy of pyloric stenosis
A
- occurs as a congenital or acquired dz
- congenital form involves the muscular layer of the pylorus
- acquiered form is hypertrophy of mucosal or muscular layer of pylorus and sometimes of pylorus antrum
8
Q
discus sthe signalment of congenital hypertrophy
A
- puppy or kitten 6-8 weeks
- brachycephalic breeds
- siamese cats
9
Q
cs of pyloric hypertrophy
A
- emanciation,stunted growth
- dehydration
- occassionally fever and increased lung sounds secondary to aspiration of vomitus
10
Q
discuss diagnosis of pyloric hypertrophy
A
- history n signalmentespercially age of onset
- cs
- laboratory data
- radiography
11
Q
discuss radiographic findings of pyloric hypertrophy
A
- Plain radiographs: enlarged stomach filled with food and fluid
- positive contrast gastrography:delayed gastric emptying-prescence of barium in stomach beyond 8-12 hrs is abnormal
12
Q
laboratory abnormalities due to pyloric hypertrophy
A
- malnutrition:hypoproteinemia,anemia,low BUN,hypoglycemia.
- pyloric vomiting:dehydration, hypochloremia metabolic alkalosis
- elevated wbc if aspiration pneumonia occurs
13
Q
discuss history for pyloric hypertrophy
A
- intermitent vomiting not always associated with feedingthat increases in frequenc y over mnths
- wt loss
- occassionally anemia ,depression,decreased activity
14
Q
discuss the signalment for acquired pyloric hypertrophy
A
- middle aged excittable small breeds of dogs, esp lhaso apso and shir-tzu
- rare in cats
15
Q
cs of acquired pyloric hypertrophy
A
- pale mm
- weakness
- emanciation
- dehydration hypochloric metabolic alkalosis
16
Q
discuss radiographic finding of pyloric hypertrophy
A
positive contrast gastrogram
- delayed gastric emptying
- irregular mucosa within pylorus or pyloric antrum
- filling defect in pylorus
17
Q
explain when the endoscope is required for pyloric hypertrophy
A
- narrow lumen in pylorus
- mucosal/submucosal hypertrophy
18
Q
discuss the Pyloric Hypertrophy/Stenosis
A
- Medical treatment not effective
- Surgery:
- Pyloromyotomy
- Pyloroplasties
- Gastroduodenostomy/gastrojejunostomy
19
Q
list the commonly used surgical procedures for pyloric hypertrophy
A
- fredet-ramstedt pyeloromyotomy
- heineke mikulicz pyloroplasty
- Y-U antral advancement flap pyloroplasty
*
20
Q
what is the indication for fredet-ramstedt
A
- congenital pyloric stenosis
21
Q
discuss the surgical technique for fredet-ramstedt
A
- Partial thickness longitudinal incision
from antrum to duodenum across
pylorus
- Seromuscular layer incised to allow mucosa to bulge into incision and
expand pylorus
22
Q
what are the advantages of fredet-ramstedt pyloromyotomy
A
- quik and easy to perform
- lumen of pylorus not opened
23
Q
what are the disadvantages of fredet-ramstedt pyrolomyotomy
A
- effective only in congenital stenosis
- effects may be temporary -stenosis may recur as the seromuscular incision heals
24
Q
discuss indications for heineke mukulicz pylorectomy
A
congenital or acquired pyloric hypertophy, biopsy
25
explain the surgicsl procedure for heineke mukulicz
* A full- A full---thickness longitudinal incision thickness longitudinal incision
crosses the ventral surface of the
pylorus
* The incision is closed transversely in
1 layer of simple interrupted sutures
26
what are the advantages of heineke mukulicz pyroloplasty
* Exposure of mucosa for biopsy
* Less likelihood of recurrence
than pyloromyotomy
27
what are the disadvantages of heineke mukulicz
* Lumen is opened
* Not usually effective with
acquired pyloric hypertrophy
28
what are the indications for Y-U pyroplasty
* acquired pyloric hypertrophy,
* resection of mucosa / submucosa
29
discuss the surgical technique for heineke mukulicz
* Make a longitudinal full---thickness pyloric incision.
