SAOP3- GI Sx

• physiologic- ileus from inflammation/ infection, drugs, or idiopathic ileus
• mechanical- FB, intussusception, neoplasia, abscess, granuloma, stricture

motility altered, blood flow, fluid accumulation, gas accumulation, bacterial overgrowth

• Acute: increased oral to FB, decreased aboral to FB (decreased intestinal content)
• Chronic: ileus d/t decreased motor activity

• increasing intraluminal pressure leads to edema d/t lymphatic stasis, capillary stasis, and venous drainage
• the FB itself causes local ischemia, ulceration, necrosis, perforation

• retention of swallowed fluid
• increased secretions (d/t stimulation by enteric bacterial toxins and increased secretion of biliary and pancreas systems )
• decreased absorption d/t lymphatic and venous congestion and decreased enterocyte turnover

• acute: retention of aerophagia, carbon dioxide formation, bacterial fermentation
• chronic: failure to pass, failure of absorption

• hypomotility
• bacterial translocation d/t impaired enteric mucosal barrier and increased permeability and translocation

• dehydration- vomiting, diarrhea, fluid sequestration
• acid-base abnormalities
• bacterial sepsis
• septic peritonitis

• Distal obstruction: metabolic acidosis- loss of alkaline duodenal, pancreatic, and biliary secretions, loss of sodium and water
• Proximal obstruction: metabolic alkalosis- loss of gastric hydrochloric acid, loss of Cl, Na, K from gastric fluids

• proinflammatory mediators-->
• DIC
• SIRS
• MODS
• ARDS

• [vary with location, chronicity, and completeness]
• vomiting: proximal--> projectile, complete--> frequent vomiting, distal or partial--> intermittent vomiting
• anorexia
• depression
• abdominal pain
• diarrhea (less common)

• 3 views of rads: right and left lateral, VD, +/- FB, gas dilated loops of small bowel. pneumoperitoneum (if perforated)
• +/- contrast radiographs
• +/- U/S: distention, fluid filled intestines, hyper or hypomotility, FB
• Bloodwork: nonspecific, dehydration, electrolyte abnormalities, leukocytosis

• intestinal diameter should be the same height as the body of L5
• >2x is likely to have obstruction

• color
• arterial pulsations
• peristalsis
• bleeding
• texture

• if bowel is healthy: incise aboral to the obstruction (in healthy, non-dilated intestine- better healing and closure)
• if bowel is ischemic or perforated: resection and anastomosis

must do resection and anastomosis!!! with wide margins

• GI FB- usually good
• dehiscence rate 3-27%, increases with hypoalbuminemia, peritonitis, high band neutrophils
• septic peritonitis- 50% mortality rate
• neoplasia- variable

• FB anchors around the base of the tongue or pylorus
• peristaltic waves move the remainder of the FB aborally--> intestines gather or plicate along the object
• over time, object becomes taut and embeds in mesenteric side of lumen

• vomiting
• anorexia
• depression
• obstruction tends to be partial

• oral exam- look under tongue
• plain radiographs- intestines clumped or plicated
• abdominal U/S
• bloodwork- dehydration, leukocytosis

• free FB from where it is lodged
• multiple enterotomies (DO NOT PULL IT, you'll saw through the intestines)
• may require R&A, short bowel syndrome

• entrapment: body wall hernia, omental tear, congenital hernia, mesenteric rents, duodenocolic ligament rupture
• mechanical obstruction
• ischemia: mucosal degeneration, bacterial and endotoxin translocation, perforation

• stabilize patient first
• ligate blood vessels and resect dead bowel- avoid reperfusion injury
• repair cause of incarceration

• young animals: enteritis (parasites (whips), parvovirus, linear FB, recent sx), idiopathic
• old animals: neoplasia

• enterocolic- most common
• enteroenteric
• gastroesophageal
• pylorogastric
• colorectal

• obstruction
• intestinal ischemia d/t occlusion of arterial and venous blood flow
• necrosis and ulceration

• palpable cylindrical mass
• looks like mechanical obstruction on plain radiographs
• U/S- concentric rings (classic target lesion)

• surgical reduction- only if the enteric vessels are visible and viable, no ischemia
• R&A- if lesions cannot be reduced, ischemic bowel, neoplasia
• treat underlying condition
• +/- enteroplication (to prevent from happening again)

• small intestine twists around mesenteric axis
• strangulating obstruction-->venous obstruction--> edema and vascular congestion
• loss of peristalsis
• luminal distention--> fluid and gas accumulation
• mucosal sloughing and hemorrhage
• bacterial proliferation
• usually fatal

young male GSD

• surgical emergency- stabilize patient
• de-rotate intestines (likely to cause reperfusion injury)
• assess for viability
• R&A (short bowel syndrome)
• usually fatal

• Cardia: gastroesophageal junction
• Fundus: dorsal to cardia, left of midline
• Body: middle third of stomach, left of midline
• Pylorus: pyloric antrum, pyloric canal, and pyloric sphnicter

