Term
| What are the general anatomic considerations w/ SI? |
|
Definition
-all layers are stuck together
-proximal decending duodenum
-duodenocolic ligament
-ileum contains antimesenteric a |
|
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Term
| What are the two major surgical indications for SI? |
|
Definition
-entrotomy
-resection and anastomosis |
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Term
| Why would we perform an enterotomy? |
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Definition
-full-thickness biopsy
-FB rmeoval |
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Term
| Why would we perform a resection and anastomosis of SI? |
|
Definition
-perforated bowel
-non-reducible intussusception
-neoplasia
-granulomatous dz (fungal) |
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Term
| What are our major surgical considerations w/ the SI? |
|
Definition
-make sure patient is stable
-avoid NSAIDs
-bacterial load changes: more types
-Abx therapy |
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Term
| What type of abx do we give w/ uncomplicated SI issues? If complicated? |
|
Definition
-preop ampicillin + sulbactam
-same abx but continue after sx |
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Term
| Why is fluid therapy critical w/ SI? |
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Definition
| -obstruction/ileus => intraluminal fluid translocation/sequestration => hypovolemia => poor tissue perfusion/aci base imbalances/shock/anesthetic risk/death |
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Term
| What type of suture do we use for SI sx? |
|
Definition
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Term
| Describe the typical behavior of a linear FB. |
|
Definition
-common to anchor at pylorus (dog) or under tongue (cat)
-causes erosion into mesenteric border |
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Term
| HOw do we diangose linear FB in SI? |
|
Definition
-survey rads +/- contrast
-U/S |
|
|
Term
| What What do we see on rads w/ SI FB? |
|
Definition
-obstructive pattern in SI
-stacking/bunching of SI
-pneumoperitoneaum/abdominal effusion = perforation |
|
|
Term
| How do we medically manage SI FB? |
|
Definition
-observe if asymptomatic +/- serial rads
-release string from under tongue
-ensure hydration
-gastroprotectants |
|
|
Term
| How do we surgically manage SI FB? |
|
Definition
-enerotomy: healthy bowel
-resection and anastomosis: damaged bowel |
|
|
Term
| Describe the process of dealing w/ linear FB. |
|
Definition
-may have to make multiple enterotomies
-milk FB orad to stomach: be careful of trauma
-gastrotomy to release anchor
-enterotomy to pull out FB |
|
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Term
| Describe in general how to do an enterotomy. |
|
Definition
-ventral midline laparotomy: large incision
-balfour retractor to inc visualization w/ full exploration
-isolate bowel w/ lap sponges, stabilize bowel, make incision on antimesenteric surface
-leak test
-wrap omentum over incision |
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|
Term
| Where in relation to the FB do we make the incision for SI FB enterotomy in order of most to least desirable? |
|
Definition
-Aborad to FB: non-dilated side
-Orad to FB: that section has higher chance to be less healthy due to trauma of passage
-over FB: least healthy tissue |
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|
Term
| How can you ID devitalized bowel for potential resection and anastomosis? |
|
Definition
-petechia, gray, green, black, purple
-dec or absent blood supply
-dry, leathery
-Foreign material or abnormal tissue present
-little luminal size, paper thin, disruptions |
|
|
Term
| How much of the bowel can we resect if necessary? Why? |
|
Definition
-up to 70%
-more = short bowel syndrome = malabsorption/maldisgestion |
|
|
Term
| What do you do w/ unequal bowel diameter during a bowel resection & anastomosis? |
|
Definition
-angle the incision on smaller side
-fish-mmouth the smaller side
-partially chole the larger side |
|
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Term
| What are the advantages and disadvantages of usign a stapling device for SI anastomosis? |
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Definition
-Advantage: quicker, creates a funcitonal side to side anastomosis
-Disadvantage must be large enough to fit the stapler |
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|
Term
| If the bowel is resected b/c of neoplasia/fungal dz, what step do we add w/ resection, anastomosis? |
|
Definition
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|
Term
| In the case of SI resection & anastomosis, what do you do if the abdomen is contaminated? |
|
Definition
-either overt spillarge or peritonitis onpresentaiton
-resect damamged segment
-LAVAGE, LAVAGE, LAVAGE & provide continuous drainage after surger
-continue abx after surgery
wrap omentum |
|
|
Term
| What are our largest complications for SI enterotomy/R&A? |
|
Definition
-leakage
-dehiscence: up to 16% |
|
|
Term
| What are some of the causes of leakage w/ SI enterotomy/R&A? |
|
Definition
-tech error
-dz tissue
-hypobolemia
-devitalized tissue |
|
|
Term
| When does dehiscence occur if it is going to w/ SI enterotomy/R&A? |
|
Definition
-accurs 3-5d after surgery
-fibrinolysis w/ loss of sealing clot occurs at this time |
|
|
Term
| How do we monitor for peritonitis after SI enterotomy/R&A? |
|
Definition
-neutrophilia w/ left shift on CBC
-neutrophis w/ bacteria in abdominal fluid
-fluid lactate & glucose: lactate high & glucose low |
|
|
Term
| What is an intussusceptum? |
|
Definition
| -proximal loop that telescopes inward in intussusception |
|
|
Term
| What is an intussuscipiens? |
|
Definition
| -distal loop that accepts the intussusceptum |
|
|
Term
| Where do intussusceptions tend to occur? |
|
Definition
| -at junctions of fixed and mobile vowel |
|
|
Term
| What are some common underlying dz that are assoc w/ SI intussusception? |
|
Definition
-enteritis
-surgery
-systemic dz |
|
|
Term
| What are some common causes of SI intussusception in young dogs? |
|
Definition
-parasites
-viral enteritis
-FB |
|
|
Term
| What are some common cuases of SI intussusception in older dogs? |
|
Definition
-neoplasia
-Infiltrative bowel dz |
|
|
Term
| What are the clinical signs of SI intussusception? |
|
Definition
-diarrhea
-anorexia
-dec appetitie
-st loss
-painful |
|
|
Term
| How do we diagnose SI intussusception? |
|
Definition
-palpable tubular mass
-rads: mass or obstructive ileus
-U/S |
|
|
Term
| How do we surgically manage a SI intussusception? |
|
Definition
-reduce manually if no acute adhesions present
-resect if necessary and submit for histopath |
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