7 wounds burns neoplasia Flashcards
What are the three phases of wound healing?
1) Inflammatory phase 2) Proliferative phase 3) Maturation/Remodelling phase
What occurs during the inflammatory phase of wound healing?
Haemostasis is initiated, resulting in fibrin clot formation, immune barrier establishment, and removal of wound contaminants
What is the role of leukocytes in the inflammatory phase?
They migrate via diapedesis to modulate the next phase of healing
What key processes occur during the proliferative phase of wound healing?
Angiogenesis, fibroblast migration, collagen synthesis, and epithelialisation
What happens during the maturation/remodelling phase of wound healing?
Reorganisation of collagen and restoration of pre-wound tissue strength
List five host factors that affect wound healing.
- Immunosuppression * Cancer treatment * Age * Breed * Obesity
How does immunosuppression affect wound healing?
It delays healing due to decreased immune response and impaired cellular activities
What impact does age have on wound healing?
Older animals have decreased dermal thickness, reduced inflammatory response, and increased risk of infection
How does obesity affect wound healing?
Adipose tissue has poor vascularity and is prone to mechanical damage
What characteristics of wounds can affect healing?
- Wound perfusion * Tissue viability * Wound fluid accumulation * Wound infection * Mechanical factors
What is the significance of wound perfusion in healing?
Healing requires oxygen delivery, which is dependent on hemoglobin-bound oxygen
How do necrotic tissues affect wound healing?
They prolong the inflammatory phase and inhibit healing
What clinical signs indicate primary hemostasis issues?
- Echymoses * Spontaneous bleeding from mucosal surfaces * Petechiation
What are the end products of primary hemostasis?
Activated platelet plug
What initiates secondary hemostasis?
Vascular injury and endothelial cell damage
What is the role of tissue factor in coagulation?
It binds with Factor 7 to activate the extrinsic pathway of coagulation
What factors are involved in the amplification phase of coagulation?
Thrombin activates platelets and cofactors FVa and FVIIIa
What is the difference between primary and secondary hemostasis?
Primary hemostasis involves platelet plug formation; secondary hemostasis involves fibrin thrombus formation
What are the components of fresh frozen plasma?
- Coagulation proteins * vWF * Natural anticoagulants * Albumin * Globulins
What is cryoprecipitate used for?
VWD, Hemophilia A, Hypofibrinogenemia, dysfibrinogenemia
What are the clinical signs of secondary hemostasis issues?
- Single or multiple hematomas * Spontaneous bleeding into body cavities * Location-dependent symptoms
True or False: Thrombin is a mediator that links coagulation on the cell surface and platelet surface.
True
What is the primary role of anticoagulant pathways?
To limit fibrin formation and prevent excessive coagulation
Fill in the blank: Factor 1 is _______.
Fibrinogen
What are the three types of von Willebrand’s disease?
Type 1, Type 2, Type 3
What is the underlying pathophysiology of von Willebrand’s disease?
It affects platelet adhesion to exposed subendothelium and prolongs the half-life of factor 8
What is Haemophilia A?
A genetic disorder caused by deficiency of factor 8.
What is Haemophilia B also known as?
Christmas factor.
What is the Stuart-Prower factor?
Factor 10.
What does the von Willebrand factor do?
Helps platelets adhere to exposed subendothelium, aggregates platelets, and prolongs factor 8 half-life.
What are the three types of von Willebrand disease?
Type 1 (mildest), Type 2, Type 3 (most severe).
What is the normal Buccal Mucosal Bleeding Time (BMBT) for dogs?
1.5–4 minutes.
What can a prolonged BMBT indicate?
Platelet dysfunction, Von Willebrand disease, Vascular defect, Thrombocytopenia, Severe Azotemia.
What are the phases of wound healing?
- Inflammatory phase
- Proliferative phase
- Maturation/Remodeling phase
What happens during the inflammatory phase of wound healing?
Haemostasis is initiated, a fibrin clot forms, and inflammatory cells are attracted.
How long does the inflammatory phase typically last for uncomplicated wounds?
3-5 days.
What is angiogenesis?
The reestablishment of vascular supply during the proliferative phase.
What is the primary function of fibroblasts in wound healing?
Migration and collagen synthesis to form granulation tissue.
What is the main focus of reducing infection risk in open wounds?
