Term
| What diagnostic techniques are commonly used for investigating GIT disease? |
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Definition
| Palpation, percussion, auscultation, endoscopy, haematology, biochem, peritoneal lavage, plain and contrast rads, ultrasound, CT, MRI, biopsy, exlap |
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Term
| For funsies and wonder, in which decades were the Lembert and Connell suture patterns developed? |
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Definition
60's and 90's...
Of the 1800's. |
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Term
| What are some important preoperative considerations when looking at performing GIT Sx? |
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Definition
Fluid loss from vom/diarrhoea (correct with fluids)
Electrolyte imbalances
Acid-base disturbances
Antibiotic Therapy (if there is a good risk of contamination) |
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Term
| What are the general principals of tissue handling in regards to the GIT? |
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Definition
Gentle and non-traumatic handling by instruments and fingers
Keep visceral surfaces moist with sterile saline |
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Term
| How do you assess the viability of the intestine? |
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Definition
Assessment of colour, presence of pulse and peristalsis.
It is important to note that none of these are fully reliable |
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Term
| What instruments are commonly used to handle the gut? |
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Definition
Fingers are the safest, but non-crushing forceps also essential to have in your arsenal (Doyen forceps, cardiovascular toothed forceps)
Loosely tied stay sutures are also used |
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Term
| Which of the absorbable suture materials cause the greatest tissue reaction? |
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Definition
|
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Term
| Which suture materials cause the greates amount of tissue drag? |
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Definition
Uncoated dexon, vicryl and safil.
If coated they have low reactivity |
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Term
| What are some of the benifits of monocryl and monosyn? |
|
Definition
Milk inflam response
Low memory
Good knot security
Lose strength within around 3 weeks |
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Term
| What size suture material should you use in most small animal GIT Sx? |
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Definition
|
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Term
| What are the three broad categories of anastomosis? |
|
Definition
| End to end, side to side, end to side |
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Term
| What are the three broad categories of suture patterns used in the GIT? |
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Definition
| Inverting, approximating, everting |
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Term
| What is the aim of inverting suture patterns? |
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Definition
| Aiming to produce serosa to serosa contact |
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Term
| What is the classical 2-layer technique of closing the bowel? |
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Definition
| INverting technique starting with a connell layer over-sewn with Lembert sutures. All layers penetrate the submucosa, as this is the layer with strength |
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Term
| What is the aim of approximating suture patterns? |
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Definition
| To realign the anatomical layers of the bowel |
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Term
| What are the three types of approximating sutures used in GIT Sx? |
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Definition
| Gambee, cutting and simple interrupted non-crushing sutures |
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Term
| What are some of the issues surrounding the use of everting sutures in GIT Sx? |
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Definition
| The results of clinical studies are kinda unclear, but it seems that everting patterns are associated with a greater number of omental adhesions and mural fibroses. |
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Term
| What are some of the issues surrounding the use of inverting suture patterns in GIT Sx? |
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Definition
| It has been shown in both smallies and largies that inverting patterns really reduce the lumen diameter. This can increase the chance of creating an intestinal obsrtuction |
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Term
| How long does it take a GIT wound to get close to 'normal' tissue strength? |
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Definition
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Term
| Where should anastomoses be started? |
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Definition
| They should start at the mesenteric border, as it has no serosal coverage and accurate suturing is essential here to prevent leakage |
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Term
| What is the generally recommended spacing of sutures used in anastamoses? |
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Definition
| 2-3mm from the incision and roughly 3-4mm apart |
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Term
| What can you do to help increase the success rate of anastamoses? |
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Definition
| Wrap that shit in omentum |
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Term
| What are some of the considerations for oesophageal Sx? |
|
Definition
No serosal covering = poor fibrin seal
Segmental blood supply = mobilization and isolation difficult
No omentum
Infection is catastrophic, so prophylactic Abs essential
Movement of ingesta can compromise healing |
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Term
| What are the sites used for surgical exposure of the oesophagus? |
|
Definition
Cervical - ventral midline
Thoracic - Right thoracotomy over the lesion |
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Term
| What are the indications for oesphagotomy? |
|
Definition
FB removal
Excision of diverticulae
Removal of tumours
Stricture resection |
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Term
