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ACVS Phase II > Abdomen and Spleen > Flashcards

Abdomen and Spleen Flashcards

1
Q

What size particle is rapidly cleared in lymphatics

A

<10um

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2
Q

What rate does peritoneum absorb fluid

A

3-8% body weight/hr

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3
Q

What are consequences of acute abdominal compartment syndrome

A
  • acute pulmonary failure to compressive atelectasis
  • increased intrathoracic pressure leading to increased pleural/ pericardial pressure
  • acute renal failure with marked oliguria
  • intestinal ischemia with bacterial translocation
  • hepatic ischemia
  • decreased cerebral perfusion/ neuronal injury
  • venous thrombosis/ thromboembolism
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4
Q

What % of primary peritonitis are monobacterial in dogs/ cats?

A
  • Dogs- 53%
  • Cats- 100%
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5
Q

What are risk factors for septic peritonitis (post GI surgery in Grimes 2011?

A
  • Pre-operative septic peritonitis
  • decreased albumin
  • decreased protein
  • intraoperative hypotension
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6
Q

What was a protective factor for septic peritonitis (post GI surgery in Grimes 2011)

A

presence of a foreign body

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7
Q

What are 2 most common bacteria found with septic peritonitis?

A
  • E. coli
  • Bacteroides fragilis
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8
Q

For septic peritonitis, what is the BG in chemistry usually? What is the B-F difference?

A

< 50mg/dL
- B-F >20mg/dL

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9
Q

For chylous peritoneal fluid, how do serum/ abdominal fluid compare?

A

Triglycerides fluid > 3X serum
Cholesterol fluid <serum

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10
Q

What is the recommended combination of antibiotics for septic peritonitis?

A

3rd generation cephalosporin or ampicillin and aminoglycoside

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11
Q

What is the recommended lavage amount?

A

200-300 ml/kg

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12
Q

What are different surgery methods to help prevent septic peritonitis?

A

-serosal patering?
- omentalization
- fibrin sealant

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13
Q

List 3 ways to manage continued effusion/ septic peritonitis post-op?

A
  1. Open peritoneal drainage
  2. Vacuum-assisted closure
  3. Closed peritoneal drainage
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14
Q

What is the downside of sump tube drainage?

A

Gives air vent to overcome vacuum phenomenon and allows airbone bacteria access to peritoneal cavity

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15
Q

What are the common complications of closed peritoneal drainage?

A

hypoprotenemia/ anemia

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16
Q

What has the literature suggested with epidurals and septic peritonitis cases?

A
  • contraindicated and survival times
  • decreased cardiac/ renal function from abdominal sympathetic blockade
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17
Q

What has been suggested with lidocaine?

A

When given intraop, improves survival.
When given post-op, survival odds are less.

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18
Q

What is the range of survival for septic peritonitis?

A

32-85% depending on the method of closure, drainage, etc.

Average ~50-60%

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19
Q

What are prognostic factors throughout VLT 67?? (sp?) that are associated with septic peritonitis?

A
  • refractory hypotension
  • CV collapse
  • respiratory distress
  • DIC
  • pre-op Protein C > 60%
  • TEG (?)
  • Increased ALT/ GGT
  • Lactate > 2.5
  • Decreased Ca
  • MODS
  • Pre-op antithrombin > 41.5%
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20
Q

What is the most common bacteria in intra-abdominal abscesses?

A

Bacteroides fragilis

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21
Q

What is the difference between a fistula and a sinus tract?

A

Fistula- abnormal pathway between 2 anatomic spaces or path leading to internal cavity or organ to surface of the body (between 2 epithelial lined structures)

Sinus- abdominal channel that orignates or ends in one opening (mesothelium distinct from epithelium)

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22
Q

What is the prognosis for abdominal mesothelioma?

A

1 report for 42 months with surgery

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23
Q

List neoplasia differential diagnoses for hemic/ nonhemic spleen?

A

Hemic- lymphoid, mast cell, histiocytic, plasma cell
Nonhemic- hemangiosarcoma, sarcoma, benign of CT origin

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24
Q

What can be ascertained on AUS with splenic torsion?

A

Hilar perivenous hyperechoic triangle noted

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25
Q

What is the agreement between FNA/ histology for diagnosis?

A
  • Complete 60%
  • Partial 30%
  • Disagreement 12%
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26
Q

What stain facilitates identification of cells of hemic origin?

A

Komanowsky

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27
Q

List options for partial splenectomy?

A
  • TA stapler
  • VSD
  • Ultrasonic cutting device
  • CO2 laser
  • Bipolar cautery
  • Suture ligation
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28
Q

What breeds most often get splenic torsions? Is there a sex predisposition?

A
  • Great Dane, St. Bernards, GSD, Irish Setter
  • Males> Females
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29
Q

What is the prognosis for a splenic torsion?

