GIT Surgery!!!!

Question 1

GIT surgery is considered clean-contaminated - which means what?

Answer 1

• give peri-op ABs (Gram -ves, anaerobes)
• isolation of viscus
• change instruments/gloves
• local lavage

Question 2

suture choice

Answer 2

monofilament, absorbable on reverse cutting/taper needle

Question 3

Indications for a gastrotomy/gastrectomy

Answer 3

• gastric FBs
• full thickness biopsy
• resection of neoplasia (uncommon)
• resection of devitalised tissue - GDV

Question 4

Gastrotomy closure technique

Answer 4

1. Closure; single layer appositional vs 2.layer appositional (mucosa then seromuscular+submucosa)
   - simple cont.
2. Run entire GIT and explore abdo

Question 5

gastrotomy post-op

Answer 5

1. IVFT and lytes
2. Gastroprotectants
3. Pro-motility drugs (ileus)
4. Food and water as soon as willing to eat

Question 6

Risk factors for GDV

Answer 6

1. Large/giant breeds (3x)
2. Thoracic depth (conformation)
3. Feeding practices?? large volumes of food at high speeds

Question 7

GDV clinical signs

Answer 7

• acute, non-productive retching
• salivation
• abdo distention and discomfort
• tachypnea, dyspnea, weakness, collapse
• pale/injected mm
• weak peripheral pulse/pulse deficit

Question 8

what rad view to diagnose GDV?

Answer 8

Right lateral view = large gas filled stomach with displacement of pylorus (smurf)

Question 9

what antibiotics to treat endotoxaemia assoc. w/ GDV?

Answer 9

3rd gen cephalosporins

Question 10

Surgical management of GDV once stable(ish)/ASAP

Answer 10

1. reposition stomach (decompress + derotate)
2. assess gastric and splenic viability
3. Permanently fix antrum to right cranial abdominal quadrant

Question 11

GDV post-op monitoring/complications

Answer 11

• IVFT
• ABs
• Gastroprotectants/motility
• Coagulopathy
• Arrhythmia
• Peritonitis/sepsis –> pyrexia, pain, abdo incision discharge ,
  distention

Question 12

what are the two approaches to a prophylactic gastropexy

Answer 12

1. Laparoscopic-assisted gastropexy

2. Open incisional gastropexy

Question 13

Indications for splenectomy

Answer 13

• neoplasia: haemangiosarcoma, lymphoa, histiocytic sarcoma
• trauma/torsion
• abscessation/splenitis (Clostridia)
• non-responsive IMT

Question 14

the major splenic pedicles

Answer 14

1. Splenic
2. Left gastroepiploic
3. Short gastrics

Question 15

what is the holding layer of the intestines when closing?

Answer 15

submucosa

Question 16

size/type suture for intestinal closure

Answer 16

monofilament absorbable 3-0 to 5-0

Question 17

risk factors for an ileocolic intussusception in young dogs

Answer 17

parasitism, enteritis, caecal inversion

Question 18

common presentation of an intestinal adenocarcinoma

Answer 18

annular, stenotic lesion in the large intestine (dogs) or jejunum (cats - siamese)

Question 19

common presentation of an intestinal lymphosarcoma

Answer 19

infiltrative, intramural disease, discrete lesion

Question 20

what is the prognosis of a cat with chronic lymphocytic lymphosarcoma?

Answer 20

2-3yrs w/ chemo

Question 21

prognosis of intestinal adenocarcinoma vs. lymphosarcoma of a dog

Answer 21

adenocarcinoma - recurrence or metastasis in 3-9months

lymphosarcoma - poor - months

Question 22

prognosis of GIST (leiomyosarcoma)

Answer 22

depends on grade - up to 12months

Question 23

CS of a high intestinal obstruction

Answer 23

vom, abdo pain

Question 24

CS of a low intestinal obstruction

Answer 24

abdominal pain, bloody, mucoid D+

Question 25

describes steps of enterotomy

Answer 25

1. Exteriorise and pack off intestinal segment 2. Milk the intestinal contents away from the proposed incision site 3. Occlude the lumen with your assistant's fingers or intestinal forceps (Doyen's) 4. Longitudinal incision on anti-mesenteric margin of intestine 5. Closure: simple interrupted full thickness sutures 6. Check closure by injecting sterile saline into intestinal lumen using 22G needle and syringe

Question 26

describe steps for intestinal resection and anastomosis

Answer 26

1. Exteriorise segment 2. ID section for resection 3. Ligate arcade vessels + Mesenteric (vasa recta) 4. Crushing forceps on part being removed - angled away from resection + non-crushing (fingers/Doyen's) on healthy tissue (~5cm from resection site to allow room) 5. Transect intestine away from crushing clamps 6. Anastomosis: simple interrupted full thickness 3-0/4-0 monofilament absorbable --> work from mesenteric edge up either side

Question 27

what do you do if there is disparity in size of intestinal edges for closure after a resection?

Answer 27

make the smaller section larger with an extension of the incision longitudinally - NEVER make the larger section smaller

Question 28

what is intestinal plication?

Answer 28

pexy the transverse colon to the greater curvature of the stomach pexy the descending colon to the left body wall + strategically placed seromuscular sutures along the length of intestine to prevent intuss recurrence

Question 29

common causes of obstipation

Answer 29

perineal hernia, perianal fistulas, anal sac disease, pelvic trauma/fxs, rectal strictures (neoplasia), idiopathic megacolon (cats)

Question 30

describe the technique of a subtotal colectomy

Answer 30

1. Removal of ileocecocolic junction 2. Preserve as much of the ileum as possible 3. Size disparity of anastomosis 4. Simple interrupted full-thickness closure

Question 31

how do you treat an acute rectal prolapse?

Answer 31

1. Lubricant 2. Epidural (morphine) 3. Manual reduction 4. Anocutaneous purse-string for 4-5days 5. Stool softener

Question 32

when is a colopexy indicated?

Answer 32

indicated for extensive or repeated prolapse

Question 33

post-op considerations for rectal prolapse amputations/colopexies

Answer 33

- stool softeners - epidural - straining - E.Collar - avoid rectal manipulation - address inciting cause

Question 34

types of primary rectal tumours dogs

Answer 34

- adenoma/adenocarcinoma - lymphosarcoma - leiomyoma/sarcoma

Question 35

types of primary rectal tumours cats

Answer 35

- adenocarcinoma - lymphosarcoma - leiomyosarcoma

Question 36

CS of rectal neoplasia

Answer 36

- haematachezia - tenesmus - rectal bleeding independent of defecation - rectal prolapse

Question 37

what rectal tumour is commonly 'egg like'?

Answer 37

leiomyoma

Question 38

what rectal tumour commonly forms strictures?

Answer 38

adenocarcinoma

Question 39

what rectal tumour is commonly assoc. w/ intramural thickening?

Answer 39

leiomyosarcoma

Question 40

prognosis of malignant rectal neoplasias

Answer 40

poor, recurrence likely 2-3months

Question 41

prognosis of benign rectal neoplasia

Answer 41

fair but frequent evaluation as malignant transformation possible and recurrence if inadequate resection