Mammary tumours are the most common tumours in the bitch. Bitches tend to experience a pair of caudal tumours whereas queens are mostly affected by cranial mammary tumours.

A mammary tumour removal is currently the only treatment known to make a difference to survival against malignant mammary tumours.

PRE OP:

X-rays required first to assess the progression of the tumour - assessing if it has already metastasised to lungs/other organs.

DURING OP:

This surgery can be done in canines and felines. In canines it's most common to remove the tumour and the effected mammary (mammectomy), whereas in cats it's more aggressive and commonly requires a mammary strip (radical mastectomy) on one or both sides. It is not recommended to perform a mammary strip on both sides simultaneously to reduce risk of wound complications.

Most mammary tumours in canines are benign.

POST OP:

Some veterinary surgeons like to take post operative x-rays after a few months to check for tumour reoccurrence - this is the most common post op complication.

All mammary gland surgery is prone to dehiscence and ideally a drain should be placed. Post op, the wound needs careful monitoring and maintenance.

Pre Opp- Before proceeding with castration it is important to check that both testicals have deceded. If both testicals are not present then the VS will have to preform a crytporchid castatrate.

Castration -

Is performed under general anaesthetic and involves the Veterinary Surgeon make and small insision inform of the testicals. The VS then ligates each testical from its spermatic cord then removed. The small insision in them sutchured up leave a small surgical wound. A scrotal abrasion can also be performed to reduce the side of the empty scrotum. However if one or both of the have not descended into the scrotum then the vet may have to make insidious into the abdomen to fine the retained teste for then it to be removed. This is know as a cyriporchid castration.

Post opp-

With any procedure it is important to keep your patient calm after its procedure. After a castration restricted exercise is implemented to stop any swell, seroma and trauma to the wound most up. Most patients will be sent home with NSAIDS as pain relief and with a buster collar to prevent and self mualtion at home to the wound

Can be an emergency surgery or if bleeding is intermittent an be carried out as an elective procedure.

Will possibly need Warmed sterile saline for lavage, Suction and Abdominal retractor (e.g. Balfour Retractor). Extra sterile swabs will be needed as well.

Autotransfusion can be carried out if haemorrhage is due to trauma and not neoplasia.

Reasons for sx:

• Neoplasia (hemangiosarcoma)

• Splenic torsion

• Trauma

• Haemorrhage

  Pre-op care and post-op care:

• Closely monitor MM colour + CRT post-op

• May need blood transfusion (Colloids)

• Fluid therapy (Crystalloids)

• Monitor temperature - active warming techniques should be used as abdomen opened for procedure. (Heat matts, socks, Bear Hugger, blankets, fluid warmer).

• Adequate analgesia post-op (regular pain scoring)

• Wound management

• ECG - monitor for arrythmias post-op

• Monitor respiratory rate post op as sudden death can occur post-op due to respiratory failure from thromboemboli (clots).

• Monitor hypotension post-op

• Monitor peripheral pulse qualities

• Repeat PCV during recovery period

• VS may want to do AFAST scan during recovery.

• Place primapore over wound if oozing also helps to visualise blood any active bleeding.

  
  

  Risks:

• Patient may have high ASA score if emergency surgery

• Patient can present in Hypovolemic shock due to blood loss.

• Hypothermia (both pre-operatively and post-operatively).

• Risk of hypotension during procedure once Spleen removed - monitor depth.

• Risk of arrythmia when spleen removed - recommend recording an ECG trace prior to induction and then ongoing ECG monitoring

• Surgery can be painful so a local block can be used (Bupivacaine)

  
  

  Complications:

• Postoperative haemorrhage as a result of displacement of ligature in abdomen.

• Wound breakdown if patient interferes with wound (Place MPS or BC).

• high incidence of rapid ventricular tachycardia following splenectomy which can be fatal

• damage to the vasculature of the stomach or pancreas, which can cause ischaemic necrosis of these organs

• Pancreatitis - from traumatic handling of the pancreas during surgery.

  
  

  References:

• BSAVA Manual of Canine and Feline Abdominal Surgery

• BSAVA textbook of veterinary nursing 6th edition Chapter 23.

