Describe the attachments of the duodenum.
- suspended by mesoduodenum
- ascending duodenum is fixed to mesocolon via duodeno-colic ligament
The pancreas is located...
within the mesoduodenum
What is the blood supply of the duodenum?
- duodenal branches of the celiac artery
- cranial mesenteric artery gives rise to jejunal a., ileocolic a., right and middle colic a.
- caudal mesenteric artery gives rise to left colic a., and cranial rectal a.
What ducts empty into the duodenum?
- major duodenal papilla- common bile duct, pancreatic duct
- minor duodenal papilla- accessory pancreatic duct (larger one in dogs)
How do you identify the illeum?
- short segment b/w jejunum and cecum/ colon
- identified by antimesenteric artery
What are the histologic layers of the intestines?
- mucosa- absorption barrier
- submucosa- HOLDING LAYER
- muscularis- motility
- serosa- quick seal after injury or incision
Describe peri-operative antibiotics with intestinal surgery.
- broad-spectrum b/c intestines are contaminated
- cephalosporin common choice- cefazolin IV
- start the drug before surgery and continue post-operatively if infection/ peritonitis is present
What are antibiotic considerations for colonic surgery?
- must reduce bacterial numbers
Describe nutritional management around intestinal surgery.
- critical for wound healing and patient survival
- malnourished animals have delayed wound healing and increased chance of dehiscence
- consider esophagostomy, gastrostomy, jejunostomy tube if anorexic
- +/- liquid diets
What aspect of technique is of paramount importance with intestinal surgery?
- maintenance of blood supply
- GENTLE TISSUE HANDLING
- do not use forceps to grab tissues- manipulate with fingers
How do you assess tissue viability? (4)
- color**- most surgeons use serosal color as primary indicator
- bleeding when cut
What sutures are used to close the intestines?
- taper-cut needle
- 4-0 polypropylene or PDS
What is the holding layer of the intestines?
Dehiscence is more likely after ________ surgery.
What patient factors may delay healing or promote dehiscence and how do you manage this as the surgeon?
- hypoproteinemia, emaciation, chemotherapy
- use non-absorbable, monofilament sutures (prolene)
How fast do the intestines heal?
80% of original strength in 10-14 days
Intestinal dehiscence usually occurs within...
3-5 days post-op
What are potential complications of intestinal surgery? (3)
- dehiscence and peritonitis
- stricture (uncommon, more common if you invert tissues at closure)
- short-bowel syndrome if large resection (>80% in SA)--> chronic diarrhea and weight loss
What are indications for intestinal surgery? (5)
- GI obstruction (FB, mass)
- trauma (perforation, ischemia)
- diagnostic/ supportive (biopsy, culture, feeding tube)
What are indications for intestinal biopsy? (4)
malabsorption, hypoproteinemia due to GI loss, chronic diarrhea of unknown etiology, suspected intestinal neoplasia
Where are stay suture places when performing intestinal surgery?
What are indications for enterotomy? (3)
biopsies, FBs, luminal examinations
Where do you incise with regard to an intestinal FB?
incise distal to FB in healthy tissue, milk FB down to incision, suture closed healthy tissue
What pattern is used to close the intestines?
simple continuous appositional (maybe simple interrupted, but probably not)
What are indications for intestinal R&A? (7)
- removal of ischemic, necrotic intestines
- neoplasia or fungus
- mesenteric volvulus
- strangulation in hernia
- idiopathic megacolon in cats
With R&A, how can you manage suturing two areas of different diameter together?
transverse incision on thicker part and oblique incision on thinner part to increase lumen of smaller intestine
What are methods of closing R&A? (4)
- approximating: simple interrupted, full thickness, sutures tied only tight enough to approximate tissues
- crushing: simple interrupted, full thickness, sutures tied tight to cut through mucosa and muscularis (not used much...don't use it)
- simple continuous: best method, minimal trauma
- stapling: device used on antimesenteric surface
What are signs of intestinal dehiscence? (5)
- high fever
- excessive abdominal pain
What is the next step if peritonitis is suspected?
- abdominal tap
- culture and sensitivity peritoneal fluid
- antibiotics and fluid therapy
- +/- aggressive treatment
Is there a higher chance of contamination with small or large intestinal surgery?