Block 3 +4 Flashcards
What needs to be done for extravasation of doxorubicin?
Cold compress
Zineguard (dexrazoxane)
What is the primary downside to doxorubicin?
Cardio issues
Toxic does is additive
What is primary downside to Tanovea?
Pulmonary fibrosis
West Highland terriers, its bad!!
Must radiograph lungs first
What is primary downside to cisplatin?
No cats
What happens with extravasation of vincristine
Warm compress
DMSO (antioxidant)
Hyaluronic acid
What are 4 drugs in CHOP?
Cyclophosphamide
Doxorubicin
Vincristine
Prednisone
What is median remition time for CHOP in lymphoma?
12 m
What are 4 drugs in LOPP?
Lomustine
Vincristine
Procarbazine
Prednisone
What is percent chance to remission with rescue protocol?
50%
What is an indolent lymphoma?
Histologically low grade
What do you stage?
A patient
What do you grade?
a tumor
What is substage A?
No clinical signs of disease
What is substage B?
Clinical signs of disease
What is CD3?
T-cell indicator
What is median survival time or CD3 (-)
12m
What is median survival time of CD3(+)
6m
What is prognosis of monotherapy with lymphoma?
6-8m
What is median survival time of A substage?
12m
What is median survival time of B substage?
1-2m
How is leukemia initially broken down into?
Lymphoid or myeloid
How is leukemia further broken down?
Acute or chronic
What type of cell is acute and chronic respectively
Large cell, small cell
What does AML stand for?
Acute myeloid leukemia
is acute leukemia common?
No
What is usually seen in CBC of ALL?
Very high WBCs
How is chronic leukemia diagnosed?
Market lymphocytosis persistently
What are clinical signs of CLL?
Vague and nonspecific lethargy, reduced appetite
What type of cell is CLL usually?
T cell
Do cats with lyphoma present with peripheral lymphadenopathy?
No
What is the most common site of feline lymphoma?
GI tract
What is the most common recommendation for treatment of feline lymphoma?
Chemo
What is the exception to this recommendation?
Localized nasal lymphoma
What is the multimodal treatment for feline lymphoma and what does it stand for?
COP
Cyclophosphamide
Vincristine
Pred
Doxorubicin isnt as effective in cats
What is the 1/3, 1/3, 1/3 rule in feline lymphoma?
1/3 complete response
1/3 partial response
1/3 don’t respond
What is the single treatment option for feline lymphoma?
Lomustine + pred
What is the most common side effect of COP in cats?
GI
Generally better tolerated than dogs
Do FeLV + cats or FeLV- cats respond better to treatment
FeLV-
Do fatter cats do respond better to therapy?
Yes
Where would Stage 1 nasal lymphoma be?
Still in nasal cavity
Nasal lymphoma is prognostically the best high grade lymphoma
What is a huge prognostic factor for mediastinal lymphoma?
FeLV status 3m vs 1 year
What are 2 chemo drugs that can be used with CNS lymphoma that cross BBB?
Lomusine and cytarabine
What is the best anatomical place to have lymphoma if youre a cat?
Nasal cavity
Should you still use doxorubicin if you can?
Yeah, not really a down side
Is surgery often indicated in lymphoma in cats?
No except biopsies or intestinal obstruction
What cancer has the pseudo capsule that look like tendrils?
Soft tissue sarcoma
Where do soft tissue sarcomas most commonly spread?
Lungs through hematogenous spread
What is the most important factor in staging soft tissue sarcomas?
3 view chest rads
What are the margins for STS?
3cm laterally and 1 fascial plane deep
What is a radical excision?
Removal of whole organ or compartment (limb)
What is a wide surgical excision?
3cm + 1 fascial plane
What is a marginal excision
Essentially just the tumor is excised (aim to remove macroscopic disease not microscopic)
Tumors below the _____ and _______ can have a lower rate of recurrence <25%
Knee and elbow
If just doing marginal excision of STS, what is the ideal follow up?
