Small Animal Sx- surgical disorders of the stomach 2

wilsbach's version from 2015-11-04 18:51


Question Answer
what are the benign neoplasms common to the stomach?adenoma, adenomatous polyp
WHO usually gets benign neoplasms of the stomach, and how do they look? how hard to excise?Rare, occur in old dogs. Often large, pedunculated. Easily excised
where do you find Leiomyosarcomas, and who usually gets them?in sm mm of stomach, usually Very old dogs (average age= 15 years in one study of 7 cases)
what are the two MAIN Malignant neoplasms of the stomache, and who usually gets which?Adenocarcinoma for dogs, Lymphosarcoma for cats
Adenocarcinoma happens most commonly in who? Age? is there a gender discrepancy?OLDER DOGS (60 - 70% of gastric cancer in dogs), avg age 8ys, 2.5:1 male to female ratio (more males get it)
Lymphosarcoma usually happens in who?Most common gastric tumor in cats (also occurs in older, usually male, dogs)
what might a gastric neoplasia look like? (diff prob)looks like a pyloric obstruction but not usually young dogs
how can you dx an animal with gastric neoplasia?(1) History of hematemesis, anorexia, weight loss, abdominal pain. (2) Contrast radiography / ultrasonography-- see mass lesion or ulcer
would you expect bloody feces or vomit in an animal with gastric neoplasia?yes! neoplasia can cause ulcers or other problems
where are malignant gastric neoplasias usually located?often located on lesser curvature or pyloric antrum
how do benign gastric neoplasias usually look?pedunculated / circumscribed
would you want to use an endoscope to bx a gastric neoplasia?usually NO (but can be useful) endo cant give full thickness bx- do exploratory celiotomy (esp if an older dog, want full thickness bc prolly neoplasia)
what are the clinical signs of an Adenocarcinoma?Hematemesis, Abdominal pain, Anemia, Melena, Signs of pyloric obstruction, Icterus
why might you see icterus in a case of gastric neoplasia?Tumors in this area may obstruct biliary outflow causing icterus (duodeinal blockage)
what is an apple core lesion/ when do you see it?radiographic filling defect in pyloric antrum, "apple core" lesion
Differential diagnosis for gastric neoplasia?(1) Pyloric hypertrophy (2) Pythiosis or phycomycosis
what should you know about Pythiosis or phycomycosis?P. insidiosum causes severe inflammatory and infiltrative lesions in alimentary tract. Most common in the Gulf states, and in hunting dogs.
if you think the dog has pythiosis instead of neoplasia, how are you gonna treat/regard this mass?highly invasive and looks like metastasis, has to be a very aggressive sx from the beginning (In the gastrointestinal tract, Pythiosis clinically mimics an invasive carcinoma, so aggressive surgical extirpation must be attempted)
how deep into the stomach layers does Pythiosis usually go?infection typically involves the full thickness of the stomach or intestine
why might you be extra concerned if you find pythiosis in the pylorus or duodeinum?can extend to the pancreas, omentum, lymph nodes, or contiguous viscera
Adenocarcinoma--> do these tend to metastasize? where?yes, to regional lymph nodes (70 - 80%), liver, lung (other sites include omentum, peritoneal surface of diaphragm)
a primary adenocarcinoma can present in what 2 kinds of ways?Scirrhous or Infiltrative
what is a scirrhous primary neoplasm look like?firm and white on serosal surface
what is a infliltrative primary neoplasm like?expansile with central crater and ulceration on mucosal surface
treatment for gastric adenocarcinoma? problems assocaited with tx?Partial gastrectomy (this is more difficult on the lesser curvature though), Gastroduodenostomy or gastrojejunostomy (Billroth I or Billroth II) often required (remove tumor and close stomach and close other end of duodenum which is shortened and attach part of the jejunum). Cholecystoenterostomy may be required with pyloric tumors (jejunum mucosa is not prepared for acid of stomach so it gets ulcers)
what are non-surgical treatments of gastric neoplasia like?No effective chemotherapy for adenocarcinoma. Gastric lymphosarcoma does not respond well to chemotherapy. Radiation therapy rarely used due to sensitivity of surrounding tissues (so...they suck)
prognosis of gastric adenoma?complete excision is curative
prognosis of gastric leiomyoma/leiomyosarcoma?mean survival is 1 yr
prognosis of gastric adenocarcinoma?surgery is palliative, mean survival is 6mo
if you want a full thickness biopsy, do what? if you want partial thickness, do what?full= Exploratory celiotomy. Partial= endoscopy
which gastric tumor can look "whiteish"?adenocarcinoma in dogs
is it normal to be able to separate mucosa from muscularis?YES- so you know if it's thickened and hard and doesnt separate that there might be neoplasia
what mimicks an invasive carcinoma?pythiosis
***6-8 week old siamese cat comes into your office with a history of vomiting following ingestion of solid food which presented at weaning. The cat seems to have a ravenous appetite but vomits up to 24 hours after eating. Radiograph shows barium in stomach beyond 8-12 hours. Which is more likely with these presenting signs? (Acquired pyloric hypertrophy / stenosis OR Congenital Pyloric Hypertrophy / stenosis)Congenital (more common in brachycephalic breeds of dog and siamese cats) **Also, Acquired is Rare in Cats**
***Which breeds more commonly get the Acquired form of pyloric hypertrophy/stenosis?Lhasa Apso and Shih-tzu
***Which surgical procedure for Pyloric Hypertrophy / stenosis does NOT enter the lumen?Fredet-Ramstedt pyloromyotomy
***Which procedure is ONLY indicated in the Congenital form of pyloric hypertrophy / stenosis?Fredet-Ramstedt pyloromyotomy (Y-U IS JUST FOR ACQUIRED)
***Which procedure has more successful results than the others? (a) Fredet-Ramstedt pyloromyotomy (b) Helneke-Mikulicz pyloroplasty (c) Y-U antral advancement flap pyloroplastyY-U antral advancement flap pyloroplasty
***Which is used for Acquired pyloric hypertrophy / stenosis? (a) Fredet-Ramstedt pyloromyotomy (b) Helneke-Mikulicz pyloroplasty (c) Y-U antral advancement flap pyloroplastyY-U antral advancement flap pyloroplasty
***Which is used for either Acquired or Congenital pyloric hypertrophy / stenosis? (a) Fredet-Ramstedt pyloromyotomy (b) Helneke-Mikulicz pyloroplasty (c) Y-U antral advancement flap pyloroplastyHelneke-Mikulicz pyloroplasty **However... it’s not usually effective with Acquired pyloric hypertrophy**
***Which is the most common gastric cancer in dogs?Adenocarcinoma
***Which is most common gastric tumor in cats?Lymphosarcoma
***True or False - Radiographic filling defect in the pyloric antrum is also called / looks like - an “Apple Core” lesiontrue
***P. insidiosum (phycomycosis) mimics what sort of cancer?Adenocarcinoma - Mimics Invasive Carcinoma
***What states and what dogs are more commonly infected by P. insidiosum (phycomycosis)?gulf states and hunting dogs
***True or False - Complete excision of Adenoma is curativeTrue
***True or False - Gastropexy for Hiatal Hernia is right-sided fundus to body wallFalse **Hiatal Hernia Gastropexy -> LEFT-sided FUNDUS to Body Wall


