Small Ani. Sx- Intestines 3

untimely's version from 2015-09-26 19:52

Sx techniques continued

Question Answer
Enterectomy - Surgical Technique (CLOSURE)The mesenteric border is sutured first!!! Then, The second suture is placed in the antimesenteric border (bc doing two that go 180*, not one that goes 360*), then The remaining sutures are placed 2-3 mm from the edge of tissue, and 2-3 mm apart
explain what you must know if you are going to cut/pierce a hole in the mesentary, and what you must do afteryou will NEED to suture it closed again so bowel doesnt herniate through it and get constricted. the mesentary often rolls up so you will need to wet your fingers and unroll it before you suture.
which type of suture and in what fashion do you close the mesentary?The mesentery is sutured with 3-0 or 4-0 absorbable suture, simple interrupted or simple continuous (maybe 5-0), not too much tension!
So, the disparity between the resections is too big for just pinching to induce shrinkage by peristalsis, and then it's also too big to fix via fishmouth technique. What else can you do? (any risks associated with it possibly?)you can partially close bigger diameter side's edges to itself until you have opposed to smaller side. food might get stuck in the little pouch that might be created by this technique, but often peristalsis flattens it out
what are 3 choices you have on how to anastomose your two resections of intestines?end to end, side to end, side to side
explain the serosal patch technique (basic with pic)where we have enterectomy site already repaired, and dont like the closure, and omentum wont fit through, use serosal patch. serosa provided by adjacent loops of bowel. make loops wide enough so no hairpinning problems. sew it to it BUT DONT PENETRATE LUMEN.
indications for serosal patching?(1) Questionable area of suturing after enterotomy or anastomosis: Tension at suture line, Damage to serosa, Repair of dehiscence (2) Superficial trauma to intestinal wall
*when does dehiss usually happen? when does infection usually happen?both are at about 3-5d
surgical technique for serosal patching (step by step)placement of an antimesenteric border of the small intestine over a suture line or organ defect--> adjacent loop of intestine is sutured over damaged area--> sutures engage submucosa but do not penetrate the mucosa. --> *avoid twisting, stretching or kinking the intestine and mesenteric vessels
what are the two kinds of stapled anastomoses?(1) Side-to-side (functional end-to-end) (2) Inverting end-to-end (often staplers used in large and expensive animals)
explain the side-to-side stapled anastomoses-- which stapler? how's it done?GIA and TA staplers
explain the end to end (inverting) stapled anastomoses-- which stapler? how's it done?EEA stapler
intestinal plication is aka?Enteroenteropexy
what is the reasoning behind why we do a intesintal plication?Developed to prevent recurrence of intussusception...however, Efficacy questionable
how do you do enteroenteropexy (plication)?Small intestine is placed in gentle loops, and seromuscular layers are sutured with small interrupted sutures
what is a colopexy done for?Colopexy is done to prevent caudal displacement of the colon and rectum. especially useful in animals with recurrent rectal prolapse (also useful for helping preven perineal hernias)
which side of the body is the colopexy done on? If you want to do a cystopexy too (attach bladder to wall) where do you do THAT?colopexy on L (bc colon on the left)....cystopexy then on R, because don't want two pexys on the same side
what type of suture do you wanna use for a colopexy?prolene or nylon so it'll stay for a long time
who is at risk for perineal hernias? what structures do you wanna pexy to try to fix it?colopexy, cystopexy, and deferentopexy (use deferens) usually pt with perineal hernias is intact male dogs. 3x times recurrence if not castrated.
how do you pexy the colon to the abd wall? (technique)on LEFT abd wall, first suture the back wall first, then the front wall. remmeber length you should have -- non less than like 2.5 or 3.5 cm in length to have a good adhesion
postop care--> when do you wanna try to give pt water?Offer water 6-8 hours after surgery
postop care--> when do you wanna try to give pt food?If no vomiting occurs, offer bland food 12-24 hours after surgery (asap bc enterocytes need glucose). Reintroduce normal diet gradually starting at 48 hours after surgery
do you wanna give abx post-op?NO ABX unless peritonitis is present
for the incisional colopexy, you need it to be how long, and *what layers do you cut?need it to be 3.5cm long!!! otherwise not strong enough. Cut into ***seramuscularis only, NOT INTO LUMEN!!!!


