Veterinary Gastrointestinal surgery part-I

• Veterinary Gastrointestinal surgeryVeterinary Gastrointestinal surgery(Part-I)(Part-I)

• 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

Gastric ulcer / Abomasal ulcer: Gastric ulcer / Abomasal ulcer: • assoc. with chronic assoc. with chronic

renal / hepaticrenal / hepatic

• mast cell neoplasiamast cell neoplasia

• gastrin producing gastrin producing neoplasianeoplasia

• gastric neoplasiagastric neoplasia

• coagulation disordercoagulation disorder

• FB / gun shot woundFB / gun shot wound

• ICHICH

• UremiaUremia

• PoisonPoison

• SnakebiteSnakebite

• Primary ulcers are Primary ulcers are less commonless common

• Ulcers secondary – Ulcers secondary – commoncommon

• Aspirin: Aspirin: experimentally to experimentally to produce ulcersproduce ulcers

• Pathophysiology: Pathophysiology:

• Gastric/ Gastric/ duodenal duodenal mucosa/ covered mucosa/ covered with mucus layer with mucus layer (sulfated mucin (sulfated mucin bound to epi. bound to epi. cells)cells)

• Offers protection Offers protection – against – – against – corrosive / corrosive / digestive effects digestive effects of gastric acid of gastric acid and pepsin (auto and pepsin (auto digestion and digestion and ulceration)ulceration)

• Reduced mucosal Reduced mucosal bl. Flow- local bl. Flow- local ischemia – sepsis/ ischemia – sepsis/ hemorrhagic hemorrhagic shock – sudden shock – sudden expulsion of expulsion of apical mucin – apical mucin – circumscribed circumscribed popn of cellspopn of cells

• Reflux of bile salts Reflux of bile salts from duodenum to from duodenum to stomach – bile salts stomach – bile salts – more destructive – more destructive than pancreatic than pancreatic juices- act as juices- act as detergents that detergents that solubilize lipid - cell solubilize lipid - cell memb and inhibit memb and inhibit the ion transport the ion transport sys.sys.

• bile content – greatest – pyloric bile content – greatest – pyloric antrum – ulcer region of stomachantrum – ulcer region of stomach

• hyper secretion of HCL hyper secretion of HCL – gastrinoma ie non beta islets cell gastrinoma ie non beta islets cell

tumour of pancreas and tumour of pancreas and hypergastinemiahypergastinemia

– in renal failure (gastrin is removed by in renal failure (gastrin is removed by kidneys)kidneys)

– increased histamine: mastocytoma and increased histamine: mastocytoma and Endotoxemia and hemorrhagic shockEndotoxemia and hemorrhagic shock

– NSAIDS- reduced secretion of mucusNSAIDS- reduced secretion of mucus• alters the biochemical composition of mucinalters the biochemical composition of mucin

• ingestion of chemicals(arsenic ,cresote)ingestion of chemicals(arsenic ,cresote)• Signs: vomiting (not immediately after Signs: vomiting (not immediately after

ingestion)ingestion)• eating – gastric pain- relieved by vomitingeating – gastric pain- relieved by vomiting• Hemet emesis and melenaHemet emesis and melena• slow bleeding: coffee colored bloodslow bleeding: coffee colored blood• sudden - massive and semi clotted bloodsudden - massive and semi clotted blood

• generalized peritonitis: gastric perforation generalized peritonitis: gastric perforation (mostly doesn’t occur due to effective (mostly doesn’t occur due to effective sealing with omentum)sealing with omentum)

• wt. loss – hepatic/ neoplasticwt. loss – hepatic/ neoplastic

• additionally in calves : due to bleeding additionally in calves : due to bleeding ulcers – recumbent suddenly – cold ulcers – recumbent suddenly – cold extremity- subnormal temp. tachycardia extremity- subnormal temp. tachycardia and dehydration- hypovolemic shock and and dehydration- hypovolemic shock and death 24 hrsdeath 24 hrs

• Abomasal ulcers Abomasal ulcers : : suckling calves and suckling calves and adult cattle adult cattle (buffaloes)(buffaloes)

• adult: 1st few wks of adult: 1st few wks of partu.(stress and partu.(stress and lactation)lactation)

• Stress related Stress related (summer months (summer months independent of independent of partu.)partu.)

