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9- SA- Gastrointestinal and Hepatic Disease > Surgical investigations and interventions > Flashcards

Surgical investigations and interventions Flashcards

1
Q

What are the 4 purposes you could use an exlap for

A

diagnostic
prognostic
therapeutic
preventative purposes

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2
Q

If you dont find anything on exlap, what should you do

A

take samples

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3
Q

Name the 5 regions of the abdomen

A
  1. Cranial quadrant
  2. Intestinal tract
  3. Right paravertebral region
  4. Left paravertebral region
  5. Caudal quadrant
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4
Q

what is the best way to close the linea alba

A

continuous suture pattern
so even distribution of tension
absorbable monofilament

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5
Q

describe post-op management of an exploratory laporotomy

A

Restricted exercise for 2-3 weeks
Monitor the incision
monitor behavious and feeding
removal of skin sutures 7-10 days post-op

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6
Q

list 3 indications of oesophageal surgery

A

Placement of oesophagostomy feeding tube (common)
Removal of an oesophageal foreign body
Partial oesophagectomy for resection of an oesophageal tumour (very rare)

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7
Q

describe how to approach investigating a potential oesophageal foreign body

A

high index of suspicion from clinical history
plain radiography
endoscopy

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8
Q

list 3 disorders that PEG tubes are most commonly placed in

A

dysphagia
oesophageal disorders
chronic diseases that may require long-term nutritional assistance

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9
Q

what is a PEG tube

A

percutaneous endoscopic gastrostomy
are a minimally invasive and highly effective method for providing proper nutrition to dogs and cats.

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10
Q

What is the suture holding layer of the stomach

A

submucosal layer

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11
Q

How can we differentiate the dueodenum and jeunum

A

the duodeno-jejunal ligament is present at the point where they change

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12
Q

what fixes the bowels semi in place

A

the mesentery

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13
Q

how can we visualise structures under all the intestines

A

using the mesenteric dam - lift the mesentery and use it to pick up all of the intestines and scoop them to the side

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14
Q

what do we expose in the duodenal mesenteric dam manoeuvre

A

caudal vena cava, caudal pole of the right kidneys, right lateral liver lobe

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15
Q

what do we expose in the colonic mesenteric dam manoeuvre

A

the left kidney and adrenal gland

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16
Q

if a dog has had previous midline surgery, what do we need to be careful of when operating

A

adhesions between the previous lilnea alba closure site and any organs

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17
Q

where is the external rectal sheath easy to catch

A

cranial to the umbilicus

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18
Q

what pattern and suture material do we use to close the linea alba

A

continuous suture pattern with an absorbable monofilament (i.e. PDS)

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19
Q

does the linea alba ever return to its full strength

A

No

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20
Q

how long does it take for the linea alba to return to 60-80% of its original strength

A

60 days

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21
Q

when should you recheck afte an exlap

A

around 4-5 days to ensure adequate wound healing and to check for dehiscence

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22
Q

how long till an animal can exercise properly following exlap

A

2-3 weeks

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23
Q

List 6 advantages of NGT

A

non-invasive
well-tolerated
doesn’t prevent eating or drinking
doesn’t require GA
easy to place
can be managed by owners at home

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24
Q

List 6 disadvantages of NGT

A

not suitable if patient is vomiting or unconscious
not suitable if patients lag a gag reflex or have megaoesophagus
easily dislodged
has a small bore
only useful for short term
can cause rhinitis or epistaxis

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25
Q

List 5 advantages of oesophagostomy tubes

A

large bores can be used
well tolerated
can be used long-term
animals can eat orally
can be managed by owners at home

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26
Q

List 5 disadvantages of oesophagostomy tubes

A

requires GA for placement
surgical procedure required
infections can occur
can’t be used in vomiting patients
can be hard to place in challenging or obese patients

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27
Q

List 3 advantages of a gastrotomy tube

A

can be used long-term
wide bores can be used
owners can manage these at home

28
Q

List 5 disadvantages of gastrotomy tubes

A

not suitable for animals that are vomiting or have a GI obstruction
placement requires GA and specialised equipment
feeding has to be delayed after placement
risk of severe complications
has to remain in place for at least 7-10 days

