Term
| Describe the upper esophageal sphincter. |
|
Definition
| -made from surrounding mm: cricothyroid & thyropharyngeus |
|
|
Term
| Describe the lower esophageal sphincter. |
|
Definition
-thickening of muscularis layer
-high pressure zone
-angle of esophagus and stomach: creates an L shape so distal esophagus gets pinched off |
|
|
Term
| Why does the esophagus have a higher dehiscence rate than any other GI structure? |
|
Definition
-only 3 layers (loacks serosa)
-segmental blood supply
-lack of omentum (the abdominal policemen)
-constat motion: swallowing, respiration
-tension at surgical site |
|
|
Term
| How do we surgically approach the esophagus? |
|
Definition
-ventral midline: cervical
-intercostal thoracotomy |
|
|
Term
| What is the most common FB in dogs? |
|
Definition
-bones or other solitary objects
-young >> older |
|
|
Term
| What is the most common FB in cats? |
|
Definition
|
|
Term
| What are the clinical signs of esophageal FB? |
|
Definition
-dysphagia/anorexia
-hypersalivation
-gagging, retching
-regurge |
|
|
Term
| How do we diagnose esophageal FB? |
|
Definition
|
|
Term
| What are the common locations of esophageal FB? |
|
Definition
-pharynx
-thoracic inlet
-base of heart
-caudal esophagus |
|
|
Term
| How do we treat esophageal FB? |
|
Definition
-endoscopic retrieval
-push FB into stomach + gastrotomy
-esophagotomy |
|
|
Term
| Describe the prognosis of esophageal FB. |
|
Definition
| -depends on chronicity, severity |
|
|
Term
| What are the secondary complications of esophageal FB? |
|
Definition
-mediastinitis, pyothroax, pneumonia, sepsis
-STRICTURE
-DEHISCENCE |
|
|
Term
| How do we diagnose esophageal strictures? |
|
Definition
-contrast esophagram
-endoscopy |
|
|
Term
| What are our major differentials for esophageal strictures? |
|
Definition
| -PRAA, mass, GE intussusception, diverticuli, hiatal hernia |
|
|
Term
| What is the most common vascular ring anomaly? |
|
Definition
| -Persistent right 4th) aortic arch |
|
|
Term
| Which breeds are predisposed PRAA? |
|
Definition
| -boston terrier, GSD, Irish setter, Simese, Persian |
|
|
Term
| What is the typical clinical presentation of PRAA? |
|
Definition
-regurge w/ solid food
-aspriation pneumonia
-failure to thrive, poor wt gain |
|
|
Term
|
Definition
|
|
Term
|
Definition
| -remove constriction at 10-12w |
|
|
Term
| What is the typical prognosis of PRAA? |
|
Definition
| -fair to good: time is of the essence |
|
|
Term
|
Definition
| -movement of the stomach and abdominal esphagus through esopahgeal hiatus |
|
|
Term
| What are the types of hiatal hernieas? Etiologies? |
|
Definition
-Congenital: unknonw, prenicesphageal ligament laxity
-Acquired: trauma, inc upper airway pressure |
|
|
Term
| Which breeds are predisposed to congenital hiatal hernias? |
|
Definition
-English bulldog
-Shar Pei |
|
|
Term
| What cuases acquired hiatal hernia due to inc upper airway P? |
|
Definition
-crachycephalic airway syndrome
-laryngeal paralysis
-chronic vomiting |
|
|
Term
| What are the clinical signs of hiatal hernias? |
|
Definition
-inappetance
-dysphagia
-hypersalivation
-st loss
-vomiting
-regurge
-dyspnea |
|
|
Term
| How do we diagnose hiatal hernias? |
|
Definition
|
|
Term
| How do we medically treat hiatal hernias? |
|
Definition
-Gastroprotectants: antacids, sucralfate
-Prokinetics: metoclopramide
-low fat diet
-feed from elevated platform |
|
|
Term
| How do we surgically treat hiatal hernias? |
|
Definition
-herniorrhaphy
-esophagopexy
-gastropexy ON THE LEFT SIDE |
|
|
Term
| What are the common complications w/ hiatal hernia? |
|
Definition
-continued dysphagia
-regurge
-aspiration pneumonia |
|
|
Term
| The healing ability is great. Why? |
|
Definition
-stomach has large blood supply
-reduced bacterial numbers due to acidity
-rapidly regen epi
-omentum |
|
|
Term
| Which abx do we think for use in stomach? |
|
Definition
-gram positive
=perioperative if clean-contaminated
-long term if more than a gastrotomy |
|
|
Term
| HOw do we avoid gastric spillage? |
|
Definition
-stay sutures
-isolate w/ lap sponges
-use sunction
-inc exposure |
|
|
Term
| How does the stomach differ from the other GI organs? |
|
Definition
| -serosa & muscularis are sepaerated from submucosa & submucosa |
|
|
Term
| How do we close the stomach? |
|
Definition
| -2-layer method: inner layer (mucosa/submucosa) w/ simple continuous & outer layer (muscularis/serosa) w/ inverting (cushing or lembert) |
