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What are some things that increase the severity of intestinal obstruction?
complete, high or strangulated obstruction
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Should intestines be exteriorized or kept in the body cavity during sx?
exteriorized and abdomen packed with moist lap sponges
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Should closing sutures be inverting, everting, or appositional? Holding layer?
- appositional (simple interrupted/continuous)
- submucosa engaged w/all sutures
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What suture is most appropriate? What needle?
- small (3 or 4-0), monofilament, synthetic, absorbable or non
- taper
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once procedure is complete, what should be done before closing abdomen?
lavage the cavity
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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)
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What is recommended antibiotics for upper and middle small intestine?
1st generation cephalosporin (cephazolin)
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What is recommended antibiotics for lower small intestine and large intestine?
2nd generation cephalosporin (cefoxitin)
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What antibiotic is used to cover anaerobes present in intestines?
metronidazole
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What is often the cause of intussusception in young dogs?
parasitism
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What is the essential amino acid for enterocytes?
glutamine
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What signalment is mesenteric torsion commonly associated with?
adult German Shepherd dogs
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After 20 minutes of hypoxia, what is extent of injury in GIT? After 60 minutes?
- 20- superficial villus injury
- 60-destruction of villus
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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
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Grossly, what kind of damage to GIT can be observed in teh first 1-3 hours of hypoxia?
- wall edema and hemorrhage
- mucosal sloughing
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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
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Gaseous distention develops within initial 12-36 hours after obstruction and is followed by what?
loss of fluid into intestinal lumen
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How can the body attempt to naturally repair denuded intestines?
omental migration/adherence
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What type of obstructions lead to alkalosis? Acidosis?
- alkalosis: pyloric/proximal duodenal obstruction
- acidosis: mid-duodenal to ileal
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an untreated obstructed patient can die of hypovolemia in 3-4 days. What is fluid loss due to?
- vomiting
- sequestration in intestinal lumen
- edema in intestinal wall, esp. w/venous occlusion of intestine
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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
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What are some causes of strangulating obstructions?
adhesions (hair pin&rough handling), intussusception, mesenteric torsion, strangulated hernia, FB
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What are 2 radiographic signs of linear FB?
- plication in cranial abdomen
- teardrop gas bubbles in intestine
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Is the surgeon more concerned with linear FB lacerating mesenteric or antimesenteric border? What is indicated if perforation happens?
- mesenteric
- resection/anastomosis
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What is intussusceptum v. intussuscipiens?
- intussusceptum is telescoped into segment of intestine (usu. the proximal segment)
- intussuscipiens "receives" the section
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What signalment and CS lead you to consider intussusception?
- puppies (w/parasites)
- bloody diarrhea, vomiting/abdominal pain
- often palpable
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Is intussusception associated with hyper or hypo-motility of the gut?
hyper
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What is a godet sign?
finger impression stays = edema
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Venous occlusion in intussusception can progress to .___ and ____
perforation and peritonitis
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Gentle traction should reduce an intussusception, but what should be done if it is not reducible or necrotic?
resection/anastomosis
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How much of the GIT can be resected?
60-80%
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What are 2 observations that indicate viability of tissue once intussusception reduced?
good CRT and peristalsis
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Who is most commonly affected by mesenteric torsion?
- adult male medium/large breed dogs
- German Shepherd, pointers
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T or F: mesenteric torsion patients can evolve from clinically normal to dead within hours.
true
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What are some CS of mesenteric torsion?
peracute/acute; pain, shock, mild abdominal enlargement, depression, recumbency; nausea, vomiting, hematochezia
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how do you diagnose mesenteric torsion?
- radiographs show entire small intestine (not stomach) distended with gas
- US, Sx, or necropsy
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What is Sx treatment for mesenteric torsion?
untwist, reposition, allow for reperfusion, assess viability, resect devitalized, lavage (consider euthanasia; reperfusion injury issues)
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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
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