specific sx conditions of GIT 2 - stomach, SI, LI, rectum, anus

Hiatal hernia - def

Herniation of cardia through oesophageal hiatus

Grade 1-4

Hiatal hernia - Common effect

Gastro oesophageal Intussusception

Hiatal hernia - Tx

Sx - suture hiatus, oesophagopexy, L fundic gastropexy

Gastrotomy - access

Ven midline coeliotomy

Pack off stomach

Stay sutures

Incise between greater + lesser curvature (Stab + scissors)

Gastrotomy - stomach Closure

½ layer

Mucosa/ submucosa simple cont/ int/ inverted

Serosa/ muscularis/ submucosa inverting

Why can inverting pattern be used for stomach + not intestine

Large lumen so no stricture

Partial gastrectomy - casue

Necrosis, Neo, ulcer

Partial gastrectomy - types

Invagination of necrotic tissues + suture healthy together → slough off

Sharp excision

Surgical staplers

GDV - common breeds + why

Purebred large/ giant dogs - setter, poodle, weinmeraner, Great Dane, St Bernard

Inc thoracic depth : width ratio (deep chested)

Rapid eating, few meals fed

Aggressive

Relative

GDV - Common rotation + effects

180 degrees clockwise → pylorus L ven, fundus R dor → compress oeseophagus, stretch duo → gas accumulation

GDV - Effects on body

Dec abd blood return → cardiogenic shock, splenic congestion

Inc abd P → limit diaphragm

Dec perfusion → myocardial Ischaemia

Inc gastric P → compress BV → necrosis → bact transfer to blood

Free radicals → Reperfusion injury

GDV - Dx

Breed

Swollen cr abd

Drum like abd (Percuss)

Reverse C rx

Inc PCV, stress leukogram

Inc bilirubin, pre renal azotaemia, inc lactate

GDV - Immediate tx

Shock Fluid therapy

Decompress stomach

GDV - How to administer large vol in shock IVFT

Wide cannula

2 cephalic cannulae

Infusion pump/ compression sleeve

Avoid HL cannula

GDV - How to decompress stomach

Conscious Stomach tube with lube + mouth gag

Flank paracentesis of fundus

LA Temp Gastrostomy

GDV - Temp Gastrostomy to decompress sotmach process

LA

Prep flank

5cm incision cd + parallel to costal arch

Stay suture stomach

Decompress stomach with needle/ stab incision

Suture gastric mucosa to skin

Re suture stomach before coeliotomy

GDV - How to prevent recurrence for torsion/ volvulus in all cases

Gastropexy

We keep talking about stay sutures, but how do we actually use them to manipulate the tissue after we’ve placed them?

Assistant moves

Held in 1 hand

Clip to drapes/ equipment

GDV - gastropexy process

Rotate stomach to norm → Fix pylorus to R abd wall (suture incisions/ Foley catheter)→ permanent fibrous adhesion → prevent torsion + volvulus, can still dilate

GDV - When is splenectomy needed (congestion normally resolves when stomach sorted)

Thrombi in splenic BV

Splenic torsion

GDV - When is gastrectomy needed

Gastric necrosis (grey/ green wall, no active bleeding, no pulse, thin wall)

GDV - Meaning of red/purple vs grey/ green stomach wall colour

R- congestion, intramural H → recovers

G- non viable → remove

GDV - Post op care

Fluids

Monitor ECG, Electrolytes

NBM 1-2d → water, small food

Gastric mucosa protectants - sucralfate, antacids

V → Metaclopramide, delay food

GDV - Long term manamgent

Small frequent meals

Avoid exercise after meals

GDV - Common ECG issue post op

VPC

Gastric outflow obstruction - causes

Neo, pyloric stenosis, hypertrophic gastritis, pyloric m hypertrophy/ dysfunction

Gastric outflow obstruction - Tx

Pyloroplasty (YU antral flap)

Gastroduodenostomy + gastrojejunostomy - billroth numbers

1= duo

2= Jejuno

Gastroduodenostomy + gastrojejunostomy - Purpsoe

Reset large amount dist stomach + pylorus

Enterotomy - process

Isolate + pack

Evacuate contents

Occlude lumen (doyen, finger)

Longitudinal antimesenteric incision

Closure - simple int/ appositional

Check closed with saline inj

Enterectomy - process

Isolate + pack

Evacuate contents

Occlude lumen (doyen, finger) - crushing + non crushing

Lig BV

Cut along crushing clamps (with antimes>mes)

Ensure lumen sizes match up (cut antimes)

Closure - simple int/ cont

Check closed with saline inj

Enteroectomy - SI closure

3-4mm from edge

Antimes + mes border knots

When you’re clamping off the intestinal lumen to do an enterectomy, which set of clamps (crushing or non-crushing) should you put on first? + why

Crushing - boundaries for resection, dec time clamped, small patients

Non crushing - can remove contents

Complications of SI/LI sx

Dehiscence

Stricture

Linear FB - tx

DONT PULL

Fixed at tongue + no peritonitis → cut + leave → in faeces 3d later

Not fixed at tongue/ peritonitis → multiple enterotomys (dist → prox)

Linear FB - Effects

Peritonitis

Cut through mesentery

Gut perforations

Intussusception - common cause

Young dogs

Hypermotility (parasites, D)

Intussusception - Common location

Ileocolic junction

Intussusception - Effects

Obstruction, Ischaemia, adhesions, necrosis

Intussusception - Dx

V

Palp mass

US

Intussusception - Tx

Manually reduce

Enterectomy

Check rest of intestine

Suture SI to each other to prevent reoccurrence

Rectal prolapse - causes

Persistent tenesmus

Defects in rectal/anal support

Anal sphincter denervation

Rectal prolapse - Tx

Treat underlying cause

Reduce

Sx- Purse string suture 1-5d, colopexy, resect + anastomosis

Rectal prolapse - Post op care

Stool softeners

Low bulk diet

Sed to dec tenesmus (acepromazine)

Anal furunculosis - def

Chronic ulcerative fistulas surrounding anus

Anal furunculosis - Common animals

German shepherd, lab, setter, collie

Anal furunculosis - CS

Tenesmus, pruritus, tracts around anus

Anal furunculosis - Tx

Immunosupp - ciclosporin

Sx excision

Anal sac adenocarcinoma - removal options

Open - probe + dissect anal sac

Closed - incision over anal sac, don’t enter anal sac

How can you differentiate a rectal prolapse from an intussusception protruding from the anus?

P- can’t separate tissue + edge of anus

I- probe between tissue and edge of anus