RT
What are 4 options with STS if you have incompletely excised margins after surgery?
Surveillance: see what happens
Scar revision: Take out more
RT: Treats microscopic dx
Electrochemo: less expensive than RT
Is STS a good prognosis?
Yes if excised and adjunctive RT
One of few cancers that cure can be reached
What should the monitoring of STS look like?
Every month for 3 months
Every 3 months for 1 year
Every 6 months for 2 years
What are the 2 vaccines that are most common with feline injection site sarcomas?
Rabies and FeLV
What are the 3 indications to get a biopsy after a injection site mass
Increase in size 1 month after injection
Larger than 2cm
Persistence after 3 months
What is metastatic rate of feline injection site sarcomas?
25%!
Should FISS be referred?
Yes
Unless can get really large margins
Should you do an excisional biopsy for FISS?
NO!!
What are the margins for FISS?
3-5cm plus 2 fascial planes
Is the risk of metastasis with FISS low or high?
Low 25%
Because risk of metastasis is relatively low, systemic treatment is not normally recommended
“If its not a tail FISS, refer”
Monitoring timeline for FISS is same as Canine STS
What is neoadjunctive therapy?
Before surgery to decrease tumor size
What is induction therapy?
Treatment with intent to cure
What is rescue therapy?
Used after tumor fails to respond
What is the maximum tolerated dose?
Highest dose that can be administered in the abscence of unaccepatble or irreversible side effects
What is the nadir?
When the side effects of a certain drug have the maximal effect on the patient (lowest neutrophils, lowest platlets)
At what point does the cell cycle become self directed?
When it passes (r) restriction point
What do cell cycle non specific drugs kill?
Actively dividing cells and resting cells
What do cell cycle specific drugs kill?
Just actively dividing cells
How are chemo drugs calculated?
With body surface area
What do you have to be cautious with using doxorubicin and vincristine with collies and shepherds?
Lower threshold due to MDR1 mutation
Which drug is released unchanged in urine?
The Platinum agents (carboplatin)
What is nadir for vincristine?
7 day
What is nadir for carboplatin?
7 and 21 day
What is nadir for lomustine in dog?
21 day
What is nadir for lomustine in cat?
42 days
What is a side effect of doxorubicin?
Nephrotoxicity
Which drug is nephrotoxic to dogs?
Cisplatin
What is the chelator for doxorubicin called?
Zinecard
What drug is contraindicated in cats?
Cisplatin - pulmonary edema
5FU - Neurotoxicity
What drug is contraindicated in West Highland White Terriers?
Tanovia - pulmonary fibrosis
What is a way to assess response of lymph node (in lymphoma) to chemo?
Measure the lymph node size
CR: normal size
PR: >30%
SD=stable disease = <30%
PD = Progressive disease = >20%
What anatomical location is uncommonly affected by high grade lymphoma in cats?
Peripheral lymph nodes
Cat who are FeLV positive are likely to be younger whne they develop lymphoma than cats who are FeLV negative
What type of radiation does RT utilize?
Ionizing radiation
What are teh 2 ways that ionizing radiation damages DNA?
Indirect - 70%
Direct - 30%
What is 1 gray equal to?
1 joule/kg of tissue
What is fractionation?
Dividing total dose of radiation into small fractions given over several weeks
Is palliative fraction size large or small
Large but not given nearly as often
When are RT side effects usually at their peak for definitive treatment?
1 week after RT
What is a common side effect of acute RT?
Desquamation (pealing and drying of skin
Halitosis
Alopecia
Nasal discharge
Uveitis
Basically anything “itis”
How often do chronic RT side effects occur?
<5%
What is a common late side effect?
Leukotrichia (white hair)
What is the difference between intensity modulated RT and 3D conformal RT?
3D = uniform dose distribution
IMRT = Non-uniform dose
IMRT can really avoid critical organs to minimize side effects
What is GTV
gross tumor volume
what is ctv
clinical target volume
what is ptv
planning target volume
What are teh 5 steps of RT in order?
