16. Surgical diseases of the stomach. Foreign body. Dilatation and volvulus. Aetiology, symptoms, diagnosis and therapy. Pericardioperitoneal hernia. Neoplasia of the stomach

What type of stomach do dogs and cats have?

Simple, glandular.

What are the sections of the stomach?

1. Cardia

2. Fundus

3. Body

4. Pylorus

What is the cardia?

The inlet (with sphincters) of the stomach, located right of the midline.

What is the fundus?

The blind outpocketing, dorsal part of the stomach.

What is the body of the stomach?

The large middle portion. Has curvatura minor and curvatura major.

What attaches to the greater curvature of the stomach?

The spleen.

What is the pylorus?

The outlet (sphincters) of the stomach, located ventrally.

What is located in the left pyloric antrum?

Four papillae connecting the stomach to the liver and bile ducts.

What are the layers of the stomach wall (internal to external)?

Mucosa, submucosa, muscle (longitudinal, circular, oblique), and serosa (peritoneum).

What are the surfaces of the stomach?

1. Parietal (facing the diaphragm and liver)

2. Visceral (facing other organs).

What is the blood supply to the stomach?

Celiac trunk (splenic, hepatic, and gastric arteries).

What are the stomach's attachments?

1. Greater omentum (superficial and deep leaf)

2. Lesser omentum

3. Gastrosplenic ligament

4. Hepatogastric ligament.

What are some indications for stomach surgery?

1. Foreign objects

2. Ulcer disease and bleeding

3. Necrosis

4. Tumours

5. Stomach dilatation

6. GDV.

What are examples of stomach surgeries?

1. Gastrotomy

2. Gastrostomy

3. Gastrectomy

4. Gastropexy

5. Billroth I

6. Billroth II

What is gastrotomy?

Incision through the stomach wall into the lumen.

What is gastrostomy?

Creation of an artificial opening to the gastric lumen.

What is gastrectomy?

Partial resection of a portion of the stomach. Can be done by invagination or resection.

What is gastropexy?

Creation of a permanent adhesion of the stomach to the body wall.

What are some types of gastropexy?

1. Circumcostal

2. Belt-loop

3. Incision

4. Laparoscopic.

What is a circumcostal gastropexy?

Seromuscular flap that is pulled & fixed behind 11th/12th rib

What is a belt-loop gastropexy?

Seromuscular flap pulled through abdominal wall muscle layer & fixed

What is an incision gastropexy?

Incision of pyloric antrum & peritoneum w/ muscle -apposition- suture

When is a laparoscopy gastropexy carried out?

Prevention

What is Billroth I procedure?

Removal of the pylorus and attachment of the duodenum to the stomach.

What is Billroth II procedure?

Removal of the pylorus and duodenum and attachment of the jejunum to the stomach.

How is a stomach wound closed?

With 2-0 to 3-0 absorbable sutures in two layers using a sero-muscular pattern

1st layer: Cushings, Connell, or simple continuous for muscularis, submucosa

2nd layer: Lambert or Cushing for serosa and muscularis).

What are the surgical approaches for laparoscopy?

Paracostal or midline.

Where is the incision made in a midline laparotomy?

Cranial to the umbilicus.

What are the muscle layers encountered in a midline laparotomy?

1. External oblique abdominal muscle

2. Internal oblique abdominal muscle

3. Transverse abdominal muscle

4. Linea alba (sits between rectus abdominis)

What are common gastric foreign bodies?

Swallowed stones, metal, threads, and other indigestible materials.

What are the potential complications of gastric foreign bodies?

Obstruction or perforation of the stomach or intestines, leading to peritonitis.

What are the clinical signs of gastric foreign bodies?

Signs of acute abdomen, vomiting, regurgitation, distension, lethargy, and anorexia.

How are gastric foreign bodies diagnosed?

X-ray (with and without contrast), USG, and endoscopy.

What are the differential diagnoses for gastric foreign bodies?

Gastric ulcers, perforation, neoplasia, parasitism, and GDV.

How are gastric foreign bodies treated?

Endoscopy (in some cases) or surgical removal by gastrotomy or enterotomy.

What is GDV?

Gastric dilatation and volvulus, a life-threatening condition affecting deep-chested, large- and giant-breed dogs.

What are some risk factors for GDV?

Overfeeding, aerophagia, decayed food, and exercise before/after eating.

What are the stages of GDV?

1st stage: Dilatation (bloat)

2nd stage: Volvulus (twisting of the stomach so entrance and exit of stomach become blocked → progressive dilatation).