Question Answer
#1 reason for sx complications of intestinal sx?poor suture technique! ALWAYS MAKE SURE SUBMUCOSA IS ENGAGED
never use what kinda suture on intestines?chromic gut
Dehiscence and peritonitis usually due to what 4 probs?Result of poor suturing technique, non-viable bowel, use of chromic gut, delayed healing
when does Dehiscence and peritonitis usually occur? (what is the rate of dehis in sm int?)Occurs between 3rd and 5th day after surgery. Rate of dehiscence of small intestine= 16%
how dangerous is intestinal dehissence?75% of patients with intestinal dehiscence die - treat aggressively!!
why can Dehiscence and Peritonitis lead to adhesions?adhesions bc serosa will move over and cover to try to help.
some ways to maybe help avoid dehiscence/peritonitis? use aspetic tech, change gloves, make sure suture in submucosa, use diff instruments to close...
what are three common int. sx complications?Ileus, Adhesions, and Stricture.
how can you minimize risk/severity of Ileus?frequent feeding of small meals and early ambulation decrease severity
what mistakes are usually done which cause strictures?rare, associated with inverting or everting suture pattern or excessive tension
*dogs with 2 or more of the following risk factors are predicted to be at high risk for developing anastomotic leakage.. (3)preoperative peritonitis, intestinal foreign body, and serum albumin concentration ≤ 2.5 g/dL.
Short bowel syndrome happens when _________(amt)_________ of sm int has been removed70-80%
C/S of short bowel syndrome?Weight loss, diarrhea, malnutrition, Anemia secondary to folic acid deficiency
how do you tx short bowel syndrome?Supportive therapy until remaining intestine adapts (1- 2 months)
apprx how long does it take to have bowels adjust to short bowel syndrome?1-2mo


Question Answer
Neoplasia of the Intestine--> most common location in dogs? cats?DOGS: colon and rectum. CATS: sm int.
are most intestinal tumors benign or malig?malig
how common is metastasis at necropsy?86% of dogs and 71% of cats have metastasis at necropsy (lymph nodes, liver, lungs) (really high!)
most common intestinal malignancy of dog?*adenocarcinoma
most common RECTAL tumor of dog?adenomatous polyp
most common intestinal tumor of cats?*lymphosarcoma (benign tumors rare)
mean age for a dog with Intestinal Adenocarcinoma? cat?DOG: 9yr. CAT: 10yr
what is the gender ratio like for Intestinal Adenocarcinoma in dogs? cats? [M:F]DOG: 21:11. CAT: 5:9 (SO, more BOYS in DOGS and more GIRLS in CATS)
which breeds of dogs are more prone to intestinal adenocarcinoma? cats?DOGS: Boxers, Collies, German shepherd dogs. CATS: Siamese
History and signalment of a SMALL int neoplasia?Weight loss, Anorexia, depression, Diarrhea, Signs of obstruction, including vomiting
History and signalment of a LARGE int neplasia?Tenesmus, Hematochezia, Dyschezia, Weight loss
which int neoplasia can cause anemia?leiomyosarcoma
what are some things you'd see upon exam which might point to intestinal neoplasia?Palpable abdominal or rectal mass, Dilated loops of intestine (obstruction), Anemia (leiomyosarcoma), Signs of peritonitis (with perforation of gut or necrosis of tumor)
how will intestinal neoplasia appear on radiographs?Abdominal mass, Dilated intestinal loops, Contrast radiography (Intramural or annular lesion, Diffuse filling defects in bowel wall)
classic radiographic lesion of intestinal neoplasm?NAPKIN RING
what might clue you toward intestinal neoplasia on US?enlarged lymph nodes or hepatic masses
Intestinal Neoplasia therapy has what two options?(1) Intestinal resection and anastomosis (2) chemo
when is Intestinal resection and anastomosis reccomended as a tx for neoplasia? (3 criteria)(1) Single mass (2) Resection < 70% of small intestine (3) No metastatic lesions present
when is chemo effective as a tx for int neoplasia? Not so much?Lymphosarcoma: some success. Adenocarcinoma: poor results
recc tx for Rectal polyps? (where usually ARE the polyps?)Submucosal resection per anus-- most are within 2 cm of anus (look like stalks of broccoli usually)
therapy of Colorectal Neoplasia which is Annular or more cranial can be txed with what 3 types of tx?(1) Dorsal approach to rectum (2) Rectal pull-through approach (3) Ventral approach to rectum
what kinda special tool can you use to remove polyp and seal off tissue?ligasure forceps (kinda like a high tech electric scalpel )
if you are removing rectal polyps and the such, what medication is super helpful that you shouldnt forget about?suppositories!
what is this approach? Rectal pull-through approach
how do you "pull through" the rectum to the outside in the rectal pull through approach?use stay sutures to pull out
If there is a mass in the rectum, and you are using rectal pull through technique- what kinda biopsy do you use? what kinda incision do you make for this, then? what would you safety margin be like?you would do an EXCISIONAL biopsy using an ELIPTICAL incision with a MINIMAL safety margin *dont forget to send sample in for path
If you have performed an excisional biopsy via rectal pull through technique, what are some things you should do post-op to help it heal?low residue diet and stool softeners
What is this procedure? When do you use it? what are the red dots about? This is a dorsal/ventral approach. It is used to access Annular or more cranial tumors in the colo-rectal area. If ventral, need to cut floor of pubis to access colo-rectal area. The red dots are where you could drill to place orthopedic wire to replace the pubis you cut away
why must you handle the colo-rectal region with care?careful with stretching primary or 2ry arcuates in Lg bowel.
what is the prog of Colorectal tumors? likelihood of recurrence?Large or sessile tumors more likely to recur. Euthanasia, usually because of failure to control dyschezia (painful defecation) or hematochezia (try to see if there is a bleeder and why is it bleeding. colon is difficult area.)