Upper GI Surgery Flashcards by Rebecca Harris

What are the clinical signs of Choke?

1) BLOAT
- Type 1 Vagal indigestion

2) Salivation
3) Coughing/Retching
4) Extended head and neck
5) Protruding tongue

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What is the first sign you will see in a cow with esophageal choke?

BLOAT

-the cow needs to erructate, if this is blocked your going to bloat

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How do you diagnose Esophageal Choke in cattle?

1) PE, passage of stomach tube
2) Endosocpy
3) Radiographs
—Surgery and contrast films
—Esophagography (contrast) Barium
4)ultrasound

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What are some Differential Diagnosis for Esophageal choke?

1) Pharyngeal trauma

2) Rabies

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When diagnosing Esophageal Choke what diagnostic tools are KEY-according to Pappa French?

- Pass stomach tube

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What is the Etiiology of Esophageal Choke?

1)Foreign body obstruction

hedge apple, potato
cabbage, beet, turnips, corn
sharp foreign bodies

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What are the complications of Esophageal choke?

1) unable to eructate = BLOAT
2) loss of saliva = metabolic acidosis
3) Aspiration pneumonia

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How would you treat an Esophageal Choke Medically?

1) manual retrieval if obstruction is proximal
2) wire snare - may damage mucosa
3) if distal Push into rumen

SEDATION, Buscopan, Lidocaine

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How would you treat an Esophageal choke surgically?

ESOPHAGOTOMY

Only if medical treatment option are exhausted
many complications

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What should your mainstay of treatment be for esophageal choke? Medical vs surgical

MEDICAL first always

There are too many complications with esophagotomy

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What is the the initial treatment of Choke?

DECOMPRESS the rumen!!!!

needle and suction
REd Devil Trocar

Hold of feed and water until resolved

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How long can you hold a cow off feed and water before they are affected?

48 hours

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What are the layers you pass through during an Esophageal Anatomy?

Layers:

Adventitious layer
Muscular layer
Submucosa
Mucosa

No Serosal Covering

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What are the associated structures you could see during an esophagotomy?

Associated structures:

Recurrent Large Gael nerve
Carotid sheath
Vagosympathetic trunk
Tracheal lymphatic trunk
Deep cervical Inn

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Why are there so many complications for esophageal surgery?

1) Dirty procedure
2) No serosal layer
3) constant movement
4) constant suture line tension
5) proximity of laryngeal nerve

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Describe the process of Cervical Esophagotomy.

1)pass the to level of obstruction
2)Exteriorize and isolate
3)linear incision in esophagus
-over healthy tissue (if possible)
4)remove obstruction
5) if healthy tissue—>CLOSE
If compromised tissue —>2nd intention healing required and daily wound care

may need to place rumen fistula
NO Food/Water for 24-48hrs post op
IV fluids with electrolyte supplementation

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What approach should be taken for cervical esophagotomy with PRIMARY repair?

-Lateral/ventrolateral approach

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Following incision for a cervical esophagotomy (Primary repair), How many layers separate and what are they?

Incision separates into 2 layers

Muscular
Mucosa/submucosa

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What suture is used to close a cervical esophagotomy?

-where do you bury the knot

PDS to close

- IN the LUMEN

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What type of strength does Mucosa/Submucosa provide? (Cervical esophagotomy)

TENSILE strethgth for closure

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T/F: Lack of serosa contributes to complications post op

TRUE

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When is ESOPHAGOSTOMY necessary?

1) if tissue is compromised

2) caudal to repaired esophagus

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Describe Esophagostomy

Study These Flashcards

1) caudal to repaired esophagus
2) Place POLYETHYLENE NG tube (0.25-1 OD)
3) secure tube
4) leave in place min 7-10 days (allow stoma formation**
5) allow to heal by 2nd intention

What material is used for Esophagostomy tube?

Study These Flashcards

Polyethylene NG tube (0.25-1” OD)

How long must an Esophagostomy tube be left to allow stoma formation?

7-10days***

How do esophagostomy heal?

2nd intention

What can be used for immediate relief of chronic bloat (type 1 indigestion)?