Diagnosis/staging
Planning CT
RT plan creating
Verification of plan
Patient treatment
What technique is used for deep, superficial RT?
Photons are deep
Electrons are superficial
What is the long term control of tumor size called in RT?
Definitive RT
What is good local control for early stage gross tumor with minimal treatment and time in hosptital?
Steotactic RT
What is the most common oral tumor of dogs?
Oral malignant melanoma
What is the metastatic rate?
60-80%
What are the margins for oral malignant melanomas?
2-3cm bone and 1cm soft tissue
What is the reoccurence rate for oral malignant melanomas?
50% local reoccurence
What is stage 1 for oral malignant melanomas?
<2 cm, no LN, no mets
what is stage 2 for oral malignant melanomas?
2-4 cm, no LN, no mets
what is stage 3 for oral malignant melanomas?
> 4, LN involvement, no mets
what is stage 4 for oral malignant melanomas?
Any size, LN involvement, mets
What is the intrralesional chemo for oral malignant melanomas?
cisplatin
What is the systemic chemo for oral malignant melanomas?
carboplatin
What is an additional promising area of research for treatment of oral malignant melanomas?
immunotherpay (Oncept vaccine)
What is electrochemotherapy?
Electrical pulses to allow greater influx of chemo agent into cells
What is prognosis of tonsillar SCC?
45 d
Sx is palliative
Chemo is inneffective since it is already mets
What are 2 Tx options in cat SCC?
RT + Chemo
Is mouth OSA better prognostically than appendicular OSAs?
Yes
Does adjunctive therapy help mouth OSAs?
No
What is stage 1 lymphoma?
Stage I: 1 LN
What is stage II lymphoma?
Stage II: Multiple nodes in a region
What is stage III lymphoma?
Stage III: Generalized (everywhere)
What is stage IV lymphoma?
Stage IV: Spleen and liver involvement
What is stage V lymphoma?
Stage V: Bone marrow (anemic present maybe)
What is a common benign lesion of the mouth?
Canine acanthomatous ameloblastoma
What are the treatments (3) for CAA?
Mandibulectomy/Maxillectomy
Can also RT but will often recur in RT field
Intralesional bleomycin is an optional injection
What is an odotoma full of?
Teeth
What are the margins on an intestinal tumor?
3-5 cm of grossly normal tissue orad and aborad
What are of the small intestine is easiest to resect from?
Jejunum
What is something that needs to be done on resection and anastomosis of intestinal tumors?
Leak test
What is typhlectomy?
Resection of the cecumW
What is colectomy?
Resection of a segment of colon
What is colorectal resection?
Resection of variable portions of both descending colon and rectum. Rectal pull-through procedure
How large is the exision of normal tissue in each direction for rectal tumors?
1-2cm
How large is teh excision of normal tissue in each direction for colonic masses?
2-5cm
What is a surgical technique for small, single, and superficial tumors in caudal-midrectum?
Rectal eversion
What are the 5 principles of treating IMHA in order?
- Prevent hemolysis with immosuppressive therapy
- Treat tissue hypoxia
- Deter formation of thromboembolic disease
- Provide supportive care
- Treat associated cause
How do you treat the immunosuppressive therapy?
Pred (2-3mg/kg/day) or dex
What is the mechanism of action of immunospressors?
Decreases macrophage phagocytosis of Ab-coated RBCs
Reduces macrophage cytokine production
Reduces effective antigen presentation to T cells
Long term: minimizes autoantibody production by B cells
How fast does pred work?
See results in 3-7 days
What is the most common cause of death in dogs with IMHA?
Thromboembolic disease
What is something owners need to be aware of with steroids in IMHA?
Steroid withdraw takes 2-4 months minimum
What are 4 principles of treatment for ITP?
- Prevent platelet destruction with steroids
- treat hypoxia
- Supportive care
- Treat associated cause
What is the mechanism of anemia in IMHA?
hemolysis
What is the mechanism of anemia in ITP?
