Enterotomy Essentials (Case)

Question

You have diagnosed a small intestinal foreign body and are planning on performing an enterotomy to relieve the obstruction.

 How do you plan to close the enterotomy site?

What technique will you use if you decide to resect a section of damaged small intestine?

Where is the most common site of leakage following enterectomy?

Answer

The suture holding layer must include the intestinal submucosa and most surgeons will select a monofilament absorbable suture material on a swaged on needle. Simple interrupted or continuous appositional techniques are ideal but an inverting pattern is used by some surgeons. Closure of enterectomy sites can be achieved with either simple continuous or interrupted appositional patterns.The most common site of leakage is at the mesenteric border due to the increased challenge to accurate suture placement in this location. 

Abdominal Mass In Cat (Case)

Question

Ziggy has an abdominal mass. His owner does not wish to pursue treatment which would require frequent veterinary visits.  Which of the following statements is true?

A-   There is no point taking matters any further; it must be neoplastic and there are no intra-abdominal tumours that could be managed without frequent veterinary visits.

B-   The most common diagnosis for an intra-abdominal mass in a cat is lymphoma.

C-   Alimentary lymphoma in cats must be treated with a doxorubicin-containing chemotherapy protocol.

D-   There is a high chance that alimentary lymphoma will perforate when chemotherapy is given.

E-   Administration of intravenous chemotherapy requires sedation or anaesthesia in cats.

Answer

B is the correct answer.

There are many possible explanations for this cat’s intra-abdominal mass. Some of those are non-neoplastic; some of them can be cured by surgery.

It is true that lymphoma is the most likely diagnosis. Alimentary lymphoma in cats is relatively poorly responsive to conventional chemotherapy. Work is ongoing which will hopefully define better treatment strategies for alimentary lymphoma cases.

A small proportion of feline alimentary lymphoma cases are of a particular type which does not respond to conventional COP or CHOP chemotherapy, instead responding for years to a much less intensive treatment comprising chlorambucil and prednisolone.

Mast Cell Tumour Management (Case)

Question:

Beech is a golden retriever with a large ulcerated mass circumferentially affecting the skin of the anal region. Which of the following statements is not true?

A- diagnosis can be made by pathological assessment of cell (FNA) or tissue (incisional biopsy) specimens.

B-  In cases of mast cell neoplasia, it is inappropriate to commence therapy without knowledge of tumour grade.

C- Canine cutaneous mast cell tumours classically spread to the regional lymph nodes first.

D- Rapidly progressive ulcerated mast cell tumours are more likely to be high-grade than small non-ulcerated minimally progressive mast cell tumours.

E- Approximately 67% of canine cutaneous mast cell tumours in the pivotal trials for both masitinib and toceranib were shown to exhibit mutations in the c-kit gene.

Answer:

B is the wrong (correct) answer.

Decisions about therapy for canine cutaneous mast cells are made based upon many factors. Tumour grade is simply a proxy measure of the probable aggressiveness of a tumour; it is not the only such measure. Proof of metastasis, for example, is a more important finding than histological grade and would effectively render information about grade redundant.