Temporary Rumen Fistula

Where do you place a temporary Rumen fistula?

In the rumen bruh so put it in the : Upper LEFT paralumbar fossa!!!!

What size of skin is removed for a temporary rumen fistula?

5cm X 3cm

Describe the placement of a Temporary Rumen Fistula.

1) 5X3cmm circle through skin - upper Left paralumbar fossa 2) Blunt direction of GRID muscle layers 3) grasp and tent rumen wall 4) suture rumen to skin in MATTRESS pattern 5) Need 1” of rumen sticking out of skin

What suture pattern is used to suture the rumen to the skin for a temporary rumen fistula?

Mattress pattern

How long does it take for a temporary rumen fistula to close

Few weeks

What can be used to secure a temporary rumen fistula?

35ml syringe casing

What are the indications for a Rumenotomy?

1) Chronic bloat 2) Foreign body 3) Reticular abscess 4) Type 2 vagal indigestion —failure of Omaha’s transport —results in distention of reticulum/rumen —multiple causes

What should be done pre-op for rumenotomy?

1) off feed 24-36 hrs 2) single dose of pre-op antibiotics 3) left flank approach

What type of surgery is a Rumenotomy?

Clean-contaminated procedure

What is the antibiotic of choice for pre-op Rumenotomy?

Procaine Penicillin

What suture pattern is used to suture the rumen to the skin for a Rumenotomy?

Cushing

Which aspect of the incision should be sutured for for a Rumenotomy?

Start suturing at the DORSAL aspect | -creating a seal between skin and rumen

T/F: during a rumenotomy the ventral aspect of the incision has the same amount of sutures as the dorsal aspec

FALSE The ventral aspect has extra sutures

What type of forceps are used to grasp the rumen and hooked onto a rumen board, during Rumenotomy?

Non-crushing rumen forceps - allow exteriorize toon of rumen - incision is made dorsally

How do you remove the fluid during a rumenotomy?

1) gravity | 2) Kingman Tube

What type of closure is required for a rumenotomy?

2 layer closure - inverting - lavage site

When closing a rumenotomy what must be done (order)?

1)2 layer inverting closure of RUMEN .......Prior to body wall closure...... I 2)Change gloves/sleeve 3)Change instruments

What is the prognosis for Rumenotomy?

Depends on reason for surgery: Foreign Body: -Good—>doesn’t penetrate thoracic cavity or involve right side of reticulum - Guarded—>involvement of right side of reticulum - Poor—>FB penetrated diaphragm

You perform a Rumenotomy on a cow and find that the thoracic cavity is intact and there is no involvement of the right side of the reticulum......What is your prognosis?

GOOD

You perform a Rumenotomy and find there is penetration of the right side of the reticulum .....What is your prognosis?

GUARDED

You perform a Rumenotomy and find a FB has penetrated the diaphragm ...What is your prognosis?

POOR

What is TRP

Traumatic reticular pericarditis

What are the CS of TRP?

1) Tachycardia with muffled heart sounds - Washing machine murmur 2) GI issues - 7days, febrile, painful 3) Right heart failure - Distended Jugular - Brisket edema - TAchypnea

How would you Diagnose TRP?

1) Radiographs 2) Ultrasound 3) Pericardiocentesis

T/F tulathromycin is NOT allow in LACTATING animals greater than 20 months of age

TRUE

What are some differential diagnosis for TRP?

1) Pericardial disease 2) Bovine Leukemia 3) Lymphosarcoma

What IV anesthesia would you use to sedate a 2 year old heifer for TRP?

1) Xylaxine 2) Ketamine 3) Butorphanol

You culture Trueperella progenies in a 2yo Heifer. Sample came from cloudy, grey-brown, putrid pericardial fluid. What would you use to treat this?

Procaine Penicillin

What are some Differential Diagnosis for RIGHT sided Heart Failure?

1) TRP 2) Endocarditits 3) Lymphosarcoma 4) Mediastinal mass

How would you treat a cow with Traumatic Pericaditis?

1) Pericardectomy 2) Rib resection 3) Foreign body removal *sequelae—>usually die of constrictive pericarditis

Upper GI Surgery Flashcards

(57 cards)