GIT sx principles 3 - complications, approaches

Why is IVFT often needed

Imbalances + deficits common

Evaporation

Causes of secondary peritonitis (inciting cause vs primary no obvious inciting cause)

Chemical, septic

Effects of peritonitis + why

Hypovolaemia- loss, intake, V

Met acid - Hypovolaemia

Electrolyte imbalances - V, intake

Endo toxic shock -bact toxins

Death

CS of peritonitis

Dep, anorexia, V, abd pain, abd distension, ileus, pyrexia, shock, ascites, praying position

Mortality rate of septic peritonitis

40-60%

When can local peritonitis occur

Trapped by omentum

Peritonitis dx

Rx - loss of detail, gas

Haem - L Neutrophilia

Biochem - pre renal azotaemia, hypoglycaemia

Centesis - neutrophils, bact, bact in neutrophils, lactate, glucose

Temp needed for phagocytosis so shows inf if bact in neutrophils

Body temp

How does glucose level from paracentesis show peritonitis

>1.1mmol/L difference from serum

Blood > abd

How does lactate level from paracentesis show peritonitis

>2mmol/l difference from serum

Abd > blood

Peritonitis tx

IVFT

Broad AB

Correct cause (ex coeliotomy)

Peritoneal lavage

Adhesions - types + prevention (worse in rabbits + horses as cant do good fibrinolysis)

Restrictive vs non restrictive

Sx technique

Short bowel syndrome cause + tx

>80% SI removed (Intussusception, torsion)

Medical management - small frequent digestible diet, vit B

Ileus - def

Poor tissue handling, peritonitis → Vagosympathetic reflex → Inadequate peristalsis of whole GIT → functional obstruction → distended

Ileus - Tx

Treat underlying dz, supportive

Ileus - Pro kinetics to give

Ranitidine, metoclopramide

List specific things you can do during your daily clinical examination to monitor your patients for postoperative peritonitis. Don’t include your general clinical examination (TPR etc.) - cats dont often show CS

Abd pain

Check for abd fluid thrill

Weight

Abd circumference at umbilicus

Approach to oesophagus (changes based on cr/cd to rib 2)

Ven cervical midline / R intercostal thoracotomy

Ven midline coeliotomy - clip area

5-10cm cd to pubis + cr to Xiphoid

Ven midline coeliotomy - Layers to incise

Skin

Sc

Linea alba (m tendon sheaths) elevated

falciform lig (cr)

Ven midline coeliotomy - Linea alba closure

Single layer simple cont appositional

5-10mm from edge, 3-12mm apart

Ven midline coeliotomy - What to include in linea alba closure

Ext sheath rectus abdominis

Laparotomy - site

Flank (incise m parallel to fibres)

Approach to terminal colon, rectum, anus

Ven pelvis osteotomy / pubic symphysiotomy

Rectum everted through anus

Rectal pull through

Dor inverted U approach to anus

Lat approach to anus

If you had a patient with a benign distal colonic / proximal rectal mass just inside the cranial end of the pelvis, what surgical approach would you use to access the affected intestine? Why?

Ven midline coeliotomy

Benign = local excision

Retract cr

Don’t need to cut pelvis