|
|
Term
| Do we leak test the stomach? |
|
Definition
|
|
Term
| Of the 4 layers of everything, which layer is the holding layer? |
|
Definition
|
|
Term
| What are some common indications for gastrotomy? |
|
Definition
-FB
-gastric wall biopsy
-gastric lumen exploration |
|
|
Term
| What is the general procedure of a gastrotomy? |
|
Definition
-pack off stomach w/ lap sponges
-go midway b/n greater and lesser curvature
-place stay sutures or babcock forceps
-make incision: stab w/ scalpel & extend w/ metzenbaum scissors |
|
|
Term
| What is the typical clinical presentation of gastric FB? |
|
Definition
-anorexia
-vomiting
-dehydration
-depression |
|
|
Term
| How do we diagnose gastric FB? |
|
Definition
|
|
Term
| How do we treat gastric FB? |
|
Definition
-endoscopy
-gastrotomy
-emesis |
|
|
Term
|
Definition
| -act of stretching a cavity/orifice |
|
|
Term
|
Definition
| -condition in which organ structure is stretched beyond normal dimensions |
|
|
Term
|
Definition
| -rotation of stomach on its mesenteric axis |
|
|
Term
| Is acute or chronic GDV more common? |
|
Definition
|
|
Term
| What is the typical physiology behind GDV? |
|
Definition
| -pylorus moves from right => ventral to left => ends dorsal |
|
|
Term
| What are the typical risk factors of GDV? |
|
Definition
-deep-chested, large/giant breed, ilder
-fed once daily
-first degree relative w/ GD/GDV
-anxiety/stress
-exercise after eating |
|
|
Term
| What is the typical clinical presentation w/ GDV? |
|
Definition
-retching
-restless/painful
-abdominal enlargement
-hypersalivation |
|
|
Term
| REVIEW SLIDE 24 IN STOMACH LECTURE |
|
Definition
|
|
Term
| What do we see on PE w/ GDV? |
|
Definition
-depressed/anxious
-tachycardia
-tachypnea
-proonged CRT
-poor peripheral pulses
-hypersalivation
-abdomen |
|
|
Term
| What do we see on CBC/Chem w/ GDV |
|
Definition
-electrolyte imbalances
-anemia
-neutrophilia w/ left shift |
|
|
Term
| What is the significance of lactate levels w/ GDV? |
|
Definition
| -better prognosis w/ lesser absolute change |
|
|
Term
| What are we most likely see on ECG w/ GDV? |
|
Definition
|
|
Term
| What are our two goals in GDV emergency stabilization? |
|
Definition
-gastric decompression
-treat shock |
|
|
Term
| Why would we prefer a large catheter w/ GDV emergency stabilization? Why in the cephalic? |
|
Definition
-can give more fluid
-do cephalic b/c easier |
|
|
Term
| What fluids do we give for emergyency stabilization for GDV? |
|
Definition
| -shock bolus w/out additives |
|
|
Term
| What is the shock dose of crystalloids? colloids? |
|
Definition
-Crystalloid: 90ml/kg
-Colloid: 5-10 ml/kg |
|
|
Term
| We always give pain meds for emergency stabilization of GDVs. Why do we avoid opioid? |
|
Definition
| -b/c will dec blood flow to GI tract |
|
|
Term
| When do we treat ventricular arrhythmias? |
|
Definition
-ventricular tachycardia (HR > 160-180)
-R on T
-multifocal
-pulse deficits
- |
|
|
Term
| If you pass orogastric tube and almost there but you hit resistance, what is wrong? |
|
Definition
|
|
Term
| How do we insert orogastric tube in GDV patient? |
|
Definition
-tape roll in mouth
-mark 13th rib to tip of muzzle
-lube
-fleck neck ventrally and advance |
|
|
Term
| What are the guidelines for trocharization of GDV patient? |
|
Definition
-at point of maximal tympany (often left side)
-aseptic prep
-puncture w/ 18G needle & provide pressure
-push opposte side of abdomen towards needle |
|
|
Term
|
Definition
-rads: only need right lateral
-ID: abnormal position of pylorus (make sure to get entire diaphragm!!) |
|
|
Term
| What indicates a worse prognosis of GDV? |
|
Definition
-free air in abdomen: gastric perforation
-surbserosal gas: mucosal integrity lost/necrosis |
|
|
Term
|
Definition
| -surgical gastric detoration w/ exploratory |
|
|
Term
|
Definition
-stand on left side
-RH: find pylorus dorsally
-left hand: place on top of fundus
-puch on fundus and pull pylorus from dorsal towards left and then ventral back to right |
|
|
Term
| How do we manage GDV postop? |
|
Definition
| -same as preop management + abx + enteral nutrition + gastroprotectants |
|
|
Term
| What is the kind of abx we use for postop GDV? |
|
Definition
|
|
Term
| What is the general prognosis w/ GDV w/ sx? |
|
Definition
-75-90% success rate
-gastric dilatation can occur again
-septic abdomen: 50% success rate |
|
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