GI Surgery

Question 1

-otomy

Answer 1

making an incision into tissue - temporary opening

Question 2

-ostomy

Answer 2

artificial opening or stoma which communicates with outside - tube

Question 3

-oscopy

Answer 3

use of device to give visual access inside cavity

Question 4

pre-op care of GI patient

Answer 4

often urgent
stabilise: fluids, plan nutrition

preop starving:
- 12h adult
- shorter for paed or brachy
- may be emergency

enema: check with surgeon

antibiotics: rarely used pre-op - dependent on degree of contamination

specific management - stomach tube in GDV

Question 5

how large should a clip be for an exploratory laparotomy

Answer 5

above xiphoid and below pubis

Question 6

surgical prep for ventral midline laparotomy

Answer 6

cli and aseptic prep of wide area
above xiphoid and below pubis
long incision

Question 7

surgical prep of oral surgery

Answer 7

flush to remove debris
chlorohexidine - rinse to reduce bacteria load

Question 8

surgical prep for anal/rectal surgery

Answer 8

positioning: sternal, tail tied up
can be specific
packing
purse string suture

Question 9

considerations for surgical patients

Answer 9

warmth:
- high heat loss - long duration and open abdomen
monitor regularly
plan temp regulation and warming - warm fluids, bair hugger

risk of regurge
- good seal on ET tube
tilt patient with head lowered
monitor and be prepped to treat

Question 10

role of vet nurse during GI

Answer 10

surgical assistance:
- scrubbed vet nurse - clamp intestines
- keep GI contents moist - warm saline
keep contaminated instruments separated
control suction machine
additional swabs and instruments to hand - biopsy

Question 11

instruments and equipment in GI surgery

Answer 11

laparotomy swabs - pack abdomen
suction
pre-warmed saline
- abdominal lavage
soaking lap swabs
keep exposed tissues moist
histopathology pot

Question 12

why and how we do surgical lavage

Answer 12

decreases risk of infection
moistens tissue
removes blood = better visibility
provided by assistant
non-toxic iso-osmotic and normothermic
0.9% saline

Question 13

why is suction used

Answer 13

remove excess fluid and blood to increase visibility

Question 14

2 types of suction

Answer 14

Yankauer:
- wide diameter tip for large volume of fluids or thick fluids
- one hole so potential blockage

Poole:
- suction tip of choice
- narrow diameter internal cannula
- outer sheath with multiple holes
- gentler pressure
drains large volume with less chance of blockage

Question 15

specific instruments for GI

Answer 15

retractors
two surgical kits
two sets of tray drapes
two sets of gloves
additional spare instruments
stomach tube and bucket
endoscope

DeBakey thumb forceps
Doyen bowel clamp
Babcock tissue forceps
Balfour abdominal retractor
Gelpi retractor

Question 16

importance of tissue retraction

Answer 16

increased visibility
= decreased tissue trauma ad time

Question 17

two types of retraction

Answer 17

hand retraction
instrument retraction: hand-held or self-retaining

Question 18

hand held retractors

Answer 18

Mathieu retractor
Hohmann retractor

Question 19

self retaining retractors

Answer 19

Gelpi - small wounds
Weitlaner - large wounds

Question 20

what suture should be used for Gi surgery

Answer 20

short duration and absorbable due to fast healing
synthetic monofilament - avoid braided due to tissue drag
needle: round bodies or taper point - least trauma
Monocryl or PDS

Question 21

when are therapeutic antimicrobials used

Answer 21

treat established infection
use until infection is cured

Question 22

when are prophylactic antimicrobials used

Answer 22

no infection present - prevent one
immediately after or during surgery

Question 23

what antimicrobials would you use on clean, clean-contam and contam wounds

Answer 23

prophylactic

Question 24

what classification of contamination is GI surgery

Answer 24

clean-contaminated unless:
- tissue viability is questioned
- infection already present
gross contamination occurs during surgery

Question 25

common antibiotics used after GI surgery

Answer 25

amoxycillin metronidazole

Question 26

examples of oral surgery

Answer 26

dental - extractions oral tumours oronasal fistulae - secondary cleft palate foreign body

Question 27

dietary modifications after oral surgery

Answer 27

soft and easy to swallow - not liquid

Question 28

post op considerations of oral surgery

Answer 28

ensure eat and drink feeding tube? owner education for dental disease

Question 29

examples of oesophageal surgery

Answer 29

foreign body: obstruction = dehydration, hypovolemia - use endoscope or push to stomach and remove stricture: - secondary to foreign body or due to GA - poor prognosis

Question 30

nc of oesophageal surgery pre and post op

Answer 30

pre: treat dehydration if needed post: feeding tube is damage to oesophagus liquid meals?

Question 31

examples of gastric surgery

Answer 31

foreign body - vomiting - endoscopic removal or gastrotomy surgery pyloric obstruction - widen or remove pylorus Gastric neoplasia Tube gastronomy

Question 32

NC of gastric surgery: pre and post surgery

Answer 32

pre: treat dehydration wide surgical site, heat loss