Decontamination and ensuring adequate perfusion.
What are the two most common oral tumors in cats?
- Squamous cell carcinoma (75%)
- Fibrosarcoma (13-17%)
What is the preferred method for diagnosing oral masses?
Incisional biopsy or excisional biopsy.
What is a total hemimandibulectomy?
Surgical removal of half of the mandible.
What adjunctive treatments are used for melanoma?
- Radiation therapy
- Intralesional cisplatin
- Carboplatin
- Piroxicam
- Immunotherapy
What is the prognosis for mandibular tumors compared to maxillary tumors?
Better for mandibular tumors due to easier complete excision.
What are the most common tumors in dogs?
- Malignant melanoma (31-40%)
- Squamous cell carcinoma (17-25%)
- Fibrosarcoma (7.5-25%)
- Osteosarcoma (6-18%)
What is the purpose of a needle core biopsy?
To obtain a sample for histopathological diagnosis.
What is debulking surgery?
Incomplete resection of a tumor with residual gross disease.
What is wide excision surgery aimed at?
Removing macroscopic and microscopic disease to prevent local recurrence.
What are the common distant metastatic sites for tumors?
- Lungs
- Liver
- Spleen
- Kidney
- Bone
What is the hormonal influence on malignant mammary tumor development?
Time of spaying significantly impacts risk; earlier spaying reduces risk.
What are the surgical procedures for treating mammary tumors?
- Lumpectomy
- Mastectomy
- Regional mastectomy
- Chain mastectomy
What is the significance of surgical margins in tumor resection?
Margins should include surrounding tissue to ensure complete removal of the tumor.
What is the relationship between lactin concentrations and malignant tumors?
Lactin concentrations seem to be higher in malignant tumors.
How do malignant tumors typically differ in terms of estrogen receptor status?
Malignant tumors seem to be estrogen receptor negative.
What is the significance of hormone dependency in malignant tumors?
Loss of hormone dependency occurs in malignant tumors.
What receptor expression levels are higher in normal mammary tissue and benign tumors?
Higher levels of estrogen and progestin receptor expression.
What is a lumpectomy?
Partial mastectomy.
Define regional mastectomy.
En bloc removal of 1-3, or 3-5 + superficial inguinal LN.
What is a chain mastectomy?
En bloc removal of 1-5 + inguinal LN.
What surgical procedure would be chosen for a small tumor?
Caudal regional mastectomy.
What is the recommended surgical approach for a 6 cm tumor?
Chain mastectomy to get adequate lateral margins.
What surgical approach is recommended for a right cranial mass?
Simple mastectomy, but a regional mastectomy taking 1-3 out is also an option.
List the prognostic factors in dogs related to tumors.
- Tumor size
- Histological type
- Tumor grade/invasiveness
- Nuclear morphometry
- Clinical stage/LN metastasis
- Gene expression profiles/molecular phenotyping
What factors do not affect prognosis in dogs with tumors?
- Micrometastasis <2mm in inguinal LN’s
- Desexing
Define macrometastasis.
One or more tumor deposits greater than 2 mm.
Define micrometastasis.
Tumor deposit greater than 0.2 mm but not greater than 2.0 mm in largest dimension.
What are ITCs in the context of tumors?
Single cells or small clusters of cells not greater than 0.2 mm in largest dimension.
Is surgery recommended in cases of inflammatory carcinomas?
False.
What percentage of canine mammary tumors are inflammatory carcinomas?
8%.
List symptoms associated with inflammatory carcinomas.
- Rapidly progressive
- Highly metastatic disease
- Massive edema
- Erythema
- Ulceration
- Pain
- Anorexia
- Weakness
- Coagulopathies
What is the median survival time for dogs with inflammatory carcinomas without treatment?
25-60 days.
What is the median survival time with piroxicam for inflammatory carcinomas?
185 days.
What are the main factors that cause burns?
- Temperature
- Duration
- Tissue conduction
What are the four types of burns?
- Thermal
- Chemical
- Electrical
- Radiation
What are the degrees of burn classification?
- 1st degree
- 2nd degree
- 3rd degree
- 4th degree
How is % TBSA burn calculated using the Veterinary Burn Card?
Number of credit cards x 0.45m / m^2.
What is Wallace’s Rule of Nines?
Each segment of the body counts for 9%.
What is the local response to burns?