• greater curvature: superficial leaf of greater omentum
• lesser curvature: lesser omentum

• left and right gastric arteries: on lesser curvature
• left and right gastroepiploic arteries: on greater curvature
• short gastric arteries: from spleen

portal vein

• cardia attached to esophagus
• hepatogastric ligament- part of lesser omentum- tethers pylorus and duodenum to the liver

submucosa (separates easily from mucosa)

• mucosa
• submucosa- holding layer
• muscularis (3 muscle layers)
• serosa (outside)

• parietal cells- acid
• chief cells- pepsin
• goblet cells- mucus

release of acid

pyloric antrum

• gastric FB
• GDV
• gastric ulceration and erosion
• benign gastric outflow obstruction
• neoplasia

• dehydration
• loss of Na, Cl, K (d/t vomiting)
• metabolic alkalosis (loss of stomach cid with vomiting)

• usually given pre-operatively and continued no more than 24 hours post-operatively
• cephalosporin is a common choice (cefazolin)

excessive inflammation can predispose to adhesions and impaired motility

• stay sutures
• lap sponges
• intraperitoneal irrigation
• clean versus dirty instrument packs

gastric FB, distal esophageal FB, biopsy, neoplasia

• least vascularized area, b/w the lesser curvature and greater curvature on ventral aspect
• AVOID pyloric region (avoid stricture)

• SUBMUCOSA
• two-layer inverting pattern- cushing or lembert
• simple continuous in mucosa and inverting pattern in remaining layers
• PDS

• neoplasia
• ulcer
• devitalized tissue (such as with GDV)
• lesions must involve greater curvature or middle portion of stomach

• gastric mucosal color
• serosal color
• wall texture, vascular patency
• bleeding incision

obstruction d/t FB, hypertrophy (chronic hypertrophic pyloric gastropathy or CHPG), ulcerations, neoplasia

• Billroth I: gastroduodenostomy
• Billroth II: gastrojejunostomy

• Fredet- Ramstedt
• correction of gastric outflow obstruction
• increase diameter of pylorus

• incise all layers of pylorus except mucosa, let mucosa be only holding layer
• disadvantages- mucosa inspection or biopsy not possible, healing may reduce lumen diameter over time

• used for gastric outflow obstruction
• Y-U plasty: Y shaped incision made into pylorus and antrum, antral flap is sutured starting at distal point of duodenal incision

• increased intragastric pressure
• caudal vena cava compression
• systemic hypotension
• portal hypertension
• CARDIOGENIC SHOCK

• right is normal orientation of pylorus
• pylorus goes from right to ventral to left (180 degree rotation)
• cardia is rotated upon itself
• outflow blocked in both directions (cardia and pylorus obstructed)

• distention
• venous stasis
• gastric wall necrosis
• mucosa death (full thickness necrosis possible)
• short gastric a. rupture

• reduced venous return- direct compression to caudal vena cava
• portal hypertension- direct compression of portal vein
• increased bacterial translocation
• decreased oxygenation- direct pressure on diaphragm
• poor coronary blood flow d/t lack of venous return- arrhythmias

• distended abdomen
• retching
• depressed
• pale
• bradycardia +/- arrhythmia
• Reverse C or compartmentalized stomach on radiographs

• stabilize patient first!
• fluids!!!! lots of them
• pass orogastric tube and try to decompress
• broad spectrum antibiotics
• correct acid-base and electrolytes abnormalities
• treat arrhythmias if present (IV lidocaine)

• orogastric intubation ideal
• if not, over the needle catheter or trocar- percutaneous, clipped and aseptically prepped

• reposition stomach
• remove devitalized tissue
• gastropexy (permanent adhesion)

pylorus should gently be retracted ventrally and to the right side, while simultaneously pushing body and fundus dorsally and left

• greater curvature
• fundus and body

• resection of devitalized stomach
• splenectomy if evidence of vascular thrombosis or necrosis

permanent adhesion b/w pyloric antrum and right abdominal body wall

• 4-5cm incision on gastric antrum through serosa, muscularis, and submcosa (NOT MUCOSA)
• 4-5cm incision through the peritoneum and transversus abdominis (2-3cm caudal to last rib)
• suture these together with 2 simple continuous lines with 2-0 PDS

• flap elevated from antrum, incorporating gastroepiploic artery
• passing through a tunnel in abdominal body wall

• flap similar to belt loop on greater curvature
• palpate 11th or 12th rib costocondral junction
• stay suture on flap to facilitate passage around rib

• prophylactic pexy only
• common with spay-pexy procedures

• IV fluids, electrolytes
• usually liquids and soft foods in 12-24 hours
• if extensive gastrectomy, delay food intake for 35-48 hours (consider jejunostomy or TPN)
• gastric atony, vomiting, and peritonitis are most common complications