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

Surgical investigations and interventions Flashcards

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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
List 5 advantages of oesophagostomy tubes
large bores can be used well tolerated can be used long-term animals can eat orally can be managed by owners at home
26
List 5 disadvantages of oesophagostomy tubes
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
27
List 3 advantages of a gastrotomy tube
can be used long-term wide bores can be used owners can manage these at home
28
List 5 disadvantages of gastrotomy tubes
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
why does a gastrotomy tube need to stay in place for 7-10 days
in order to allow adhesions to form between the stomach and the abdominal wall - prevents leakage of stomach contents into the abdomen
30
where do we want oesophagostomy tubes to sit
in the distal portion of the oesophagus - if we push pas the sphincter, we may get reflux
31
why do we tend to put oesophagostomy tubes in all cats having had oral surgery
they tend not to eat afterwards so it is a good idea to have one
32
do oesophageal foreign bodies cause vomiting or regurgitation
regurgitation
33
List the clinical signs of oesophageal foreign body
retching regurgitation ptyalism anorexia restlessness cervical pain
34
what is pytalism
excessive salivation
35
where is the most common site of obstruction in the oesophagus
between the heart base and the diaphragm
36
what is the issue with barbed fish hooks
if you pull these out you can tear the tissues
37
how can most oesophageal foreign bodies be removed
endoscopically using forceps - some may need surgery, some may be able to be pushed into the stomach
38
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
tie the line to the collar
39
common complication post oesophageal foreign body
oesophagitis
40
what can happen if there was a severe oesophagitis
stenosis
41
define stenosis
narrowing, stricture
42
what can we do to prevent stenosis formation post OFB removal
H2 antagonists Proton pump inhibitors sucralfate analgesia soft food
43
why do we not want to do open surgery on the oesophagus
the oesophagus has no serosal surface and there is a lot of movement so the wound will likely breakdown
44
where do most gastric tumours develop
in the lesser curvature of the stomach
45
where do we aim to place the PEG tube
into the greater curvature - on the animals left caudal to the ribs
46
how do we make our incision into the stomach
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
what are the two layers you can close the stomach in
submucosal mucosal layer and the seromuscular layer
48
what are the different methods for closing the stomach
single layer full thickness double layer simple interrupted, continuous or inversions
49
what suture material do we close the stomach with
monofilament, absorbable suture - PDS
50
what can we do after we have closed the stomach to promote healing
omentalise it
51
what is a cholecystoenterostomy
Creation of a connection between the gallbladder and intestine
52
how can we clamp of the bowels
using atraumatic clamps or using an assistants fingers
53
can you take punch biopsies of the small intestines
yes but a lot of the time they won't go full thickness and they are harder to close
54
how do we recognise the ileum
it has antimesenteric blood supply
55
what happens in cases with linear foreign bodies
the intestine tries to pass the FB but can't as it is anchored somewhere, this results in the intestines scrunching up
56
how do we remove linear FBs
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
where do linear FBs commonly anchor
around the tongue or in the stomach
58
why can linear FBs be disastrous
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
what do we have to be mindful of when doing an enterectomy
not leaving behind tissue that no longer has a blood supply
60
how do we close the bowel after an enterectomy
end to end anastamosis - can do simple interrpted or simple continuous
61
when do most surgical wounds break down
within the first 3-4 days
62
if we are unsure about whether a wound has broken down or not, what can we do
open up and check - better to do a surgery before peritonitis occurs
63
if closure on the intestines breaks down, what do we have to do
an enterectomy
64
what is an intussusception
telescoping of the intestines
65
what is an insulinoma
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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