29
Q

why does a gastrotomy tube need to stay in place for 7-10 days

A

in order to allow adhesions to form between the stomach and the abdominal wall - prevents leakage of stomach contents into the abdomen

30
Q

where do we want oesophagostomy tubes to sit

A

in the distal portion of the oesophagus - if we push pas the sphincter, we may get reflux

31
Q

why do we tend to put oesophagostomy tubes in all cats having had oral surgery

A

they tend not to eat afterwards so it is a good idea to have one

32
Q

do oesophageal foreign bodies cause vomiting or regurgitation

A

regurgitation

33
Q

List the clinical signs of oesophageal foreign body

A

retching
regurgitation
ptyalism
anorexia
restlessness
cervical pain

34
Q

what is pytalism

A

excessive salivation

35
Q

where is the most common site of obstruction in the oesophagus

A

between the heart base and the diaphragm

36
Q

what is the issue with barbed fish hooks

A

if you pull these out you can tear the tissues

37
Q

how can most oesophageal foreign bodies be removed

A

endoscopically using forceps
- some may need surgery, some may be able to be pushed into the stomach

38
Q

if an owner says their dog has eaten a fish hook and the line is still hanging out what should you tell them to do

A

tie the line to the collar

39
Q

common complication post oesophageal foreign body

A

oesophagitis

40
Q

what can happen if there was a severe oesophagitis

A

stenosis

41
Q

define stenosis

A

narrowing, stricture

42
Q

what can we do to prevent stenosis formation post OFB removal

A

H2 antagonists
Proton pump inhibitors
sucralfate
analgesia
soft food

43
Q

why do we not want to do open surgery on the oesophagus

A

the oesophagus has no serosal surface and there is a lot of movement so the wound will likely breakdown

44
Q

where do most gastric tumours develop

A

in the lesser curvature of the stomach

45
Q

where do we aim to place the PEG tube

A

into the greater curvature - on the animals left caudal to the ribs

46
Q

how do we make our incision into the stomach

A

place stay sutures and lift the stomach out of the abdomen, then pack the abdomen full of swabs and make an incision into a stomach, being careful to miss any blood vessels

47
Q

what are the two layers you can close the stomach in

A

submucosal mucosal layer and the seromuscular layer

48
Q

what are the different methods for closing the stomach

A

single layer full thickness
double layer
simple interrupted, continuous or inversions

49
Q

what suture material do we close the stomach with

A

monofilament, absorbable suture - PDS

50
Q

what can we do after we have closed the stomach to promote healing

A

omentalise it

51
Q

what is a cholecystoenterostomy

A

Creation of a connection between the gallbladder and intestine

52
Q

how can we clamp of the bowels

A

using atraumatic clamps or using an assistants fingers

53
Q

can you take punch biopsies of the small intestines

A

yes but a lot of the time they won’t go full thickness and they are harder to close

54
Q

how do we recognise the ileum

A

it has antimesenteric blood supply

55
Q

what happens in cases with linear foreign bodies

A

the intestine tries to pass the FB but can’t as it is anchored somewhere, this results in the intestines scrunching up

56
Q

how do we remove linear FBs

A

cut the anchor point and then using multiple enterotomy points, move the FB along each site until you are able to remove the whole thing

57
Q

where do linear FBs commonly anchor

A

around the tongue or in the stomach

58
Q

why can linear FBs be disastrous

A

there can be multiple perforation sites where the FB has been pulled through the wall and there might be too many to resect them all

59
Q

what do we have to be mindful of when doing an enterectomy

A

not leaving behind tissue that no longer has a blood supply

60
Q

how do we close the bowel after an enterectomy

A

end to end anastamosis - can do simple interrpted or simple continuous

61
Q

when do most surgical wounds break down

A

within the first 3-4 days

62
Q

if we are unsure about whether a wound has broken down or not, what can we do

A

open up and check - better to do a surgery before peritonitis occurs

63
Q

if closure on the intestines breaks down, what do we have to do

A

an enterectomy

64
Q

what is an intussusception

A

telescoping of the intestines

65
Q

what is an insulinoma

A

a benign tumor of the pancreas that causes hypoglycemia by secreting additional insulin

9- SA- Gastrointestinal and Hepatic Disease (14 decks)

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