Post on 09-Jun-2015
• Veterinary Gastrointestinal surgeryVeterinary Gastrointestinal surgery(Part-III)(Part-III)
• Presented byPresented by• Dr. Rekha PathakDr. Rekha Pathak• Senior scientist , IVRISenior scientist , IVRI
The photographs have been collected from different sources i.e. Internet,
text books etc
G. neoplasmG. neoplasm
• Avg. age 8 yAvg. age 8 y• Alimentary tract: oral Alimentary tract: oral
cavity – rarely in cavity – rarely in stomachstomach
• Persistent vomiting Persistent vomiting unrelated to eating unrelated to eating
•Within the antrum on the Within the antrum on the lesser curvature lesser curvature
•Metastasis: liver, lungs, spleenMetastasis: liver, lungs, spleen
•Leiomyoma/ Leiomyoma/ rhabdomyosarcoma/polyps rhabdomyosarcoma/polyps (solitary or multiple)(solitary or multiple)
• Polyps – due to Polyps – due to sharp fragment sharp fragment of bones- resting of bones- resting for long in for long in antrum - injure antrum - injure mucosa – mucosa – herniation of sub herniation of sub mucosamucosa
• Clinical signs; Clinical signs; anorexiaanorexia
•Loss of wt. Loss of wt. Obstructing Obstructing gastric out flow gastric out flow
•Normal Normal peristalsis is peristalsis is interfered interfered
•AnemiaAnemia•Abd. PainAbd. Pain
• Emesis unrelated to Emesis unrelated to ingestion of food ingestion of food /water/water
• MelenaMelena• palpationpalpation• Exploratory Exploratory
laparotomylaparotomy
• RG: contrast – RG: contrast – filling defectfilling defect
• Endoscope Endoscope • UltrasonographyUltrasonography• Adenocarcinoma: Adenocarcinoma:
most commonmost common• Sex predilection for Sex predilection for
malesmales• Treatment Treatment • Chemotherapy: Chemotherapy:
not successfulnot successful
• SurgicalSurgical
• Gastrectomy: Partial Gastrectomy: Partial gastrectomy is done gastrectomy is done
• Removal of any portion Removal of any portion of the stomach and up to of the stomach and up to (30-40%) in antrectomy(30-40%) in antrectomy
• Partial gastrectomy – 40-Partial gastrectomy – 40-70% 70%
• Subtotal gastrectomy : Subtotal gastrectomy : 70- 90%70- 90%
• Antrectomy: Antrectomy: reconstruction- reconstruction- gastroduodenostomygastroduodenostomy
(bilroth I ) or (bilroth I ) or gastrojejunostomy(II)gastrojejunostomy(II)
• Two variations of partial Two variations of partial gastrectomy gastrectomy
• A-CA-C : stay sutures are : stay sutures are placed to elevate the placed to elevate the stomach and to minimize stomach and to minimize leakageleakage
• Necrotic tissue is excised Necrotic tissue is excised with a rim of viable tissuewith a rim of viable tissue
• A two layer inverting A two layer inverting closure is usedclosure is used
• D-ID-I : atraumatic forceps : atraumatic forceps are placed across viable are placed across viable tissue and necrotic tissue tissue and necrotic tissue is excised is excised
• The stomach body is The stomach body is subsequently closed subsequently closed with a parker- Kerr line with a parker- Kerr line
• The first inverting The first inverting layer suture is placed layer suture is placed over the clampsover the clamps
• Remove clamps, pull Remove clamps, pull and invert the suture and invert the suture lineline
• Second inverting Second inverting suture rowsuture row
• End to end End to end anastomosis of anastomosis of stomach stomach
• Bilroth II – Bilroth II – performed if more performed if more radical radical gastrectomy is gastrectomy is required, if there required, if there is excessive is excessive duodenal duodenal involvement or involvement or bothboth
BloatBloat
• Bloat : Major problems- GIT – cattle Bloat : Major problems- GIT – cattle and buffaloesand buffaloes
• Higher in buffaloesHigher in buffaloes• Acute/chronicAcute/chronic• Gaseous bloat – free gas - dorsal part Gaseous bloat – free gas - dorsal part
of rumenof rumen• Frothy bloat – gas trapped with Frothy bloat – gas trapped with
ingesta- dispersed throughout the ingesta- dispersed throughout the rumen contentrumen content
• Acute: rapid feeding and sudden diet Acute: rapid feeding and sudden diet change – large ruminantschange – large ruminants
• s. ruminants – large quantities of s. ruminants – large quantities of grain ingestion/cerealsgrain ingestion/cereals