  
  

• can cause a blockage in the intestine, resulting in the inability to move food through the intestine

• can occur in any area of the intestine and can also involve the colon, cecum, or stomach.

• can also happen in multiple areas of the gastrointestinal tract at the same time.

• most likely to happen in young dogs, but can happen in older patients too.

• often seen in German Shepherds.

  
  

SIGNS, SYMPTOMS & DIAGNOSTICS - episodes of D & V prior to the intussusception happening, once it has happened there may be small amounts of bloody diarrhoea, , anorexia, dehydration, depression, tachycardia, you may be able to palpate what feels like a cylindrical abdominal mass, similar symptoms to a genuine obstruction such as a foreign body. Ultrasound is the preferred method to diagnose this.

SURGERY INFO - surgery involves removing the part of the intestines causing the issue & then performing anastomosis, but in some rarer cases the intestines can be manually manipulated back into a normal position. This surgery is a referral case as it is complicated.

RISKS & COMPLICATIONS - by the time these patients are treated with surgery they are often very unwell so the procedure is therefore high risk. It is often likely that the issue with reoccur in the future. Infection is also a risk. Supportive IVFT should be considered.

POST-OP CARE & NURSING CONSIDERATIONS - restoring the patients hydration after a prolonged period of V & D, electrolytes reintroduced, appropriate diet to be provided gradually, prognosis of surgery is good providing that intussusception has not been in place for a very prolonged period of time & no tissue damage has occurred. It is also important that the underlying cause is identified as this can reoccur (usually from 24hours - 5 days post-op). This is a very invasive surgery so we need to be regularly pain scoring & reporting to the VS so that we can provide adequate analgesia. Ensuring that these patients are eating & drinking after surgery is paramount.

Enterectomy = section of intestine removed if necrotic or tumour is present - ends are sutured to form anastomosis

May be necessary to remove large portion of small intestine - results in "short bowel syndrome" categorised by persistent D+ and poor body condition due to inadequate nutrition from shortened bowel

Could be emergency or elective depending on nature

Post-op care = healing is enhanced if animal eats ASAP after Sx

monitoring faecal output vs food intake

pain relief - pain scoring - opioids/NSAIDs

Wound management - deterring with buster collar/shirt

Keep eye on wound - exudate/swelling - any free fluid/seroma - post op imaging?

IVFT

Monitoring vitals - signs of shock?

Risks/Complications

Infection risk- spill risk of intestinal content into abdomen/risk of rupture - could lead to sepsis - ABs needed during and after

Risk of peritonitis

Risk of dehiscence

Hypothermia risk especially if flushing abdomen with saline - active warming techniques

Fluid loss/Haemorrhage - treat with IVFT or blood products if needed

Monitor vitals - MM/CRT, blood pressure, heart/resp/pulse rate and quality, SPO2, ETCO2/ECG

Wound breakdown risk

Nosocomial infection risk

Sx can be long - doing pre operative imaging if possible to potentially reduce time in Sx

https://www.vetsurgeryonline.com/enterotomy-vs-resection-anastomosis/

https://www.petmd.com/dog/procedure/dog-intestinal-blockage-surgery

An opening through the skin into the stomach.

WHY WOULD WE DO THIS?

Gastrointestinal surgery is performed very commonly in small animals for biopsy, removal of a foreign body, upper gastrointestinal bleeding, resection of a nonviable segment of intestine, resection of nonviable portion of the stomach, and resection of a neoplasia, and can be done to help decompress the stomach.

CLINICAL SIGNS

• Vomiting

• Loss of appetite

• Abdominal pain 

• Diarrhea 

• Dehydration 

• Lethargy

BEFORE SURGERY

ensuring that the patient has be starved prior to surgery.

NURSING CARE

Helping with x-rays or ultrasound to find out a prognosis.

Intravenous fluid therapy is essential not only in stabilising patients prior to surgery but also post-operatively.

It is important to provide nutrition early post-operatively and different methods may be required to get a patient to eat such as warming food, hand feeding or placement of feeding tubes until the patient is maintaining their daily nutritional requirement independently.

