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91 terms

GI III

STUDY
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clinical signs
intestinal FB - _______ determined by: location of FB, degree of obstruction, moving vs stationary, integrity of intestinal wall (ulceration or perforation)
linear foreign bodies
intestine - more common in cats; sewing thread, yarn, string, tinsel; clinical signs occur when the foreign body becomes fixed at some point cranially typically around tongue or at pylorus
tongue pylorus
two typical locations for linear foreign bodies to become fixed
linear foreign bodies
clinical signs and physical exam findings - vomiting, depression, abdominal pain (posture, gait, guarding on palpation), palpable bunching of intestines in central abdomen, check under tongue
oral exam
linear FB - ______ - examine oral cavity closely - FB can become embedded in mucosa and not be easily visualized
linear foreign body
intestinal plication with eccentric air bubbles
linear foreign body
sx mgmt - free FB cranially by removing from base of tongue or performing gasrotomy; examine mesenteric border of intestine for perforations; remove FB through enterotomy(ies)
red rubber catheter
may be an option for small diameter linear foreign bodies - if you can ID the proximal and distal ends - minimizes the number of enterotomies req'd
perforation
linear foreign body - if there is a rough appearance to intestines - look for _________
linear foreign bodies
complications - impaired intestinal fxn secondary to inflammatory changes; short bowel syndrome with extensive resection
non linear foreign bodies
sx mgmt - complete exploratory; removal through enterotomy aboral (distal) to foreign body most commonly recommended, but if it is easier to remove proximal, do it
pinch intestine to stimulate peristalsis
what is most reliable method to evaluate intestinal viability?
intussusception
more common in dogs; young (<1 yr); identify underlying cause; clinical signs influenced by location and degree of obstruction
intussusceptum
part of the intussusception that telescopes into the other
intussuscipiens
part of the intussusception that telescopes over the other
ileocolic jxn
most common location for intussusception to form
intussusception
common locations - ileocolic jxn, ileum, jejunum, cecum (inversion), duodenum, colon
intussusception
sx mgmt - attempt manual reduction; assess viability if successful; resection and anastomosis (irreducible, nonviable)
fibrin seal development
what process in the pathology of an intussusception will make it hard to manual reduce it?
tear
complication of manual reduction of intussusception
intestinal plication
prevent recurrence of intussusception; plicate entire small intestine; avoid tight turns; complications - obstruction, strangulation, perforation
intestinal plication
suture intestinal loops together at 3-5 cm intervals with interrupted sutures placed along lateral wall; use absorbable suture material such as poliglecaprone 25 (monocryl)
opioids
lower rates of recurrence of intussusception recently may be due to increased use of ________
25%
intussusception recurrence rate up to _____ without plication
intestinal plication
____________ considerations - caution in very young patients with significant growth potential remaining; if done, plicate from duodenocolic to ileocolic jxn; surgeon preference
colorectal
most common location for intestinal neoplasia in the dog?
small intestine
most common location for intestinal neoplasia in the cat?
leiomyoma/sarcoma adca lsa
(3) most common intestinal neoplasias in dogs
duodenal polyps Adca lsa
(3) most common intestinal neoplasias in cats
chemotherapy
preferred tx for LSA
regional lnn liver
intestinal neoplasia staging is done by checking (2)
surgical excision
with the exception of LSA what is the treatment of choice for intestinal neoplasias
focal
intestinal neoplasia - which form of LSA has a better prognosis?
excellent
what is the prognosis for benign intestinal neoplasia with complete excision?
10 months
MST for intestinal AdCA in dogs
2 years
MST for intestinal AdCA in cats
1 year
MST for intestinal leiomyosarcoma
intestinal
principles of ________ sx - minimize contamination - pack off affected area, occlude intestine proximal and distal with intestinal forceps or fingers (if intestines are empty occlusion is not mandatory and decreases manipulation / trauma; decompress dilated bowel loops; local lavage unless generalized contamination; gentle tissue handling
viability
intestine - assessment of ________ - pink, moist glistening color; pulsation of mesenteric vessels; bleeding from cut surface; peristalsis - pinch test; Fluoroscein dye injected IV
intestines
suturing principles - sutures must penetrate submucosa, modified gambee pattern, simple interrupted or simple continuous pattern, monofilament absorbable suture material
intestinal
______ biopsy - full thickness biopsy wide enough that all layers remain intact - 3-4 mm wide; techniques - longitudinal biopsy w/ longitudinal closure, longitudinal biopsy w/ transverse closure (dont do), TRANSVERSE BIOPSY, dermal punch
transverse wedge biopsy
intestines - full thickness wedge 3-4 mm wide taken perpendicular to long axis of intestine; wedge should not be >20-25% of circumference
resection and anastomosis
principles of intestinal ___________ - pack off affected segment, determine extent of excision and ligate blood supply, occlude proximal and distal segments as atraumatically as possible, minimize mucosal eversion, begin anastomosis at mesenteric border, interrupted or continuous suture pattern, close rent in mesentery, wrap anastomosis with omentum
more control more traumatic
adv / disadv of using scissors to cut intestines
angling cut
intestinal R&A - ______ enlarges lumen size initially to acct for the 10-20% narrowing which typically occurs during healing
mucosal eversion
intestines - minimize manipulation - to minimize _____________ - which increases risk of infection and adhesion formation
mesenteric
intestinal R&A - begin anastomosis at _________ border; leakage most common at this site - no serosa; fat in mesentery impairs visualization
close tightly at tips