| What is the general technique for oesophagotomy? |
|
Definition
Pack off oesophagus with moist packs
Incise into healthy tissue only
Resect as little as possible
Monitor and manage acid-base things (loss of saliva) |
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Term
| What are the two main methods of incision closure in the oesophagus? |
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Definition
Traditional - 2 layer closure (mucosa/submucosa closed first with simple interrupteds with the knot in the lumen and then the muscularis is closed, also using SI sutures)
Newer - longer lasting monofilament, absorbable, in a single layer. Not as strong as a double layer and the placement of sutures must be precise |
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Term
| What are some of the things than can be used to creat a full thickness oesophagus graft? |
|
Definition
Sternothyroideus muscle in cervical region
Diaphragmatic pedicle flap in thoracic region |
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|
Term
| What are the post op considerations following oesophageal Sx? |
|
Definition
Withhold food for 24-72hrs
Parental fluids only, or gastrostomy tube
Prophylactive Abs
Soft foods initially |
|
|
Term
| What are some common complications following oesophageal Sx? |
|
Definition
| Stricture, leakage, infection, diverticulae formation |
|
|
Term
| What are the common site of oesophageal FBs? |
|
Definition
Crico-oesophagus
Thoracic inlet
Base of the heart
Cardia of stomach |
|
|
Term
| What are some common causes of oesphageal obstruction? |
|
Definition
| FB, diverticulum, neoplasia, stricture, vascular ring abnormalities |
|
|
Term
| What are the 4 sections of the stomach? |
|
Definition
| Fundus, body, pyloric antrum and pyloris |
|
|
Term
| What is the main blood supply to the stomach? |
|
Definition
| Celiac artery through the splenic, left gastric and hepatic artieries |
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|
Term
| What are the indications for gastric Sx? |
|
Definition
| Removal of FBs, gastric ulceration, gastric neoplasia, GDV |
|
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Term
| What is the general technique for a gastrotomy? |
|
Definition
Pack off stomach with moist abdo packs and place stay sutures
Make a longitudinal incision in the ventral wall, midway between the greater and lesser omentum OR in a relatively avascular area
Closure is two layer with 3/0 or 4/0 material
Lavage abdo liberally with sterile saline if contamination is suspected |
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|
Term
| How much of the stomach can you remove? |
|
Definition
|
|
Term
| Why do you use a Y-to-U pylorplasty? |
|
Definition
| For treatment of delayed gastric emptying. This widens the pylorus and speeds up gastric emptying |
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Term
| What is the general procedure for enterotomy into the small intestine?` |
|
Definition
| Milk away contents of segment anduse fingers or forceps to stabalise the area. Incise along the anit-mesenteric border |
|
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Term
| What is the general procedure for intestinal resection? |
|
Definition
Pack off the loop of bowel to be resected, ligate the blood vessels supplying the segment to be resected.
Resect segment, and preform an end to end anastamosis. Wash the anastamosis with warm saline and wrap in omentum prior to replacement into the abdomen. |
|
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Term
| What are some techniques that can be used to overcome luminal disparity? |
|
Definition
Incise the smaller end at an angle, leaving less antimesenteric wall to maintain intestinal viability
Connect the two ends of bowel and close off the excess width of bowel with a two layer closure
Cheattle incision |
|
|
Term
| What are some of the complications found following colorectal Sx? |
|
Definition
| Sepsis, wound breakdown, stricture formation and faecal incontinence |
|
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Term
| What are the two methods used to reduce the bacterial load in the large bowel preop? |
|
Definition
Removal of faeces (enemas, isolate solid faeces, laxatives, high calorie foods, low residue diets, whitholding food for 24-36hrs)
ABs Prophylaxis |
|
|
Term
| How is the best healing acheived when closing incisions in the large instestine? |
|
Definition
| Avoid close, tight sutures, single layer of simple interrupted, monofilament sutures in an approximation or inverting, interrupted pattern. |
|
|
Term
| What is the significance of using continues suture patterns when closing an incision in the large bowel? |
|
Definition
| A continuous pattern increases the production of collagen in the early phases of wound healing |
|
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Term
| How can you distinguish a GDV from straight gastric dilation prior to opening the abdomen? |
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Definition
| It should be easy to tell the difference based on abdominal radiographs. A volulus should have 2 distinct sections formed by a pillar of folded tissues, while a dilation without volulus will pribably look like just a giant gas filled stomach |
|
|
Term
| What are some of the complications of intestinal Sx? |
|
Definition
| Short bowel syndrome, illeus, |
|
|
Term
| What is short bowel syndrome and how does it occur? |
|
Definition
| SBS is a syndrome that often presents with intractable diarrhoea. It is a syndrome that presents as a complex of Malabsorption, maldigestion, bacterial overgrowth and fatty acid and bile salt mediated diarrhoea. Resection of up to 50% of the small bowel is often unproblematic. |
|
|
Term
| What are the surgical approaches to the colon? |
|
Definition
Colon/colorectal junction - Ventral midline +/- Ischial-pubic flap
Middle third - Dorsal perineal approach or abdomino-anal pull through
Caudal third - caudal rectal pull through |
|
|
Term
| What is, in general terms, a pull through? |
|
Definition
| It is an intentional prolapse, usually of the rectum or colon, that allows you to access a section that is not easily reachable by sectioning it and pulling it through to a section of the abdomen that CAN be easily accessed. |
|
|
Term
| What are the main indications for colon surgery? |
|
Definition
| Neoplasia, benign and malignant, rectal stricture, perforation, prolapse, obstipation, megacolon. |
|
|
Term
| In general terms, how would you preform a partial liver lobectomy? |
|
Definition
| 'Finger fracture' the lobe (squish it tightly and then tear it apart gently) and feel for the main vessels. Ligate those individually. Cut the dead bit off and chuck it. Leave the lobe uncovered |
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