| Question | Answer |
|---|
| who does pyloric hypertrophy usually happen to? | Occurs predominantly in dogs and, less commonly, in cats |
| what is the etiology of Pyloric Hypertrophy/Stenosis? | unknown |
| Difference in what is affecting in Congenital VS acquired hypertrophy | Congenital form involves muscular layer of pylorus. Acquired form is hypertrophy of mucosa or muscular(one or both) layer of pylorus and sometimes of pyloric antrum |
| what is the most common signalment of a animal suffering from CONGENITAL pyloric hypertrophy/stenosis | Puppy or kitten, usually 6-8 weeks old. Brachycephalic breeds of dog and Siamese cats have higher incidence |
| what is the history like for a patient presenting for CONGENITAL pyloric hypertrophy/stenosis? (what has been happening to them? ) | History of vomiting following ingestion of solid food, manifested at weaning, Vomiting occurs at regular period up to 24 hours after eating. May have history of ravenous appetite. |
| If you have pt that you suspect has pyloric hypertrophy/stenosis, and they are pyrexic, what might you suspect? | ddx aspiration pneumonia |
| Clinical signs of CONGENITAL Pyloric Hypertrophy/Stenosis? | Emaciation, stunted growth, Dehydration, Occasionally fever and increased lung sounds secondary to aspiration of vomitus |
| how can you diagnose CONGENITAL pyloric hypertrophy/stenosis? | History and signalment, especially age at onset (around weening, 6-8wk), clinical signs, lab data, radiography |
| how does Radiography look like (plain and positive contrast) with CONGENTIAL pyloric hypertrophy/stenosis? | Plain radiographs: enlarged stomach filled with food and fluid. Positive contrast gastrography: delayed gastric emptying - presence of barium in stomach beyond 8-12 hours is abnormal |
| Laboratory abnormalities for an animal who has pyloric hypertrophy/stenosis? | Malnutrition leads to hypoproteinemia, anemia, low BUN, hypoglycemia. Pyloric vomiting leads to dehydration, hypochloremic metabolic alkalosis. Elevated white blood cell count if aspiration pneumonia occurrs |
| what is the history of an animal with ACQUIRED pyloric hypertrophy/stenosis? | Intermittent vomiting, not always associated with feeding, that increases in frequency over months. Weight loss. Occasionally anemia, depression, decreased activity |
| how do you dx ACQUIRED pyloric hypertrophy/stenosis? | History, signalment and physical examination findings, Clinical signs, Laboratory data, Radiography |
| Signalement of a dog with ACQUIRED pyloric hypertrophy/stenosis? (breed disposition?) | Middle aged excitable small breeds of dogs, especially Lhasa Apso and Shih-tzu. RARE in cats |
| clinical signs of ACQUIRED pyloric hypertrophy/stenosis? | Pale mucous membranes, Weakness, Emaciation, Dehydration, Hypochloremic metabolic alkalosis |
| how does radiography look with ACQUIRED pyloric hypertrophy/stenosis? (what contrast do you use?) | positive contrast gastrogram, Delayed gastric emptying, Irregular mucosa within pylorus or pyloric antrum, Filling defect in pylorus  |
| how does acquired pyloric hypertrophy/stenosis look like with endoscopy? | Narrow lumen in pylorus, *mucosal/submucosa hypertrophy  |
| what are the different kinds of treatment available for pyloric hypertrophy/stenosis? | Medical treatment not effective-- need SX!! Pyloromyotomy, Pyloroplasties, Gastroduodenostomy/gastrojejunostomy |
| three commonly used surgical procedures used to treat pyloric h/s? | FREDET-RAMSTEDT pyloromyotomy, HEINEKE-MIKULICZ pyloroplasty, Y-U antral advancement flap pyloroplasty |
| what is the procedure which would be considered radical for treating pyloric h/s? | Billroth I gastroduodenostomy |
| explain the FREDET-RAMSTEDT pyloromyotomy (is it used for congenital or acquired? what is the surgical technique?) | used for CONGENITAL. Partial thickness longitudinal incision from pyloric antrum to duodenum across pylorus. Seromuscular layer incised to allow mucosa to bulge into incision and expand pylorus (mucosa not cut)  |
 what technique is this, what is it used to tx? | FREDET-RAMSTEDT pyloromyotomy, for CONGENITAL pyloric h/s |
| advantages of the FREDET-RAMSTEDT pyloromyotomy? | Quick and easy to perform, Lumen of pylorus not opened (use stay sutures) |
| disadvantages of the FREDET-RAMSTEDT pyloromyotomy? | Effective only in congenital stenosis, Effect may be temporary – stenosis may recur as seromuscular incision heals (tend to heal and give you reoccurence of the dz) |
| how should you take the stomach out, and why is it difficult to expose the stomach properly? | take stomach out with fingers, babcocks, or stay sutures. hard to expose stomach properly due to gastrohepatic lig |
| what are the indications for a HEINEKE-MIKULICZ pyloroplasty? what is the surgical technique like? | for CONGENITAL OR ACQUIRED pyloric hypertrophy/stenosis, biopsy. This is a A full-thickness LONGITUDINAL incision crosses the ventral surface of the pylorus. The incision is closed transversely in 1 layer of simple interrupted sutures |