• Calves: dietary Calves: dietary transition from low transition from low DM to high DMDM to high DM

• TrichobezoarsTrichobezoars

• Asso. With Asso. With impaction alsoimpaction also

• Type I erosion and Type I erosion and ulcers with slight ulcers with slight hemorrhagehemorrhage

• Type II bleeding Type II bleeding ulcersulcers

• Type III perforation Type III perforation with acute with acute circumscribed circumscribed peritonitisperitonitis

• Type IV perforation Type IV perforation with diffuse with diffuse peritonitisperitonitis

• Diagnosis: Diagnosis:

• TRP ; pain on left TRP ; pain on left of xiphoidof xiphoid

• Abomasal ulcer: Abomasal ulcer: pain on rt. sidepain on rt. side

• RG: double RG: double contrast: create contrast: create pneumoperitoneupneumoperitoneum and give m and give barium mealbarium meal

• Barium: ulcers Barium: ulcers appear as appear as outpouchings from outpouchings from lumen containing lumen containing the contrast the contrast materialmaterial

•Fluoroscopy: helps in variable Fluoroscopy: helps in variable positioning and pin point the sitepositioning and pin point the site

•Endoscopy: not Endoscopy: not in threatened in threatened bleeding cases bleeding cases (allows (allows biopsies)biopsies)

•Exploratory: Exploratory: laparotomylaparotomy if if life threatening life threatening hemorrhagehemorrhage

Treatment Treatment

• Surgical excisionSurgical excision

• Cranial midline incisionCranial midline incision

• Carefully palpate from fundus to Carefully palpate from fundus to pyloruspylorus

• If ulcers then – adhesion, serosal If ulcers then – adhesion, serosal scarring and irregular thickened scarring and irregular thickened areas on gastric wall areas on gastric wall

• Inspect the Inspect the pancreas- pancreas- gastrinoma- p. gastrinoma- p. nodules nodules

• If gastrinoma- en If gastrinoma- en block resection block resection of a lobe or of a lobe or complete complete pancreas(90% pancreas(90% removal – no removal – no endocrinal endocrinal insufficiency)insufficiency)

• If no ulcers foundIf no ulcers found

• Open stomach- find the bleeding site- Open stomach- find the bleeding site- also on pyloric antrum(equidistant also on pyloric antrum(equidistant from lesser / greater curvature)from lesser / greater curvature)

• Extend to duodenum if necessaryExtend to duodenum if necessary

• Small ulcers : Small ulcers : elliptical incision- elliptical incision- mucosa closed – mucosa closed – simple continuous simple continuous – 3/0 or 4/0 – 3/0 or 4/0 absorbable absorbable chromic and chromic and interrupted interrupted Lambert on serosa Lambert on serosa and muscularis and muscularis

• Multiple ulcers on Multiple ulcers on pyloric part – pyloric part – bilroth I bilroth I gastrectomy gastrectomy techniquetechnique

• Bilroth technique I : Bilroth technique I : ligate the rt. Gastric ligate the rt. Gastric artery near pylorus artery near pylorus on the lesser on the lesser curvaturecurvature

• Rt. Gastroepiploic Rt. Gastroepiploic vessels ligated vessels ligated

• Take care not to Take care not to injure the pancreasinjure the pancreas

• Pyloric and gastric Pyloric and gastric branches supplying branches supplying the area to be the area to be resected are ligated resected are ligated

• 2 st. intestinal 2 st. intestinal clamps are placed clamps are placed across the pyloric across the pyloric antrumantrum

• another 2 are another 2 are placed distal to placed distal to the pylorus and the pylorus and avoid the avoid the common bile common bile duct.duct.

• Excise the pyloric Excise the pyloric sphincter and sphincter and canal canal

• Gastric mucosa Gastric mucosa is apposed with is apposed with 3-0 synthetic 3-0 synthetic absorbable absorbable suture in an suture in an Cushing pattern Cushing pattern starting from the starting from the lesser curvature lesser curvature and continuing and continuing towards the towards the greater greater curvaturecurvature

• Equal in size to the Equal in size to the duodenal diaduodenal dia

• Apposed – 3-0 – Apposed – 3-0 – synthetic synthetic absorbable, absorbable, polypropylene, or polypropylene, or nylon – lamberts nylon – lamberts patternpattern

• Duodenum is then Duodenum is then anastamosed with anastamosed with stomachstomach