• More pressure on diaphragm – More pressure on diaphragm – hypoventilation and red. Venous hypoventilation and red. Venous return to the heartreturn to the heart
• signs: bulge on Para lumbar fossasigns: bulge on Para lumbar fossa
• Abdominal distensionAbdominal distension
• Cyanotic mmCyanotic mm
• v. serious – lying down – asphyxiated v. serious – lying down – asphyxiated – open mouth- protruded tongue and – open mouth- protruded tongue and tachycardiatachycardia
• Treatment: puncture wall – left side with Treatment: puncture wall – left side with trocar and canulatrocar and canula
• if frothy – antifoaming agents – if frothy – antifoaming agents – turpentine oil (80ml) + mustard oil (500-turpentine oil (80ml) + mustard oil (500-1000 ml)1000 ml)
• antifroth prepn. – bloatosilantifroth prepn. – bloatosil• gives immediate relief to ailing animalgives immediate relief to ailing animal• avoid conc. – 2-3 days and leguminous avoid conc. – 2-3 days and leguminous
fodderfodder
• Resort to rumenotomy / rumenostomyResort to rumenotomy / rumenostomy
• S. animal: IV- RL or oral soda bicarbS. animal: IV- RL or oral soda bicarb
• Chronic bloat: TRP (FBS) – reticuloperitonitis/ Chronic bloat: TRP (FBS) – reticuloperitonitis/ fibrinous pneumonia – pleuritis involving the fibrinous pneumonia – pleuritis involving the vagus nervevagus nerve
• Liver abscess, splenic cyst and abscess, Liver abscess, splenic cyst and abscess, enlarged mediastinal lymph nodes, pyloric enlarged mediastinal lymph nodes, pyloric stenosisstenosis
• Rumen fistulation / rumenotomy can be doneRumen fistulation / rumenotomy can be done
• Rumen fistulation: Rumen fistulation: • Anesthesia and surgical Anesthesia and surgical
prepn.: standing prepn.: standing positionposition
• Sternal recumb. – Sternal recumb. – CamelCamel
• Left Para lumbar fossa Left Para lumbar fossa • Circular area – ventral to Circular area – ventral to
transverse process of transverse process of lumbar vertebrae- lumbar vertebrae- approx 10 cm dia.- approx 10 cm dia.- infiltrated infiltrated
•A circular piece of A circular piece of skin (4cm) – skin (4cm) – removed to removed to expose the expose the underlying underlying abdominal mus.abdominal mus.
•Bluntly dissect Bluntly dissect and expose and expose rumen – grasp – rumen – grasp – pulled in a cone pulled in a cone fashion to the fashion to the skin surfaceskin surface
•Anchor with 4 Anchor with 4 horizontal horizontal mattress mattress suture through suture through rumen and rumen and skinskin
• Remove central Remove central portion of rumenportion of rumen
• Incised edge of Incised edge of rumen is sutured to rumen is sutured to the skin with the skin with simple interrupted simple interrupted and non- and non- absorbable absorbable
• Alternately – all the Alternately – all the layers – apply layers – apply interrupted interrupted mattress sutures in mattress sutures in circular rimcircular rim
• Rumenotomy: Rumenotomy: • Indications: FB, Indications: FB,
ruminal ruminal impaction, bloat, impaction, bloat, atony of atony of omasum or omasum or abomasumabomasum
• Inverted L – Inverted L – blockblock
• Local infiltration Local infiltration along line of along line of incisionincision
• Para vertebral Para vertebral blockblock
• Surgical Surgical technique: 20 cm technique: 20 cm incision- middle of incision- middle of tuber coxae and tuber coxae and last riblast rib5 cm ventral to 5 cm ventral to lumbar processlumbar process
• Caudal to last rib Caudal to last rib (close to (close to reticulum)reticulum)
• Esp. in deep Esp. in deep bodied animals bodied animals
• Anchor rumen to Anchor rumen to the incision to the incision to avoid avoid contamination of contamination of abdominal m. abdominal m. and peritoneumand peritoneum
• Continuous Continuous inverting pattern – inverting pattern – non-absorbablenon-absorbable
• Alternatively use Alternatively use weingarts ring weingarts ring (quicker)(quicker)
• Incise rumen Incise rumen with scalpelwith scalpel
• Evacuate and Evacuate and explore for FB in explore for FB in reticulum and reticulum and removeremove
• Try to feel for Try to feel for abscess in abscess in reticular areareticular area
• Reticulum is Reticulum is swept with a swept with a magnet to magnet to retrieve the iron retrieve the iron FB FB
• Rumen cud + Rumen cud + soda bicarb= soda bicarb= mineral oil mineral oil