CVM 737B: Lecture 5 & 6

incision into the intestine

enterotomy

removal of a segment of intestine

enterostomy

enterostomy with reestablishment of continuity between the divided ends

intestinal resection and anastomosis

surgical fixation of one intestinal segment to another

intestinal plication (enteroenteropexy)

fixation of an intestinal segment to the body wall or another loop of intestine

enteropexy

surgical fixation of the colon

colopexy

partial or complete resection of the colon

colectomy

resection of the cecum

typhlectomy

surgical creation of an opening between the colon and the surface of the body

colostomy

straining to defecate

tenesmus

pain or discomfort on defecation

dyschezia

passage of stools that contain red blood

hematochezia

passage of tarry stools (digested blood)

melena

What is the most common indication for surgery of the small intestines?

GI obstruction

Preoperative Management of Patients Undergoing Intestinal Surgery:

• obtain ________ ________

• ________ the ________

• ________ hydration, electrolyte, and acid base abnormalities

• transfuse if the packed cell volume is less than ________ or if the animal is clinically weak or debilitated

• withhold food from mature animals for ____-____ ________ and from pediatric patients ____-____ ________ before induction

• administer ________ ________ if needed

• minimum database

• localize; lesion

• correct

• 20%

• 12-18 hours; 4-8 hours

• prophylactic antibiotics

True or false; Abdominal ultrasounds are typically done before the contract studies because it often provides the diagnosis and allows the contract study to be circumvented.

true

What is the preferred imaging modality?

ultrasonography

allows visualization and biopsy of the duodenum and sometimes the upper jejunum

gastroduodenoscopy

allows visualization and biopsy of the ileum

colonileoscopy

What can visualization of intestinal mucosa detect?

U
E
I

• ulcers

• erosions

• infiltrated mucosa and or lymphangiectasia

allows multiple biopsies of the small intestine and allows one to direct the biopsy to obvious mucosal lesions

endoscopy

True or false: If the animal deteriorates clinically despite aggressive medical management and complete obstruction, perforation, strangulation, necrosis, or sepsis is suspected, emergency exploratory surgery is indicated without delay.

true

What part of the GI tract contains the most bacteria when compared to the rest of it? Therefore, what should be done preoperatively? Unless what?

colon; colonic emptying and cleansing to reduce bacterial load; perforation or obstruction is suspected

diet that proposes the ingestion, or in more severe cases use of a gastric feeding tube or intravenous feeding of liquid nutrients in an easily assimilated form and is usually composed of amino acids, fats, sugars, vitamins, and minerals

elemental diet

Enemas given any closer to surgery than ____ ________ pre op may liquefy intestinal content and add to the dissemination of contaminated material during surgery.

3 hours

What type of enemas should never be given to small or constipated patients?

hypertonic phosphate enemas

Enemas given to cats may be ineffective when suffering from what?

megacolon

True or false: Enemas can further deteriorate debilitated, anorectic patients and may cause colonic perforation.

true

operative wounds in which the respiratory, gastrointestinal, or genitourinary tract is entered under controlled conditions without unusual contamination or without significant spillage of contents

clean-contaminated wounds

open, fresh, accidental wounds; procedures in which gastrointestinal content or infected urine is spilled or a major break in aseptic technique occurs and should be put on antibiotics

contaminated wounds

Risk of infection after what type of surgery is high? What should be given?

colorectal; systemic perioperative antibiotics effective against anaerobes and gram negative aerobes

What type of suture for intestinal surgery?

monofilament, synthetic absorbable

What type of needle?

swaged on taper or taper cut

What does optimal healing require with intestinal surgery?

G
A
M

• good blood supply

• accurate mucosal apposition

• minimal surgical trauma

What suture patterns should be used?

simple interrupted or simple continuous

What is the intestinal layer that provides mechanical strength? Therefore what must be done?

submucosa; it must be engaged when suturing the intestine to provide a secure closure

When it comes to intestinal surgery, how can the surgical site be covered? What needs to be done with instruments and gloves before closing the abdomen?

omentum or serosal patch; change them

For intestinal closure, how far from the edge are the simple interrupted sutures placed? How far apart?

2 mm; 2 to 3 mm apart

gambee suture pattern

intestinal biopsy

How can an enterotomy be closed if the intestinal lumen is small?

transversely

What type of anastomosis is more expensive?

stapled anastomosis

What are the 4 stapled anastomosis techniques?

1. T

2. I

3. S

4. E

1. triangulating end-to-end anastomosis

2. inverting end-to-end

3. side-to-side or functional end-to-end

4. end-to-side anastomosis

triangulating end-to-end anastomosis

inverting end-to-end anastomosis

side-to-side or functional end-to-end

telescoping or invagination of one intestinal segment into the lumen of an adjacent segment

intussusception

What is the cause of most intussusceptions?

unknown

What is the presence of an intussusception in a cat more likely associated with than dogs?

neoplasia

What will an ultrasound reveal with an intussusception?

target or bull’s eye pattern

What is a major concern when performing colonic surgery?

blood supply

True or false: You need to reduce colonic bacterial numbers by eliminating oral intake, preparing the colon, and giving antibiotics.

true

With what type of bowel surgery is dehiscence more likely?

large bowel surgery

create permanent adhesions between serosal surface of the colon and abdominal wall to prevent causal movement of the colon and the rectum

colopexy

What is colopexy used to treat?

chronic recurring rectal prolapse

colopexy

What is colectomy and resection used primarily for?

colonic mass removal and megacolon

Up to what percent of the colon can be resected in animals without adverse side effects?

70%

Do cats or dogs tolerate colonic resection better?

cats

Subtotal colectomy is often done in ________, but should be avoided in ________.

cats; dogs

What do you need to warn owners about after subtotal colectomy in cats?

cat will probably defecate frequently and have soft stools

True or false: You can angle your needle so that slightly more serosa than mucosa is engaged to prevent mucosa from protruding between sutures.

true

True or false: Sutured anastomosis techniques are essentially like those in a small intestinal sutured anastomosis.

true

What can be done if there is a minor disparity between the lumen sizes?

space sutures around the larger lumen slight further apart than the sutures in the segment with the smaller lumen

What should you do if there is tension at the anastomotic site?

two layered anastomosis

Where is the first layer placed? Where are the knots tied?

to appose the mucosa and submucosa; within the lumen

Where is the second layer placed? Where are the knots tied?

apposed the muscularis and the serosa; extraluminally

What can the distal colon be anastomosed to?

ileum or jejunum

persistent increased large intestinal diameter and hypo-motility associated with severe constipation

megacolon

mechanical, neurologic, or endocrine cause cannot be identified

idiopathic megacolon

difficult or infrequent defecation with passage of unduly, hard dry fecal material

constipation

extreme constipation (no feces may be passed)

obstipation

Megacolon is most common in ________.

cats

What is recommended for megacolon initially?

medical management

What are the measurements for it be considered megacolon?

diameter of the colon is greater than 1.5 times the length of L7

________ often handle subtotal colectomy well but ________ tend to not handle subtotal colectomy well.

cats; dogs

removal of the entire colon except a short distal segment needed to reestablish intestinal continuity

subtotal colectomy

Healing of the LI is similar to the SI, but is ________.

delayed