Alimentary tract surgery

1) Facial / head surgery

- Cleft palate. Found in neonates, there are a whole range of defects affecting the face (harelip) and hard and soft palates. The structures of the palate fail to close across the mid line. Small defects are relatively easy to repair, treating them as though they were cuts through the rof of the mouth, although the movement of the tongue can cause wound breakdown problems. large defects may be associated with hypoplasia in which case finding enough tissue to close can be a problem. Correction must be done early. If the pups are not inspected for this at birth, then the first sign noticed by the owners is usually milk returning down nostrils at feeding.

- Labial dermatitis- Seen mostly in Cockers, where folds of skin at either side of the lower lip lead saliva down the skin causing wetness and allowing skin damage and bacterial infection. Owners report this as halitosis, but the smell is unaffected by teeth cleaning. Owners can usually be convinced by allowing them to smell a cotton bud which has been run down the affected fold.

- Tumours- treated by resection (cutting out) and radiation. Fibrosarcoma, melanoma, Squamous cell carcinoma are all malignant, and are usually found in older animals.
Benign epulis are often spotted by owners, who will notice a swelling on the gum. Boxers are particularly affected, and these masses can be removed easily using cautery.


2) Megaoesophagus

Surgical correction of megaoesophagus can be performed if the problem is due to a vascular ring (see the notes on cardiovascular system disease). If not done early, the megaoesophagus may not correct. Nursing care involves feeding from a height, and avoiding dry bulky foods. Inhalation pneumonia is a constant risk in these patients.

3) Gastric dilation and volvulus

This is an emergency which develops in particular breed types with large, deep chests, such as G.S.D.’s, Setters, Poodles, etc.
The condition is thought to be associated with food and exercise in the at risk breeds. The stomach begins to swell with a mixture of gas and froth produced by bacterial action.( The dilation part). After this the stomach rotates around the long axis of the body (torsion), shutting off the entrance and exit so causing sudden inflation. The massively inflated stomach then causes circulatory problems by acting like a tourniquet in the abdomen, also breathing becomes difficult due to pressure on the stomach.

HOW TO DEAL WITH GDV

Procedures performed:
i/ Decompression with stomach tube.
If the problem is caught before the stomach rotates, then it may be posible to decompress the animal by passing a stomach tube. The dog is often collapsed and not very responsive, so passage of a stomach tube using a bandage as a gag may be possible. Always pre-measure from nose to sternum tip, and there is often resistance at the cardiac sphincter.
It may be possible to deflate via a needle through the body wall, under veterinary direction.
SHOCK is rapid in onset and severe in GDV, so fluids are essential. When the stomach is de-rotated at surgery, enormous amounts of toxin flood into the circulation, and heart arrhythmias can be a real problem, requiring careful nursing monitoring.

Surgery to stabilise and/or de-rotate the stomach is always necessary,

ii/ PEG tube. (Percutaneous endoscopic gastrostomy). This is used to both decompress and stabilise, as it creates a stoma and adhesion at the body wall. Nursing care at stoma is vital whilst in place. Stoma care involves use of padde non-adherent dressings, possibly with water proofing ointments such as vaseline. If feeding is done through the stoma, cleaning and flushing is necessary.


4/ Enterectomies, enterotomies, foreign bodies and intussusception

The key word in these procedures is contamination, as they involve opening up into the lumen of the bowel.
Foreign bodies may be very easy or very difficult to locate. Easy are completely occluding radiopaque ones such as stones. The animal vomits and becomes ill, and X-rays reveal the problem. Difficult are incompletely occluding radiolucent ones such as pieces of string, when the animal may show very vague signs or occasional vomiting.
Intussusceptions act as foreign bodies, when one section of intestine is sucked into an adjacent length. The complication with an intussusception is that the blood supply to part of the intestine is quickly cut off.
Enterotomy - cutting a hole into the intestine (usually along its length to avoid causing a stricture.
Enterectomy - cutting out a section of bowel and anastomosing the two ends. Large segments may be removed, but enterectomies are more prone to breakdown of the wound or to strictures.
Nursing care:
Potential contamination can be reduced by using pre-op antibiotics, or enemas in the lower bowel. Fluid therapy should start before surgery. Double drapes can be applied so that any contaminated during surgery can be removed.

Post op care
Prevent contamination and check for wound breakdown. Monitor return to feeding - fluid only per os for first 1-2 days then little and often liquid feeds for 2-3 days, then frequent small meals to the end of the first 76-10 days. Lead exercise, and watch for signs of peritonitis - guarding, dullnes,, temperature rise.


5) Anal sac disease
Anal sacs are scent glands only, and clients can be reassured that they can be safely removed. Dogs and cats use them for territory marking and also will express them in fright. The glands can cause problems either through over-filling or becoming infected. Expressing using a lubricated finger is often effective, but surgery is also fairly common.
Nursing care: Advise re feeding. Faecal bulkers may help to express the glands (e.g. bran, Peridale granules).

6) Anal furunculosis
A severe skin eroding condition around the perineum of certain breeds. Originally thought to be an infection, but in some dogs, particularly GSD’s, it is an immune problem. Nursing advice is aimed at perineal hygiene using saline or antibacterial washes on a daily basis. Some dogs benefit from daily hosing down.

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