important quality of staples when doing an intestinal R&A
angle
intestinal R&A - cutting the smaller diameter segment at an ______ may reduce disparity and facilitate anastomosis
omentum
the ________ is very important in reducing the risk of wound healing problems after intestinal surgery
serosal patch
done when omentum is not available; reinforcement of suture lines in questionable tissue - enterotomy, colotomy, urinary bladder; induces permanent adhesion much stronger than omentum
large intestine
sx of the _________ - principles same as small intestine but differences - high bacterial population, healing, blood supply
collagenase
due to high _______ population the LI heals differently than the SI - sutures will be the only thing holding it together for the first few days
cecum
dz of the _____ - cecal inversion, cecal dilatation, cecal impaction, neoplasia
cecal inversion
cecal intussusception; chronic diarrhea with hematochezia (melena)
cecal inversion
tx - attempt manual reduction, expose through colotomy if irreducible; typhlectomy
megacolon
increased diameter associated with chronic constipation (obstipation); causes - colonic inertia, outlet obstruction
idiopathic megacolon
most common in cats; middle to old age; colonic smooth muscle dysfunction
idiopathic megacolon
dx - hx - increased time in litter box; PE - wt loss, poor coat, ADR, grossly distended colon; radiography, rule out medical causes of colonic inertia
idiopathic megacolon
tx - deobstipate; dietary modification; stool softeners; motility modifiers - cisapride from compounding pharmacies; subtotal colectomy
subtotal colectomy
goal is to remove as much colon as possible - colocolostomy, ileocolostomy
subtotal colectomy
post operative course - diarrhea (4wks to months, may persist in dogs); soft formed stools; increased frequency of defecation; potential complications - SIBO with ileocolostomy, intermittent constipation
intestinal
post op care of ________ sx patients - taper fluid and electrolyte therapy as oral intake returns to normal; offer food and water the day after sx unless contraindicated; pain mgmt
GI
post op monitoring of ____ sx patients - most complications first 3-5 days; general attitude, MM, abdominal palpation, temperature BID to TID, cbc, abdominocentesis or DPL (diagnostic peritoneal lavage), US, re-exploration
intestinal
complications following ______ sx - ileus, adhesions, obstruction - intussusception, entrapment, stenosis, dehiscence, peritonitis, short bowel syndrome
dehiscence
risk factors for ________ after intestinal sx - multiple intestinal procedures, pre-existing peritonitis, underlying cause (trauma, FB), lack of omentum
dehiscence
intestinal - overall rate <10%; mortality rate >80%; not influenced by: suture material, suture pattern
rectum
dz of the _______ - rectal prolapse, rectal stenosis / stricture, neoplasia
anus and perianal area
dz of the ___________ - anal sac (impaction, inflammation/abscess, neoplasi), anus (imperforate anus, stenosis/stricture), perianal (inflammation [fistula], hyperplasia, neoplasia)
complete
rectal prolapse - all layers
incomplete
rectal prolapse - only mucosa
rectal prolapse
secondary to tenesmus - rectal / anal disease, urogenital disease
prolapsed intussusception
what is the primary differential for rectal prolapse?
rectal prolapse
tx - identify and treat underlying cause, reduce and place purse-string suture if viable, amputate if nonviable, coloplexy if recurrent
amputation
_____ of rectal prolapse - need to control inner portion; use a tube inserted with straight needle passed through to prevent it from sucking back into rectum; interrupted sutures to allow for stretch
amputation
complications after rectal prolapse ________ - infection, dehiscence, stricture, recurrence
coloplexy
indications - recurrent rectal prolapse, perineal hernia; techniques - suture - absorbabl / non absorbable; for incisional, use absorbable
incisional coloplexy
descending colon - apply cranial traction; similar to incisional gastropexy; incision through seromuscular layers of colon and transversus abdominus of body wall; can perform in more than one spot on descending colon
adenomatous polyps leiomyoma fibroma
benign colorectal neoplasia (3)
adca leiomyosarcoma lsa
malignant colorectal neolplasia (3)
rectal adenomas
c/s - hematochezia, tenesmus / dyschezia, visible mass (may be intermittent); presentation - most occur in distal rectum - polyploid, sessile, multiple
rectal adenomas
diagnosis - direct observation, rectal palpation, proctoscopy / colonscopy; biopsy - incisional v excisional - always submit excised masses even when pre-op biopsy is performed - up to 25% will come back as a more aggressive tumor (carcinoma in situ, invasive Adca)
rectal adenoma
tx - sx excision - transanal, dorsal approach, mucosal resection; cryosurgery - cant evaluate margins, cant confirm dx
rectum colorectal jxn
surgical approaches to the _______ and ________ - transanal, dorsal approach, rectal pull-through (modified, swenson's pull-through [lesions that extend beyond peritoneal reflection into abdominal cavity])
transanal approach
epidural block; limited to lesions in the caudal 4-6 cm of the rectum
rectal
complications of ______ sx - dehiscence, infection, stricture, incontinence (sphincteric, sensory)
anal sac dz
________ - anal sac impaction, anal sacculitis, anal sac abscess; common problem, small dogs (poodles, chihuahua); rare in cats
anal sacculectomy
manage infected or abscessed glands medically until inflammation resolves; anal sacs lie within external anal sphincter; open and closed techniques
closed anal sacculectomy
use blunt probe or instrument; paraffin injection; catheter - to delineate it, make incision parallel to muscle fibers
open anal sacculectomy
insert one blade of scissors into sac; apply upward pressure to tips to minimize tissue cut OR insert groove director or probe through duct into anal sac; incise over instrument with caudal tension on instrument to minimize damage to sphincter; dissect anal sac from anal sphincter
anal sacculectomy
complications - infection, draining tracts - incomplete removal of anal sac, must excise to resolve; fecal incontinenc