- Vasodilation
- Increased capillary permeability
- Edema
- Influx of inflammatory cells
What are the systemic effects of burns on the pulmonary system?
- Smoke inhalation
- Carbon monoxide poisoning
- Hydrogen cyanide poisoning
- Hydrochloric irritation
- Increased pulmonary vascular permeability
- Pulmonary edema
- ARDS
What cardiovascular effects can occur due to burns?
- Hypovolemia
- Vascular dysfunction
- Oedema
- Myocardial stiffness
- Reduced cardiac output
- Cardiomyocyte necrosis
What gastrointestinal effects can occur due to burns?
- Gut barrier dysfunction
- Translocation of gut bacterial endotoxin
- Decreased motility
What renal effects can occur due to burns?
- Acute renal failure
- Hypotension
- Hypoalbuminemia
- Hemoglobinemia
- Myoglobinemia
- Sepsis
What are the effects of burns on the hemopoietic system?
Reduction in circulating RBCs, known as ‘burn anemia’.
What are the neurological effects associated with burns?
Disproportionately high levels of pain and massive sympathetic discharge.
Describe the metabolic/endocrine changes after burns.
- Initially hypometabolism
- Followed by hypermetabolic flow phase
- Increased energy expenditure
- Increased utilization of proteins and carbohydrates
What is the definition of SIRS?
Systemic Inflammatory Response Syndrome.
What are the symptoms of SIRS?
- Redness
- Swelling
- Pain
- Fatigue
- Fast heart rate
- Abnormal breathing
- Fever or hypothermia
- Shaking or chills
- Skin rash
What is MODS?
Multi-Organ Dysfunction Syndrome.
What is pulmonary oedema?
Increased pulmonary vascular permeability, venoconstriction, rapid accumulation of mucous, fluid, neutrophils within alveoli and airways
It is a condition characterized by excess fluid in the lungs, affecting gas exchange.
What is ARDS?
Atelectasis, deactivation of pulmonary surfactant, decreased lung compliance
Acute Respiratory Distress Syndrome (ARDS) is a severe lung condition that occurs when fluid builds up in the air sacs.
What cardiovascular changes occur in response to severe burns?
Hypovolemia, vascular dysfunction, oedema
These changes can lead to reduced cardiac output and increased myocardial stiffness.
What is ‘burn anemia’?
Reduction in circulating RBCs, up to 10% decrease in a large burn
It is characterized by decreased erythropoiesis due to decreased iron availability.
What are the gastrointestinal effects of burns?
Gut barrier dysfunction, translocation of gut bacterial endotoxin, cytokines
These effects can lead to systemic inflammatory responses.
What are the renal system effects during acute renal failure (ARF) post-burn?
Hypotension, hypoalbuminemia, hemoglobinemia, myoglobinemia, sepsis
These conditions can result in impaired kidney function.
What neurological changes occur due to burns?
Disproportionately high levels of pain due to viable cutaneous nociceptors, amplified by prostaglandins and kinins
Massive sympathetic discharge can promote cardiovascular burn shock.
What metabolic changes occur after burns?
Hypometabolism followed by hypermetabolic ‘flow phase’, increased energy expenditure, insulin resistance
The energy expenditure can more than double due to heat loss.
What is Von Willebrand’s Disease?
Most common congenital disorder in dogs, characterized by defective platelet adhesion and aggregation
It is caused by a deficiency of von Willebrand factor (vWF).
What are the three types of Von Willebrand’s Disease?
- Type 1: Reduced concentration of all multimers
- Type 2: Disproportionate loss of high molecular weight multimers
- Type 3: Almost complete deficiency <0.1% of vWF
Type 3 is the most severe and often fatal in the first year of life.
What is the primary diagnostic test for Von Willebrand’s Disease?
Prolonged BMBT with normal platelet count
vWF levels are measured by ELISA, and <50% is considered deficient.
What does the BMBT test measure?
The length of time it takes for bleeding to stop from standardized incisions
A normal BMBT for dogs is 1.5–4 minutes, and for cats, it’s 1–2.5 minutes.
What is the treatment for Von Willebrand’s Disease?
vWF in cryoprecipitate, Desmopressin adjunctive treatment
Cryoprecipitate takes effect in 30 minutes for 4 hours, while Desmopressin reaches max effect in 1-2 hours.
