What are some things that increase the severity of intestinal obstruction?
complete, high or strangulated obstruction
Should intestines be exteriorized or kept in the body cavity during sx?
exteriorized and abdomen packed with moist lap sponges
Should closing sutures be inverting, everting, or appositional? Holding layer?
- appositional (simple interrupted/continuous)
- submucosa engaged w/all sutures
What suture is most appropriate? What needle?
- small (3 or 4-0), monofilament, synthetic, absorbable or non
once procedure is complete, what should be done before closing abdomen?
lavage the cavity
In a clean-contaminated or contaminated procedure, what should be done with instruments before closing abdomen? What is protocol for antibiotic use?
- replace contaminated instruments and gloves before close
- use prophylactic Abs (30 min before or at induction)
What is recommended antibiotics for upper and middle small intestine?
1st generation cephalosporin (cephazolin)
What is recommended antibiotics for lower small intestine and large intestine?
2nd generation cephalosporin (cefoxitin)
What antibiotic is used to cover anaerobes present in intestines?
What is often the cause of intussusception in young dogs?
What is the essential amino acid for enterocytes?
What signalment is mesenteric torsion commonly associated with?
adult German Shepherd dogs
After 20 minutes of hypoxia, what is extent of injury in GIT? After 60 minutes?
- 20- superficial villus injury
- 60-destruction of villus
After 4 hours of hypoxia, what is extent of injury to GIT? after 8 hours?
- 4hr- transmucosal necrosis, turgid segment with whole blood collecting in lumen
- 8hr-transmural infarction, becomes black, distended and elongated by 12hr
Grossly, what kind of damage to GIT can be observed in teh first 1-3 hours of hypoxia?
- wall edema and hemorrhage
- mucosal sloughing
When is gross necrosis evident in the hypoxic gut? Without treatment, when would death result? Due to what?
- by 20hr
- fatal in 3-4 days due to hypovolemia
Gaseous distention develops within initial 12-36 hours after obstruction and is followed by what?
loss of fluid into intestinal lumen
How can the body attempt to naturally repair denuded intestines?
What type of obstructions lead to alkalosis? Acidosis?
- alkalosis: pyloric/proximal duodenal obstruction
- acidosis: mid-duodenal to ileal
an untreated obstructed patient can die of hypovolemia in 3-4 days. What is fluid loss due to?
- sequestration in intestinal lumen
- edema in intestinal wall, esp. w/venous occlusion of intestine
What is a strangulating obstruction? What does these cause?
- simple obstruction plus occlusion of blood supply to intestine
- -bacterial overgrowth/translocation--> increased bowel permeability --> perforation/escape of contents ==> PERITONITIS
What are some causes of strangulating obstructions?
adhesions (hair pin&rough handling), intussusception, mesenteric torsion, strangulated hernia, FB
What are 2 radiographic signs of linear FB?
- plication in cranial abdomen
- teardrop gas bubbles in intestine
Is the surgeon more concerned with linear FB lacerating mesenteric or antimesenteric border? What is indicated if perforation happens?
What is intussusceptum v. intussuscipiens?
- intussusceptum is telescoped into segment of intestine (usu. the proximal segment)
- intussuscipiens "receives" the section
What signalment and CS lead you to consider intussusception?
- puppies (w/parasites)
- bloody diarrhea, vomiting/abdominal pain
- often palpable
Is intussusception associated with hyper or hypo-motility of the gut?
What is a godet sign?
finger impression stays = edema
Venous occlusion in intussusception can progress to .___ and ____
perforation and peritonitis
Gentle traction should reduce an intussusception, but what should be done if it is not reducible or necrotic?
How much of the GIT can be resected?
What are 2 observations that indicate viability of tissue once intussusception reduced?
good CRT and peristalsis
Who is most commonly affected by mesenteric torsion?
- adult male medium/large breed dogs
- German Shepherd, pointers
T or F: mesenteric torsion patients can evolve from clinically normal to dead within hours.
What are some CS of mesenteric torsion?
peracute/acute; pain, shock, mild abdominal enlargement, depression, recumbency; nausea, vomiting, hematochezia
how do you diagnose mesenteric torsion?
- radiographs show entire small intestine (not stomach) distended with gas
- US, Sx, or necropsy
What is Sx treatment for mesenteric torsion?
untwist, reposition, allow for reperfusion, assess viability, resect devitalized, lavage (consider euthanasia; reperfusion injury issues)
How high is mortality for mesenteric torsion? How much of intestines are usually non-viable by time of sx?
- up to 100%
- entire jejunum and ileum