GI surgery

Question 1

-otomy definition

Answer 1

opening something up then closing it again

Question 2

-ostomy definition

Answer 2

opening something and keeping it open (gastrostomy= opening of the stomach to allow decompression or feeding bypassing the oesophagus, via a tube)

Question 3

-oscopy definition

Answer 3

looking inside something (endoscope

Question 4

-ectomy definition

Answer 4

removing something (enterectomy= removing part of the intestine)

Question 4

-ectomy definition

Answer 4

removing something (enterectomy= removing part of the intestine)

Question 5

pre-op care of GI patient

Answer 5

• often emergency surgeries
• fluid and electrolyte stabilisation
• starve for 12hrs ideally

Question 6

surgical prep for oral surgery

Answer 6

• flush mouth with saline to remove debris

Question 7

surgical prep for ventral midline laparotomy

Answer 7

• clip and aseptic prep of wide area to allow for wide incision
• above xiphoid to below pubis

Question 8

surgical prep for anal/rectal surgery

Answer 8

• packing or purse string suture
• check positioning with surgeon

Question 9

equipment for GI surgery

Answer 9

• tilt patient slightly as high risk of aspiration
• lap swabs to pack off abdomen
• pre-warmed saline for abdominal lavage
• stomach tube and bucket

Question 10

suture material for GI surgery

Answer 10

• short duration, absorbable- GI tract heals quite quickly
• synthetic monofilament- braided can wick in infection
• taperpoint/round body needle ideal as least traumatic

Question 11

treatment plan for GDV

Answer 11

1. treat shock
2. IV antibiotics
3. decompressions of stomach through stomach tube
4. right lateral radiograph to confirm diagnosis
5. surgery to decompress and de-rotate stomach

Question 12

what to monitor post op

Answer 12

• TPR
• CRT
• nutritional status (glucose levels)
• hydration status
• wound care
• analgesia

Question 13

immediate post-op complications

Answer 13

• physiological abnormalities worsening (hypothermia, hypotension)
• pain
• haemorrhage
• drug/anaesthetic reaction
• vom/regurgitation
• wound breakdown

Question 14

long term post-op complications

Answer 14

• pain
• haemorrhage
• aspiration pneumonia
• ileus (gut stops contracting)
• infection of wound

Question 15

major complications following GI surgery

Answer 15

• dehiscence

Question 16

dehiscence definition

Answer 16

• disruption of wound edges
• most common days 3-5 post-op
• skin, abdominal wall or intestines

Question 17

skin/cutaneous dehiscence clinical signs

Answer 17

• usually 4-5 days post-op
  clinical signs:
• serosanguinous/purulent discharge
• swelling
• necrosis of edges

Question 18

abdominal wall dehiscence clinical signs

Answer 18

• usually within first 7 days post-op
  clinical signs:
• wound oedema/inflammation
• serosanguinous drainage
• creates hernia

Question 19

intestinal dehiscence clinical signs

Answer 19

• leads to septic peritonitis
• usually within 2-5 days post-op
  clinical signs:
• depression, anorexia, vom, abdominal pain, acute collapse

Question 20

risk factors for dehiscence

Answer 20

• surgical technique (suture choice, tension)
• self trauma
• underlying neoplasia of area
• closure of non-viable skin
• systemic factors (obesity, endocrine disease, hypoproteinaemia, viral status of cat)

Question 21

peritonitis

Answer 21

• inflammation of the peritoneum
  primary peritonitis- only happens in cats
  secondary peritonitis- result of another pathology
• aseptic- reaction of surgery itself
• septic- infection

Question 22

peritonitis causes

Answer 22

• dehiscence
• ischaemic necrosis
• leakage during surgery
• insufficient lavage
• insufficient prep

Question 23

peritonitis clinical signs

Answer 23

• anorexia, vom, lethargy, pyrexia, acute collapse
• may adopt prayer position (sign of abdominal discomfort)

Question 24

oesophagus complications

Answer 24

- regurgitation - oesophagitis - strictures

Question 25

stomach complications

Answer 25

- vom - anorexia - ulceration - gastric outlet obstruction (stricture) - pancreatitis

Question 26

small intestine complications

Answer 26

- peritoneal/serosal adhesions - ileus - perforation - stenosis - diarrhoea - anorexia

Question 27

large intestine complications

Answer 27

- haemorrhage - faecal contamination - leakage - stricture - stenosis - incontinence

Question 28

perineum, rectum and anus complications

Answer 28

- tenesmus - rectal prolapse - temp/perm incontinence - anal stricture - urethral obstruction - stenosis

Question 29

aims for post-op care plan

Answer 29

- restore hydration and maintain electrolyte balance - resume normal feeding and gut motility - manage GI effects (nausea) - pain management - prevent infection

Question 30

useful drugs for managing nausea

Answer 30

- maropitant (anti-emetic, pain relief) - cerenia, prevomax - metoclopramide (anti-emetic, prokinetic) - vomend, emeprid

Question 31

pain management

Answer 31

NSAIDs- caution as can cause ulceration and GI upset opiods- almost always used - may affect gut motility codeine- can cause constipation paracetamol- dogs only