* Extend it into the pyloric antrum Extend it into the pyloric antrum making 2 making 2
```
diverging incisions (Y)
The incised gastric wall is closed by
suturing into a āUā shape
```
30
what are the advantages of Y-U pyloplasty
* Good exposure of mucosa
* Redundant mucosa and submucosa
can be resected (use 1 layer closure)
* Greater expansion of pylorus
31
what are the disadvantages of Y-U pyloplasty
* Lumen is opened
* More lengthy procedure
32
what are the indications for Pylorectomy and
## Footnote
Gastroduodenostomy (Billroth I)
* severe acquired pyloric hypertrophy,
* necrosis of pylorus,
* neoplasia
33
discuss the surgical procedure for Pylorectomy and
## Footnote
Gastroduodenostomy (Billroth I)
* Ligate branches of right and left gastric vessels vessels
* Remove omentum omentum and mesentery
* Identify and preserve duodenal papilla
* Excise pylorus and proximal duodenum between clamps
* Correct lumen disparity by partially closing gastric incision
* 1 or 2 layer closure of pyloric antrum to duodenum, closing far side (back wall) of
incision first
34
what are the advantages of Pylorectomy and
## Footnote
Gastroduodenostomy (Billroth I)
* Abnormal tissue removed completely
* All tissue layers excised for biopsy
* Large increase in size of opening to
pylorus
35
what are the disadvantages of Pylorectomy and
## Footnote
Gastroduodenostomy
* Technically difficult, lengthy procedure
* Increased risk of leakage compared to
pyloroplasty techniques
36
what are the indications for partial gastroctomy
* neoplasia, ischemic injury (GDV) or penetrating injury (ulcer or trauma)
* I**schemic injury commonly occurs at the**
**greater curvature**
* Ischemic injury involving both
curvatures is not suitable for surgery
37
explain the incisional techique for partial gastrecctomy
* branches of the gastroepiploic vessels to the affected area are ligated.
* a continuous suture may be run concurrently with resection
* the incision is closed in 2 layers
38
discuss the morphological appearance of the adenocarcinoma
* primarily may be scirrhous or infiltrative
* scirrhous:firm and white on serosal surface
* infiltrative:expansive with central crator and ulceration on mucosal surface.
39
treatment for gadenocarcinoma
* Partial gastrectomy
40
what are the disadvantage of partial gastrectomy when treating adenocarcinoma
* more difficult on lesser curvature
* gastroduodenostomy or gastrojejunostomy often required
* cholecystoenterotomy may be required with pyloric tumers
41
indications for gastrojejunostomy
* neoplasia
* necrosis of pylorus or antral region of stomach
42
discuss the surgical technique of pylorectomy and gastrojejunostomy
* ligate branches of right and left gastric and gastroepiploic vessesls
* remove omentum and mesentery, identify deodenal papillae
* resect pylorus,pyloric antrum and proximal deodenum
* Close duodenal and antral stumps
* Complete with side-to-side anastomosis of stomach and a loop of proximal jejunum
43
advantages of gastrojejunostomy (billroth)
* abnormal tissue removed
* compared to bilroth 1,reduces tension on suture line when extensive resection is required
44
disadvantages of pylorectomy and gastrojejunostomy (biliroth)
* difficult legnthy procedure,not rewarding
*
*
* marginal ulceration of jejunal limb from exposure to gastric fluid
45
discuss the prognosis for gastric adenoma
complete excusion is curative
46
discuss the prognosis for leiomyoma/ leiomyosarcoma
mean survival:1 yr
47
discuss the pregnosis for adenocarcinoma
surgery is palliative (preventing surfuring)
mean survival is 6 mnths
48
define heital hernia
protrution of abdominal esophagus, gastroesophageal junction and sometimes a portion of gastric fundus through the esophageal hiatus of the diaphragm into the caudal mediastinum
49
discuss etiology for hiatal hernia
* usually congenital,associated with abnormalities of hiatus, espercially of the phrenicoesophageal lig.
* possible traumatic
* may be associated with upper airway obstruction
50
discuss the signalment for hiatal hernia
* dogs and cats
* male shar peei and bulldogs predisposed
51
discuss the history for hiatal hernia
* often asymptomatic
* reguagitation ,vomiting or dyspnea
* hematemesis
* anorexia,wt loss
52
diagnosis for heital hernia
* radiography,flouroctomy
* endoscopy (esophagitis)
53
surgical treatment for heital henia
* for symptomatic patients only
* gastroplexy-left sided fundus to body wall
* hiatal reduction and esophagopexy
* gastrostomy tube
* nissen fundoplication -indicated only if reflux and esophagitis are present