Ensuring the patient has had pain relief and that pain scores are being done regally.

ensuring that the patient is eating when awake from surgery to ensure the GI tract is moving, fed small, frequent, low-fat, highly digestible meals for several days

Ensuring that clients understand how to care for the patient when returning home, on lead toilet brakes, no big walks, no jumping, no running.

COMPLICATIONS

A possible complication of gastrointestinal surgery is peritonitis (leakage of intestinal contents into the abdominal cavity caused by the breakdown of the intestinal suture line) which occurs around three to five days after sur­gery

Hypothermia can be a common complication, so ensuring the patient is warm can be key.

websites

Nursing patients with gastrointestinal emergencies - Veterinary Practice

Gastrointestinal foreign body obstruction in dogs | Cornell University College of Veterinary Medicine

• Infection of the uterus common in older female dogs, occasionally cats.

• It occurs secondary to hormonally induced changes about 5-6 weeks after a season

• Can be open or closed

• Emergency surgery involves the removal of the uterus and the ovaries

Clinical signs include:

• vomiting

• shock

• abdo pain

• purulent vaginal discharge

• weakness and lethargy

Post-op care -

• Buster collar or surgical suit to prevent patient interference and the risk of infection

• Administration of antibiotics

• Pyometra is more often diagnosed once the patient is already very ill so fluids should be administered to stabilise prior and post surgery

• Once discharged the patient should remain indoors and kept calm to give the surgery wound time to heal

Risks/complications -

• More common in older dogs so anaesthetic risk

• Risk of sepsis, septic shock or infection

• Pain both before and after procedure

References -

- National Library of Medicine

https://pmc.ncbi.nlm.nih.gov/articles/PMC9987112/

-BMC Veterinary Research

https://bmcvetres.biomedcentral.com/articles/10.1186/1746-6148-10-6#:~:text=Potentially%20life%2Dthreatening%20complications%20of,hemorrhage%20%5B19%E2%80%9321%5D.

- pdsa

https://www.pdsa.org.uk/pet-help-and-advice/pet-health-hub/conditions/pyometra-infected-womb-in-dogs

GDV (Gastric Dilatation-Volvulus) surgery in dogs involves untwisting the stomach, assessing for damage, potentially removing damaged tissue, and performing a gastropexy (suturing the stomach to the abdominal wall) to prevent recurrence.

Post-op care -

·IVF – this should be tailored to the type of shock the patient is presenting with, bolus often required

·Close monitoring of blood pressure and ECG to check for arrhythmias

·PCV

·Regular TPR

·Monitor urine output to assess kidney function

·Regular pain scoring and report to veterinary surgeon

·Suitable environment e.g. comfy mattress with padding

·Turn regularly to reduce chance of decubital ulcers and hypostatic pneumonia

·Early nutritional support – reduce lactic acid build up and likelihood of SIRS

·High calorie recovery diet recommended and feeds should be little and often to prevent overstretching of stomach wall, and intake slowly increased

·Restricted exercise

·Prevent patient interference – b/c or MPS

Risks following GDV surgery –

·Ischaemia Reperfusion injury – tissue damage when blood flow is restored; monitor for excessive abdominal pain, arrythmias, electrolyte imbalances

·Over-perfusion of IVF fluids

·Disseminated Intravascular Coagulation (DIC)  - can occur due to lack of clotting factors or following ischaemic reperfusion injury

·Aspiration pneumonia from post-operative vomiting/regurgitation

Post-operative complications –

·Sepsis  - increased risk due to disturbance of gastrointestinal barrier

·Surgical site infection

· Dehiscence

·Patient interference

·Haemorrhage

.Gastric necrosis or perforation if stomach wall severely damaged

Clinical signs:

The uterus everts through the birth canal, with the endometrial surface visible, and may hang below the hocks. 

Treatment:

Removing the placenta (if still attached), thoroughly cleaning the endometrial surface, and surgically repairing any lacerations. 

However this is still a risk of them re-prolapsing

Can occur in Bitches, queens and Rabbits.