Question Answer
DEFINE hiatal herniaprotrusion of abdominal esophagus, gastroesophageal junction and sometimes a portion of gastric fundus through the esophageal hiatus of the diaphragm into the caudal mediastinum
Etiology of hiatal hernia?Usually congenital, associated with abnormalities of hiatus, especially of the phrenicoesophageal ligament. Possibly traumatic.
what other body system/problem is associated with hiatal hernias?May be associated with upper airway obstruction
which ligament is usually the troublemaker with hiatal hernias?phrenicoesophageal ligament
what is the usual signalment of an animal suffering from hiatal hernias?Dogs and cats (rare in cats), Male Shar-pei and Bulldogs predisposed
what is the usual history of an animal suffering from a hiatal hernia?could be NO history- often asymptomatic and hernia is an incidental finding. However, can also present as Regurgitation, or vomiting, or dysphagia, Hematemesis, Anorexia, weight loss (very vague GI signs so have good ddx rule outs and listen very carefully)
(said in class) what is the most common hiatial hernia, and why might it be hard to dx?sliding esophageal is the most common hernia, cant dx with endoscopy
how can you dx a hiatial hernia?Radiography, fluoroscopy. Endoscopy (can see with endoscope if there is esophagitis<--happens with any harm to the esophagus)
why is fluoroscopy so useful in dx a haitial hernia?can see DYNAMIC MVT with it
If you suspect a perforation but you want to do a contrast study when trying to dx a hiatial hernia, what should you use?use IODINE instead of of barium (super bad if it gets into body cavities)
when do you tx hiatial hernia?only intervene with sx if symptomatic! with asymptomatic, monitor
why would you want to be very careful of the dorsal esophageal hiatus?VAGUS N LIVES THERE
4 options for surgical treatment of hiatal hernia?(1) gastropexy (2) hiatal reduction and esophagopexy (phrenoplasty) (3) gastrostomy tube (4) nissen fundoplication
how would you gastropexy for a hiatal hernia?left-sided fundus to body wall
a hiatal reduction and esophagopexy (phrenoplasty) essentially does what?reduce the size of the esophageal hiatus
nissen fundoplication is indicated when?indicated only if reflux and esophagitis are present
explain a little about the nissen fundoplication procedure, and why esophagitis being present is necessary to justify the procedurereflux damages the esophagus >>esophagitis >> scar formation >> stricture >> not let bolus into stomach >> regurg. perform by putting umbilical tape around the abdominal esophagus, dont disturb vagus n, elevate the stomach, ID fundus, wrap fundus around esophagus and suture it to itself >> makes a cuff of stomach around the esophagus
what procedure is this? when is it used?nissen fundoplication, indicated only if reflux and esophagitis are present with a hiatal hernia (basically make a cuff around the esophagus with the fundus so that its wider and less likely to slip through the hiatus)
what procedure is this? what is going on?gastropexy-- hiatial hernia incision on fundus and other on left abd wall. 3.5-4 cm incision to create strong adhesions.
explain the hiatal reduction and esophagopexy (phrenoplasty)1. reduce the size of the hiatus with simple stitches 2. esophagoplexy = attach esophagus to the other side of the opening
what is a tube gastropexy?tube gastropexy - place a tube on the fundus... gastropexy is you're fusing the sera muscularis to the ab. wall aka tube gastrostomy
explain how a gastropexy differs between a GDV and a hiatial hernia treatment?GDV has the pexy on the pyloric antrum on the RIGHT side. The hiatal hernia has the pexy on the fundus on the LEFT side. (GDV doesnt have a L in it but Hiatal does)
how long should the incisional gastropexy be in order for it to properly adhere?3.5-4 cm long else it'll not adhere permenantly
*dx hiatal hernia with??fluoroscopy
worst bones you could give to cause lots of problems?pork bones
what is a paired hiatal hernia?eso AND part of fundus get through hiatus
a hiatal hernia might lead to gastro-esophageal dilation...why is this problematic?pressure on thorax--> impair breathing
whats a phrenoplasty?reduce size of opening and suture esophagus to edges of diaphragm hiatus, prevents abd esophagus from migrating into thorax