SA Sx GI II
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What are two main concerns for patients who survive mesenteric torsion sx?
- reperfusion injury can be lethal
- short bowel syndrome
What are 3 indications for enterotomy?
- remove FB
- full thickness biopsy
- evaluate intestinal mucosa for viability
For enterotomy to remove FB, should stab incision be made proximal or distal to FB?
distal (tissue healthier here)
How do you close enterotomy?
- simple continuous/interrupted; appose
- 2mm from edge, 2-3mm apart
- transverse closure to increase lumen size
what are indications for enterectomy?
- removal of nonviable/necrotic intestine,
- irreducible intussesceptions,
- traumatized intestine,
- solitary neoplasia or fungal lesions (pythiosis)
What are criteria for evaluating intestinal viability?
- wall texture/thickness
- pulsation of mesenteric arteries
- bleeds when incised
what should normal pulse oxymetry of intestine be (compared to peripheral saturation)?
saturation within 1cm of normal peripheral saturation
Is fluorescein dye given IV accurate in detecting non-viable bowel? What about detecting viable?
- accurate for non-viable
- inaccurate for viable
When closing an anastomosis, should sutures be 360 or 2 sets of 180 degrees?
180 to avoid stricture
When performing enterectomy, what is done with mesentery and vessels from resected intestine?
- vessels from resected intestine are ligated
What are non crushing clamps that can be safely used on intestine? When is it ok to use crushing clamps?
- crushing ok if section to be removed
For resection/anastomosis, are you cutting to make the mesenteric or antimesenteric side shorter?
antimesenteric side shorter than mesenteric
How should cuts be made if anastomosis of smaller to larger lumen?
- smaller cut at acute angle
- larger cut more obtuse angle
- incise antimesenteric border of smaller segment to spatulate or fish-mouth smaller segment
Is mesenteric or antimesenteric border sutured first? Where is second suture placed? How are remaining sutures placed?
- mesenteric side first (12 oclock)
- 2nd suture in antimesenteric border (6 oclock)
- remaining placed 3mm from the edge of tissue and 3mm apart
What are indications for serosal patching?
- tension on sutures,
- damaged serosa
- repair of dehiscence
- superficial trauma to intestinal wall
When suturing a serosal patch, should mucosa be penetrated?
engaged but NOT penetrated
What is the purpose of enteroenteropexy (intestinal plication)?
prevent recurrence of intussesception (efficacy questionable)
what is colon attached to in colopexy? indications?
- lateral abdominal wall
- prevent caudal movement of colon/rectum, esp if recurrent rectal prolapse/pereneal hernia
When surgery lasts longer than __minutes, another full dose of antibiotics is warranted.
> 90 minutes
how many days after surgery does dehiscence usually occur? Why does it occur (pathophysiology)? What percent of these will die?
- 3-5 days
- increased collagenase activity - degradation exceeds collagen synthesis
How can ileus post-op be avoided/treated?
frequent small meals and early ambulation
What are complications of intestinal surgery?
- stricture (rare)
Dogs with what risk factors are more likely to develop anastomotic leakage?
- preop peritonitis
- intestinal FB
- serum albumin <2.5 g/dl
What is advantage of vaccuum assisted closure?
speeds generation of healthy granulation tissue by removing excess fluid/bacteria
How much of the small intestines are removied before short bowel syndrome is a concern? How long before remaining intestines adapt?
- more than 70-80%
- supportive care until adapt by 1-2 months
Short bowel syndrome patients can be anemic secondary to what?
folic acid deficiency
Where in GI is neoplasia most common in dog? Cat?
- dog: colon and rectum
- cat: small intestine
Are most neoplasias in dog/cat malignant or benign? Are mets common?
- yes, usu. lymph nodes, liver, lungs
- (86% dogs/71% cats have mets at necropsy)
What is most common neoplasia in dog? cat?
- dog: adenocarcinoma of intestine; adenomatous polyp in rectum
- cat: lymphosarcoma
What is mean age for dogs and cats to get intestinal neoplasia? more males or females? What breeds more prone?
- dog: 9yr; males
- cat: 10yr, females
- Boxer, collie, ..german shepherd
- siamese cats
What type of adenocarcinoma is sometimes palpable and described as "napkin ring"?
annular adenocarcinoma of distal jejunum
Intestinal neoplasia can cause weight loss regardless of location, what are signs that distinguish small from large intestine?
- small: anorexia, diarrhea, melena, signs of obstruction/vomit
- large: tenesmus, hematochezia, dyschezia
Anemia is common with which intestinal neoplasia?
What is tx of choice for neoplasia in intestine? Which tumors have some success with chemo?
- resection/anastomosis (if mets not present)
Which type of Colorectal tumors are likely to recur? Why is euthanisia usually the decision with these?
- large, sessile tumors likely to recur
- failure to control dyschezia/hematochezia
What are some causes of rectal prolapse? Should ice or sugar be used to reduce?
- decr. peristalsis
- incr. laxity/incr. diarrhea
- no ice (burns)
- sugar helps reduce size via osmosis
what is an acquired disorder of cats characterized by colon dilation and inffective transport of feces, resulting in chronic constipation? Why would dogs have this condition?
- feline idiopathic megacolon
- dogs from narrowed pelvis that narrows colon
What is signalment of cats with megacolon? what is duration?
- adult, either sex, any breed
- 6mo -10yrs (mean 2.5 yr)
what are options for medical management of idiopathic megacolon?
- warm water enema; hydrogen peroxide enema
- lubricate/break down feces
- mineral oil to diet (NOT cooking oil)
- only short term relief
What are options for surgical management of idiopathic megacolon?
- colectomy (removes colon + ileocolic valve + cecum = ileorectal anastomosis)
- subtotal colectomy (remove colon only = colorectal anastomosis, valve stays)
- *colotomy not recommended
should enemas be performed prior to colectomy?
How long should you expect to see tarry feces following colectomy? what about tenesmus?
- tarry: 2-3 days
- tenesmus: 5-7 days or longer/until regain full control
- may also be anorexic for 7d (PEG tube if needed)
After colectomy, should you see significant changes in fluid, electrolytes or vitamin absorption?
T or F: following colectmy, most cats continue to have soft feces.
T or F: subtotal colectomy is curative for megacolon in cats.
true (good to excellent prognosis when ileocolic junction is preserved
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