Surgical investigations - vomiting and regurgitation

• Exploratory laparotomy for diagnostic and prognostic purposes is indicated if:

  A diagnosis may only be made by inspection or palpation of the abdominal contents.

  A diagnosis depends on samples obtained at laparotomy:

  • Culture of samples
  • Cytological or histological analysis of samples.
• Exploratory laparotomy for therapeutic purposes is indicated if:


  Control of haemorrhage, correction of the source of contamination or infection.

  Elimination of the cause of pain. Removal of mass lesions.

  Removal of visceral obstruction.

  Removal of traumatised organs.

  Relief of non-responsive dystocia.

  Removal of abnormal accumulation of fluids.

  Supportive care e.g. enteral tube placement, cystostomy tube.
• Exploratory laparotomy for preventative purposes is indicated if:


  Reduce the incidence of a particular disease e.g. gastropexy for GDV.

  Reduce the recurrence of a particular disease e.g. enteroplciation for intussusception.
• Exploratory laparotomy - key points

  Be thorough and systematic

  Take appropriate samples

  Avoid the ‘peek and shriek’ - don’t make the whole to small to look around.
• Exploratory laparotomy - common mistakes

  Failure to make a large enough incision, failure to explore the entire abdominal cavity.

  Failure to take appropriate biopsies.

  Failure ti be prepared for the likely diagnosis or diagnoses.

  Failure to approach the intra-operative findings in a logical fashion.
• Exploratory laparotomy - steps and regions

  The entire abdominal cavity should be divided into regions to ensure that all of the organs are inspected. A simple procedure is to divide the abdomen into 5 regions:

  1. Cranial quadrant.
  2. Intestinal tract.
  3. Right paravertebral region.
  4. Left paravertebral region
  5. Caudal quadrant.
• Closure of the linea alba

  Continous suture patterns preferable:

  • Even distribution of tension along length of closure.
  • More rapid closure
  • Less suture material (=less foreign material).
  • 6 throws at each end (sliding self-locking knot and Aberdeen knot).

  Absorbable monofilament e.g. polydioxanone or polyglyconate.
• Post-operative management

  Restricted exercise for 2-3 weeks.

  Monitor the incision for redness, swelling, oozing, heat, pain to touch.

  Re-examination appointment 5-5 days, post-operatively.

  Monitor urination/ defecation, behaviour and feeding.

  Removal of skin sutures (if required) 7-10 days, post operatively.
• Indications for oesophageal surgery

  Placement of Oesophagostomy feeding tube (common).

  Removal of an oesophageal foreign body.

  Partial oesophagectomy for resection of an oesophageal tumour (very rare).
• Common oesophageal foreign bodies - dogs

  Bones.

  Rawhide

  Toys and balls.

  Fish hooks

  Clothing
• Common oesophageal foreign bodies - cats

  Needles

  String

  Toys

  Hair
• Common oesophageal foreign bodies - clinical signs

  Retching, regurgitation (food and water).

  Vomiting - can owner differentiate regurgitation from vomiting.

  Ptyalism

  Anorexia

  Restlessness

  Cervical pain
• Common oesophageal foreign bodies - investigations

  High index of suspicion from clinical history.

  Plain radiography (in most instances).

  Endoscopy
• Common oesophageal foreign bodies - treatment

  In most instances, an emergency requiring immediate removal.

  Most can be removed endoscopically using grasping forceps.

  Refer to a centre that has the appropriate equipment and expertise.

  Approximately 10% can not be removed orally and are pushed into the stomach; bony FBs will then be digested with no requirement for a Gastrotomy.
• Common oesophageal foreign bodies - post removal management

  Medical therapy to reduce likelihood of stricture formation.

  • H2 antagonist
  • Proton-pump inhibitor.
  • Sucralfate

  Analgesics

  Feed soft food.
• Indications for gastric surgery

  Placement of gastric feeding tubes (percutaneous endoscopic gastrostomy (PEG).

  Gastrotomy for removal of a gastric foreign body.

  Gastropexy to prevent volvulus.

  Correction of gastric dilation volvulus (GDV).

  Pyloroplasty to manage gastric outflow disease.

  Partial gastrectomy for resection of a gastric tumour, ulceration.
• Percutaneous endoscopic Gastrostormy (PEG)

  Tubes are a minimally invasive and highly effective method of providing proper nutrition to dogs an cats.

  They are most commonly placed in animals with:

  • Dysphagia.
  • Oesophageal disorders.
  • Chronic diseases that may require long-term nutritional assistance.
• Indications for small intestinal surgery

  Full thickness biopsy (e.g. inflammatory bowel disease).

  Enterotomy for removal of a foreign body.

  Enterectomy

  Enteroplicatio (potential aspect in the management of intussusceotion).

  Cholecystoenterostomy (biliary tract bypass procedure).
• Indications for large intestinal surgery

  Colopexy (e.g. as part of management of perineal hernia).

  Colotomy (e.g. impaction, foreign body).

  Colectomy (e.g. tumour, polyp).

  Subtotal colectomy (e.g. Megacolon in the cat).
• Indications for pancreatic surgery

  Biopsy - pancreatitis.

  Islet cell tumour - insulinoma

  Pancreatitis

  Pancreatic abscess.

  Pancreatic pseudo cyst.

  Pancreatic tumour - carcinoma.