A

-Guarded to good with chronic torsions carrying a better prognosis (decreased incidence of cardiovascular shock/ toxemia)

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30
Q

What 3 breeds are overrepresented with splenic hemangiosarcoma?

A

GSD, Labrador, Golden retriever

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31
Q

What % of cat splenic masses are neoplastic? What are the most common types?

A

73%
LSA, MCT

32
Q

How is HCT connected with neoplasia of splenic masses?

A

One study showed odds of malignancy that increased 3 fold for every 10% decrease in PCV

33
Q

What are locations reported to get HSA apart from the spleen?

A

Retroperitoneal space, prostate, adrenal glands, diaphragm, kidneys, GIT, urinary bladder

34
Q

What are factors associated with prognosis for those that just had surgery?

A
  • Number of gross lesions
  • Stage of tumor
  • Age at the time of diagnosis (some has older live longer post-op)
35
Q

What are factors that are negative prognostic indicators for splenic hemangiosarcoma?

A
  • tachycardia at presentation
  • bicavitary effusion
  • development of severe respiratory disease
  • need for transfusion
  • preop decreased platelets/ HCT- increased risk for death
36
Q

What is the MST for splenic MCT? Is it guarded in cats?

A

~2 to 34 months (wide range)

37
Q

What is T1, T2, T3 and Stage I, II, III for splenic hemangisarcoma?

A

T1 < 5cm
T2 > 5cm
T3 invasive
I T1 or 1, N0, M0
II T1 or 2, N0 or 1, M0
III T2 or 3, N any, M1

38
Q

List complications of splenectomy

A
  • hemorrhage
  • vascular compromise
  • portal system thrombosis
  • arrhythmia
  • systemic inflammation derangement
  • GDV
  • Infection
  • O2 transport
39
Q

What breed has been seen to have fucosidosis (autosomal recessive neurovisceral lysosomal storage disease)? Which is associated with umbilical hernias?

A

English Springer Spaniel

40
Q

What is an omphalocele?

A

large midline umbilical/ skin defects permit organs to protrude from body?

41
Q

How are gastroschists diferent from an omphalocele?

A

Looks the same but the defect is PARAmedian

42
Q

What breeds are seen to occur more with umbilical hernias?

A

Airedale terrier, Basenji’s, Pekingese, Pointers, Weimaraners, Females > Males

43
Q

What breeds are predisposed to inguinal hernias?

A

Basenji, pekingese, Poodle, Basset Hound, Cairn Terrier, CVKC, Chihuahuas, Cocker spaniels, Dachschunds, Pomeranian, Maltese, Westies

44
Q

What sex predisposed to inguinal hernias?

A

Males> Females

45
Q

What passes through the inguinal canal?

A
  • Genital branch of the genitofemoral nerve, artery, vein
  • External pudendal

Males- spermatic cord and cremaster muscle
Females- round ligament

46
Q

What are the borders of the inguinal canal?

A
  • Internal- medial R.A.
  • orantally ???? IAO
  • Caudal inguinal ligament and external mg? –> slit in and AO aponeurosis
47
Q

What are 3 factors for inguinal hernia?

A
  • Anatomy- enlargment of the vaginal process
  • Hormone- Estrus or is pregnant= estrogen
  • Metabolism- obesity
48
Q

Which side inguinal hernia is worse usually?

A

Left > right

49
Q

What are approaches to inguinal hernia treatment?

A
  • Conventional- over hernia directly
  • Midline abdominal
50
Q

Which caudal abdominal hernias are immediate surgery?

A
  • Nonstrangulated scrotal hernia
  • strangulated inguinal hernias
  • Anything strangulated
51
Q

What are the most common complications after inguinal hernia treatment?

A

Seroma/ hematoma

52
Q

For femoral hernias, where is the femoral canal located?

A

Caudal abdominal wall just lateral to the inguinal ligament

53
Q

Where are muscular and vascular lacuna and what is contained within those?

A
  • Muscular- within substance of ilipsoas m. and contains the femoral n.
  • Vascular- craniolateral to the muscular lacuna and contains the femoral a./ v. and saphenous n.
54
Q

Describe approaches for complicated and uncomplicated femoral hernias

A
  • Uncomplicated- incise parallel to inguinal ligament
  • Complicated- midline ventral then underneath to see femoral canal
55
Q

What type of hernias often occur with trauma?

A

Inguinal, prepubic tendon avulsion, dorsolateral, paracostal

56
Q

List 5 benefits of delaying surgery of large hernia for several days?

A
  • Allow improvement of blood supply
  • Reduction of edema
  • Resolution of hemorrhage in accute trauma tissue
  • Reduce risk for infection and better exposure of structures
  • Stronger tissue for suture placement
57
Q

List 2 ways to augment an avulsed pubic ligament?