| if the gastrohepatic ligament is preventing you from getting good exposure of the pylorus, what can you do? | when severing gastrohepatic lig, do it halfway to give your good exposure of the pylorus, too far through lig = into the bile duct |
| what is best to get the stomach out? | babcocks better than stay sutures |
| during the HEINEKE-MIKULICZ pyloroplasty, you cut a full thickness line through part of the pylorus. Often, mucosa "mushrooms" out with full thickness luminal incisions. what can you do about this excess mucosa? | if muscosa redudant= can trim it |
| If you are doing a HEINEKE-MIKULICZ pyloroplasty and you need more exposure, what can you do? | blunt dissection around mucosa/submucosa with a hemostat |
 What technique is this? when can it be used? | HEINEKE-MIKULICZ pyloroplasty, can use for CONGENITAL OR ACQUIRED pyloric h/s |
| what type of closure do you use on a HEINEKE-MIKULICZ pyloroplasty, and why? | single layer apposition only!!! cant use 2 layers because it reduces the lumen size too much. |
| what are the advantages of the HEINEKE-MIKULICZ pyloroplasty? | Exposure of mucosa for biopsy, Less likelihood of recurrence than pyloromyotomy. |
| what are the disadvantages of the HEINEKE-MIKULICZ pyloroplasty? | Lumen is opened, Not usually effective with acquired pyloric hypertrophy |
| what are the indications for a Y-U pyloroplasy? what is the surgical technique? | acquired pyloric hypertrophy, resection of mucosa / submucosa. TECHNIQUE: Make a longitudinal full-thickness pyloric incision. Extend it into the pyloric antrum making 2 diverging incisions (Y). The incised gastric wall is closed by suturing into a U shape |
 What technique is this? when is it used? | Y-U pyloroplasty, good for acquired pyloric hypertrophy |
| what type of suture pattern is used for the Y-U pyloroplasty? suture? | single apposition (as to not narrow the lumen) and absorbable suture |
| what are the advantages of the Y-U pyloroplasty? | Good exposure of mucosa, Redundant mucosa and submucosa can be resected (use 1 layer closure), Greater expansion of pylorus |
| what are the disadvantages of the Y-U pyloroplasty? | Lumen is opened, More lengthy procedure |
| when is a Pylorectomy and Gastroduodenostomy (Billroth I) indicated? (what is it basically?) | severe acquired pyloric hypertrophy, necrosis of pylorus, neoplasia (end to end anastomoses of duodenum and stomach ) (note: have to reestablish enterohepatic circulation to keep bile going into duodenum- but then bile is free flowing constantly) |
| (Pylorectomy and Gastrojejunostomy (Billroth II)--what is going on?) | (side to side anastomosis of jejunum bowel loop to stomach. incision shd be not less than 3-4 cm bc shrinkage can occur during healing process up to 50%. pylorus and part of duodenum are gone. duodenum is a stump. jejunum attached to body of stomach. prob- jejunum not used to acidicty of stomach- so anastomoses can become ulcerated) |
| what are the indications for a partial gastrectomy? | neoplasia, ischemic injury (GDV) or penetrating injury (ulcer or trauma) |
| where does ischemic injury usually occur in the stomach? | commonly occurs at the greater curvature |
| when is a pt NOT suitable for sx (partial gastrectomy)? | if there is ischemic injury involving both curvatures |
| explain the INCISIONAL partial gastrectomy technique | Branches of the gastroepiploic vessels to the affected area are ligated, A continuous suture may be run concurrently with resection. The incision is closed in 2 layers |
 what technique is this? | partial gastrectomy |
| If you are trying to find where the necrotic tissue from an ishemia ends, how can you tell which tissue is alive? | knick it a bit and see if it bleeds |
| what is the layer with the main blood supply to the stomach? | submucosa- may bleed throughout sx |
| when ligating vessels during a partial gastrectomy, what must you be careful about? | don't cut off blood supply to spleen |
| partial gastrectomy with STAPLES technique? | Branches of the gastroepiploic vessels to the necrotic area are ligated, The tissue to be resected is drawn into the jaws of the TA (55 or 90) stapler, The tissue is stapled, then excised. (staples cut and close at same time) |
| diff between fever and hyperthermia? | hyperthermia is a clinical sign fever is a syndrome (many clinical signs) |
| how could you help reduce the recurrence of pyloric h/s after a FREDET-RAMSTEDT pyloromyotomy procedure? (why is there recurrence?) | recurrance can happen bc two layers which were cut can heal back together (muscularis and serosa)--> recurrence of dz. do pylorectomy- remove a little strip of pylorus- (muscularis) to prevent reoccurence. lumen is NOT penetrated |
| for any procedure, where do you want to avoid your suture going? | avoid curvatures-- might compromise blood supply with sutures |
| after a Y-U pyloroplasty how should you feed your pt? | dont over feed patient- need small frequent meals |
| what is a "TA" stapler? | thoracic abdominal stapler |
| memorize |
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biyubaye's
version from
2016-07-01 22:22
what is going on in this picture, and why?