Hemorrhage
What is long term therapy for IMHA and ITP?
Decrease steroids by 25% every 2-4 weeks
What is IMHA + ITP at same time?
Rare: Evan’s Syndrome
Why do a lot of people think they have a patient with Evan’s syndrome?
They have an ITP patient with anemia but really anemia is from hemorrhage
What are survival times for local therapies for thyroid tumors?
2-3 years
What do bigger thyroid tumors mean?
Worse (palpate thyroid glands during physical)
What si teh gold standard for feline thyroid tumor treatment?
Radioiodine
Are Pituitary tumors or pituitary tumors more common?
Pituitary tumors
What is the treatment for pituitary macroadenomas?
RT
Do insulinomas metastasize?
Yes 90-95%!
Where do insulinomas mostly metastasize?
Liver
What is Stage I for insulinoma?
Just pancreas 2 year MST
What is Stage II for insulinoma?
LN mets 1.5 year MST
What is Stage III for insulinoma?
Distant mets 0.75 MST
How do you medically manage insulinomas?
Smaller more frequent feedings
Diets with complex carbs, no simple carbs, lots of fiber
Avoid strenous exercise
Pred
Diazoxide: Inhibits insulin release
What are 6 sources of pain in cancer patients?
Visceral stretching
Invasion of cancer cells into surrounding cells
Organ distension/obstrcution
Neuropathic Pain
Release of chemical mediators
Poor circulation
What are the 3 levels of WHO recommendations for controlling pain?
Mild pain - NSAIDs
Moderate pain - weak opioids
Severe pain - strong opioids
What tumors do NSAIDs have anti-tumor effects in?
Carcinomas
How can you decrease the calcium (hypercalcemia)?
Bisphosphonates
What is paraneoplastic syndroms?
Produces chemicals or hormones like calcium
How often should you consider rechecks for QOL?
1-2 months
what is the most common cutaneous tumor in dogs?
Mast cell
What are the most common sites of metastasis for mast cell tumors?
LNs, liver, spleen
What is a rare place for mast cells to metastasize?
Lungs
What are the margins for Mast cell?
2-3cm lateral and 1 fascial plane deep
What is an adjunctive therapy that can be injected into MSTs?
Stelfonta is injected causing tissue necrosis
Where can you inject stelfonta SQ?
Distal to elbow and hock
What is the response rate with stelfonta?
75% with one injection
What do you still need to do with stelfonta?
Sedate the animal so you dont stick yourself
What is another interesting treatment for MST?
Oral pred can help reduce tumor size prior to surgery
How many levels of grade are there for MCT?
1-3 AND high vs low
What is HN0
Non-metastatic
What is HN1
Pre-metastatic
What is HN2
Early metastatic
What is HN3
overt metastatic
What does monitoring look like?
Exam every month for 3 months then every 3 months for a year then every 6 months
Up to 70% of incompletely excised low grade MCTs will not recur
What are some palliative options for MCTs?
H1 antagonistis (diphenhydramine)
H2 Antagonists (famotidine and omprazone)
Steroids
What is the average age of AGASACA patients?
9-11
What is the most common clinical sign of AGASACA?
PU/PD - hypercalcemia
What is the most common malignant neoplasia to cause hypercalcemia?
T cell lymphoma
What are the most common sites of metastasis for AGASACA?
Medial and internal iliac LNs
Lungs are uncommon sites of metastasis
What is the staging of the clinical AGASACA?
o 1: <2.5cm mass, no LN, no distant mets
o 2: >2.5cm mass, no LN, no distant mets
o 3: any tumor, <4.5cm node metastasis, no distant mets
o 4: Any tumor, >4.5cm node metastasis, no distant mets
o 5: Any tumor, any node met, distant mets
What is prognosis of AGASACA dogs?
Multiple years
What is treatment for AGASACA?