A
  • Mesh cuff
  • Double layer mesh technique
58
Q

What is the ideal suture-to-wound length ratio to reduce morbidity/ risk of incisional havia? (??)

A

4:1

59
Q

What are 3 ways to manage heavily contaminated open defects?

A
  • treatment with open peritoneal drainage
  • treatments with negative-pressure wound therapy
  • manage with lavage, continuous suction drain placement, and skin closure until wound environment is stable
60
Q

List muscular flaps for abdominal wall defects (major vascular pedicle?)

A
  • Latissimus dorsi (lateral thoracic) - only select ventral and lateral part of cranial abdomen
  • Cranial sartorius flap and branch of femoral artery and vein
  • External abdominal oblique and cranial abdominal artery
  • Rectus abdominis flap- cranial/ caudal epigastric
61
Q

List 3 synthetic meshes used for abdominal wall defects

A
  • polypropylene mesh
  • New ultralight macroporous mesh (coloplast restorelle)
  • Composite meshes (absorbable and nonabsorable)
62
Q

List tissue mesh or bioprosthetic meshes for abdominal wall defects?

A

SIS, dermis, pericardium

63
Q

List 3 mesh reconstruction techniques

A
  • Onlay (superficial to rectus fascial)
  • Intrapositional (mesh edge to fascial edge)
  • “sublay” or underlay ( deep to rectus abdominis m.)
64
Q

Which has increased risk for infection and which has the lowest rate of reherniation and complications?

A
  • Increased risk of infection- interpositional
  • Decreased rate of reherniation- sublay/ underlay
65
Q

Hydrothorax and ascites occurs in ___% of animals with liver herniation

A

30%

66
Q

What are ways to diagnose a diaphragmatic hernia?

A
  • radiographs
  • contrast with barium
  • pneumoperitoneography
  • positive- contrast pleurography
  • portography
  • cholecystography
  • angiography
  • AOS
  • CT
67
Q

What are the alternative methods for closure for diaphragmatic hernias?

A
  • omentum
  • transversus flap
  • autologous fascia
  • lyophilized collagen sheet (porcine SIS)
  • rectus abdomonis
  • latissimus dorsi
  • synthetic implants–> Teflon- reinforced silicone sheets, propylene mesh, Gore-Tex
68
Q

Why be careful with prolonged expansion of lungs while tying sutures?

A

Valsalva effects from the decreased venous return due to increased intrathoracic pressure

69
Q

What are recommendations made for intraabdominal pressures post diaphragmatic repair?

A

If 5-10 mmHg, monitor, hydrate
If 11-20 mmHg- medical therapy, analgesis, evacuate intraperitoneal fluid, IVD, BP monitoring
If >20 mmHg- If MM not helping, do surgical decompression! (remove organs (spleen, advase (??) diaphragm

70
Q

Describe the attachment of tendons that form the diaphragmatic crura?

A
  • bifurcate tendon arise from bodies of 3rd and 4th lumbar vertebrae
  • medial to psoas minor muscles
71
Q

What are the 3 adjuvants of peritonitis? How do they exacerbate the inflammation?

A
  • Gastric mucin- heparin like anti-complement effect–> inhibits phagocytosis
  • Bile salts- lower surface tension–> alter cell adhesion and lyses RBCs
  • Hemoglobin- interferes with phagocyte cell chemotaxis and phagocytosis- provides FC to microorganisms - inhibits bacterial clearance by interfering with lymphatic drainage
72
Q

When biopsies of the spleen are taken, what stain ehlps ID cells of hemic origin?

A

Romanowsky

73
Q

Name 4 mechanisms of splenic congestion and give examples of each

A
  • CHF- right sided
  • portal hypertesion- infections (adenovirus, lepto)
    - toxic (carprofen, acetaminophen, pheno)
  • Vascular outflow obstruction- splenic torsion, masses, caudal vena cava obstruction
  • relaxation of splenic capsule- barbiturates, thipental, phenobarb, phenothiazine
74
Q

What makes up the deep inguinal ring?

A
  • ventral inguinal ligament
  • fleshy border of internal abdominal oblique
  • lateral border of rectus abdominis
75
Q

-What are the origins of the 3 muscles that form the aponeuroses of the linea alba?

A
  • external abdominal oblique- 4/5th- 12th rib and thoracodorsal fascia superficial to rectus abdominis
  • Internal abdominal oblique- TL fascia and caudal to the last rib and tuber coxae
    - cranial 1/3 of abdomen S & D
    - umbilicus caudally–> superficially to rectus abdominis
  • Transversus- lumbar- transverse process lumbar vertebrae and TL fascia
    - costal- medial 12th/13th rib and 8th-11th costal cartilages
    - cranial 2/3 deep to rectus abdominis, caudal 1/3 superficial

ACVS Phase II (7 decks)

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