What are the consequences of gastric volvulus?

1. Blockage of the stomach entrance and exit, progressive dilatation

2. Pressure on the diaphragm (dyspnoea)

3. Compromised circulation ( → shock)

4. Potential trapping of the spleen.

What are the clinical signs of GDV?

Non-productive retching, salivation, pale mucous membranes (progressing to hyperaemia and cyanosis), tachycardia, dyspnoea, abdominal distension, arrhythmias, back-arching, abdominal tympany, and collapse.

How is GDV diagnosed?

X-ray (showing a "boxing glove" or "two separate gas-filled stomachs" appearance).

What are the differential diagnoses for GDV?

Simple dilation, gastric ulcers, foreign body, perforation, neoplasia, and parasitism.

What is the treatment for GDV?

1. Stabilisation (fluid therapy [crystalloids], antibiotics, and oxygen therapy).

2. Gastric decompression

3. Surgery

What are some methods of gastric decompression in GDV?

1. Passage of a stomach tube/gastroscopy.

2. Percutaneous decompression with catheters or trocars

3. Gastrotomy

What are the surgical components of GDV treatment?

1. Inspection of the stomach and spleen. remove damaged or necrotic tissues

2. Decompression and correction of malpositioning

3. Gastropexy to prevent subsequent malpositioning

What is a pericardioperitoneal hernia?

A congenital communication between the abdomen and pericardial sac (a type of diaphragmatic hernia).

What is the aetiology of a pericardioperitoneal hernia?

Congenital anomaly with the failure of development or pre-natal injury of septum transversum (thick plate of mesodermal tissue) → formation of thin diaphragmatic tissue, which easily ruptures, allowing herniation of abdominal viscera into pericardial sac

What are clinical signs of pericardialperitoneal hernia

Ascites, muffled heart sounds, murmurs, dyspnoea, shock, pneumothorax, peritonitis (often as a complication)

How are pericardioperitoneal hernias diagnosed?

CS, history, physical exam, X-ray of heart and thorax, USG

How are pericardioperitoneal hernias treated?

1. Dyspnoea: oxygen, sternal position, all 4 limbs elevated

2. Shock: fluids, ATB (if septic or as prophylaxis)

3. Surgery: ventral incision through the sternum - close defect in the diaphragm and remove air from pleural cavity and pericardial sac - repair sternal and abdominal wall defects

Are gastric tumours common?

No.

What are some types of gastric tumours?

1. Adenocarcinoma (most common)

2. Adenoma (polyps)

3. Leiomyoma (polyps)

4. Malignant lymphoma

5. Carcinoma.

What are the clinical signs of gastric tumours?

Acute abdomen, vomiting, anorexia, melaena, weight loss, and abdominal distension.

How are gastric tumours diagnosed?

Radiography, gastroscopy, and biopsy.

What are the differential diagnoses for gastric tumours?

Gastric ulcers, GDV, foreign body, perforation, and parasitism.

How are gastric tumours treated?

Surgical resection if possible.

What are some causes of gastric perforation?

NSAIDs and neoplasia.

What are the clinical signs of gastric perforation?

Lethargy, anorexia, vomiting, and weight loss.

What laboratory abnormalities may be seen with gastric perforation?

Stress leukogram, hypoproteinaemia, and hypocalcaemia.

How is gastric perforation diagnosed?

Abdominal X-ray (loss of detail and free gas) and exploratory laparotomy.

What are the differential diagnoses for gastric perforation?

Gastric ulcers, GDV, foreign body, neoplasia, and parasitism.

How is gastric perforation treated?

Exploratory laparotomy, resection, partial gastrectomy, debridement, and closure (depending on the cause).

What should be done if a dog with GDV comes into the clinic?

1. Stabilise (ABC, IV fluids, administration of ATB, CCS, O2 mask)

2. Gastric decompression (Gastric tube, per cutaneous, gastrotomy)

3. Surgery (Gastropexy)

What type of laparotomy will be carried out in the case of GDV?

Cranial ventral laparotomy

Which veins are important to avoid when opening the stomach?

1. Right and left gastric arteries

2. Left gastroepiploic artery

What breeds are predisposed to GDV, and when does it occur?

• Large, deep chested breeds

• Exercise after eating

Which surgery is used to prevent GDV?

Gastropexy (between pyloric antrum and right abdominal wall [11-12th rib])

What can be seen on x-rays in the case of GDV?

Distension of the stomach with gas (black)

What is gastroscopy for in the case of GDV?

Gastric decompression