-
Incisions heal from ___________ but they dehisce from ___________.
side-to-side; end-to-end
-
Why is gastric surgery safer than intestinal surgery? (3)
blood supply, reduced bacterial numbers, rapid epithelial healing
-
What are important technical points of small animal gastrotomy?
- stay sutures
- moist lap sponges aggressively packed around stomach (COUNT THEM)
- 2 layer closure of stomach- submucosal apposition by simple continuous AND seromuscular inversion by simple continuous
-
What are the most common indications of small intestinal surgery in small animals? (5)
FB, masses, intussusception, perforation, volvulus/ torsion
-
What are the most common indications of small intestinal surgery in horses? (2)
simple vs strangulating obstruction, intussusception
-
What are the most common indications for small intestinal surgery in cattle? (3)
intussusception, intestinal wall hemorrhage, volvulous
-
What surgical procedures can be done to the small intestine? (3)
- enterotomy
- resection/ anastomosis
- anastomosis (bypass)
-
What is an appropriate preoperative antibiotic for small animal patients undergoing small intestinal surgery? Horses?
- SA: cephalosporin
- Eq: penicillin, genamicin
-
When do you give postoperative antibiotics after small intestinal surgery? What is an appropriate antibiotic?
- evidence of obstruction, ileus, fever, leukoanything, shock
- broad spectrum antibiotic including anaerobes
-
When performing resection/ anastomosis, how do you assess viability?
- color, motility
- err on the side of removing questionable bowel
-
How much small intestine can you resection in SAs and horses?
- SA: 70-80% of small intestine
- Eq: 60-70% of SI
-
Describe ligation technique for resection/ anastomosis.
- leave enough mesentery for easy closure- balance time it takes to ligate several vessels versus leaving enough mesentery
- 2-0 or 3-0 suture
- LDS staple
-
What are 2 important tools to use when performing a SI resection/ anatomosis?
lap sponges, impermeable drapes (NOT surgery towels) to pack off intestines
-
How should you occlude the bowel on either side of a resection/ anastomosis region?
- on the side that stays in the animal- Doyen forceps, penrose drain around and clamp drain
- resected bowel side- crushing forceps are fine
-
What is the proper angle of resection in a resection/ anastomosis surgery?
angle towards vascular supple in mesenteric to antimesenteric direction
-
If the 2 pieces of bowel that you are anastomosing are different sizes, then you can...
angle, spatulate, place sutures differently on two pieces of bowel, side-to-side anastomosis (close ends, open of side of each piece of bowel, suture sides together)
-
Omental patches around an intestinal anastomosis provide: (5)
mechanical strength, lymphatic drainage, fibrin seal, immune cells, blood supply
-
What are possible ways to close the intestine after anastomosis or enterotomy?
- 2 simple continuous layers
- inverting pattern
-
What type of suture do you use to close the small intestine?
absorbable monofilament with a taper needle
-
What is the disadvantage to stapling GI visceral organs closed?
everted edge
-
How do you suture the mesentery after resection/ anastomosis?
- simple continuous pattern; cushing is friable or if vessel near the rent in the mesentery
- 2-0 or 3-0
- avoid vasculature
-
What are the major concerns after resection/ anastomosis surgery? (2)
- adhesions in equine patients- tissue handling, lavage, inverting suture pattern, and avoid leakage
- ileus- tissue handling, lavage, apposition, avoid contamination
-
What are indications for large intestinal surgery in small animals? (6)
obstruction, tumor, intussusception, granulomatous mass, trauma, megacolon
-
What are indications for large intestinal surgery in large animals? (4)
obstruction/ impaction, colon displacement (horses), strangulation/ torsion (cecal torsion in cattle), colopexy
-
What are concerns about large intestinal surgery in small animals? (1)
high bacterial count and increased incidence of infection (true for small colon in horse)--> use more aggressive antibiotics (3r gen cephalosporin, aminoglycoside and metro)
-
What are concern about large intestinal surgery in large animals? (2)
- contamination not as large of a concern with large colon (greater with small colon)
- usually emergency surgery for displacement, impaction, or torsion/ volvulus- questionable viability
-
How do you close an enterotomy site?
simple continuous through all layers followed by an inverting pattern in a horse (have large enough lumen to invert, unlike small animals)
-
Adhesions are mainly a problem in _________, and can be avoided by... (8)
horses; asepsis, gentle tissue handling, moisture/ lavage, antibiotics, heparin, carboxymethylcellulose, hyaluronic acid membrane, inverting suture pattern
-
What are complications after GI surgery? (5)
adhesions, intestinal obstruction d/t stricture, intestinal dehiscence/ leakage, septic peritonitis, wound dehiscence/ hernia
-
Intestinal dehiscence/ leakage is mainly a complication in ___________; and is avoided by... (3)
small animals; technique, using viable intestine, omental/ serosal patch
-
What is the holding layer in each of the following surgery sites:
ventral midline:
ventral paramedian:
paralumbar flank:
- ventral midline: linea alba
- ventral paramedian: external rectus sheath
- paralumbar flank: external abdominal oblique muscle and aponeurosis
-
Describe technique for closure of linea or rectus sheath.
- simple continuous or interrupted pattern
- cutting needle
- SA: 2-0 or 3-0
- LA: #1 or #3
|
|