Surgery
Adjunctive is usually RT
What are the margins for surgical excision of sarcoids?
at least 1cm+
What is the gold standard for sarcoids in horses?
Radiation therapy
What horses get melanoma the most?
Grey horses!
Where are horse melanomas usually located?
Under the tail
What percentage of grey horses over 17 were melanoma free?
6%
What is staging of equine melanomas?
o 1. <0.5cm nodule
o 2. Several <0.5cm nodules or single >2cm
o 3. One or several of >5cm or SQ at typical locations
o 4. Extensive SQ nodules with necrosis or metastasis
o 5. Exophytic tumor growth with wet surface and ulceration, metastasis to organs with clinical signs
What are the treatment options for equine SCC?
Surgery: excisional, cryosurgery, adjunctive treatments
Chemo: Intralesional (cisplatin, carboplatin) Topical (5-FU, mitomycin-C ophthalmic)
RT
What are margins of SCC surgery?
5mm
What are the common sites for SCC surgery?
3rd eyelid removal
Penis and prepuce
What are the best options for topical SCC chemo
5-FU
Mitomycin-C
Intralesional - injection of beads
What is the most common bone tumor?
Osteosarcoma
What is teh most common metastatic site for osteosarcomas?
Lungs!!
With amputation, how do dogs die?
Systemic, not local disease
BOTTOM LINE IS THAT CHEMO AFTER SURGERY DOUBLES SURVIVAL TIME!! WITH OSA
What chemo drug choice is best for OSA?
Carboplatin
What is teh Popcorn ball of the skull?
Multilobular osteochondroma (MLO)
Good or bad: OSA in foot
good
Good or bad: OSA in radius or femur
bad
Good or bad: OSA in scapula humerus
Ugly
Good or bad: OSA in extra-skeletal
Ugly
Good or bad: OSA in rib
Ugly
Good or bad: OSA in vertebrae
Ugly
What dogs have really bad prognosis?
Younger dogs or obvious metastasis at diagnosis
What percent of dogs undergoing splenectomy develop arrhythmias?
25%
What is teh MST of hemangiosarcoma with sx alone?
1-3m
What is the drug used for metronomic chemo?
Cyclophosphamide
What is a side effect of metronomic chemo with cyclophosphamide?
Sterile hemorrhagic cystitis
Is there a benefit in hemangiosarcoma patients to supplements?
No
What may cause dermal HSAs?
UV light exposure
How do you protect patients from further staging dermal HSA?
Prevent exposure to UV light
What is teh most common cardiac site for HSA to show up?
Right auricle
What percent of hemoperotineum is neoplasia in cats?
46%
What percent of those neoplasias are HSA?
60%
Surgery now baby half way there I think…
What is the extrinsic pathway for coagulation cascade?
VII
What is the epinephrine concentration for vasoconstriciton?
1:10
How many mLs does a fully soaked sponge hold?
15mL
What are the forceps from smallest to largest
Mosquito>Kelly>Crile>pean>Carmault
What suture size should be used for SQ bleeder?
3-0 or 4-0
Which direction do you point you forceps using the tip clamping technique?
Tip of clamp is pointing down
What are the 2 techniques for hemostasis?
Tip clamp
Jaw clamp
Which direction do you clamp using the jaw clamp technique?
Curvature facing up
What vessels usually need transecting hemostatsis?
Prepuscial artery and vein
How do you clamp and transect larger vessels?
Use 2 hemostats and point them toward each other
Then cut between them with Metzenbaum scissors
How are hemostats handed to surgeon via the assisstant?
With curve positioned AWAY from the palm of the surgeons hand
During hernia repair, what is an option if the local region is inadequate for closure?
Bring in muscle flaps or use synthetic mesh
What do you close a hernia with?
PDS
What is the most common hernia?
Umbilical hernias
Do umbilical hernias resolve spontaneously sometimes?
Yes
Will repair early in shelter dogs to get them adopted
What is the most common cause of acute incisional hernias?
Surgeon’s error
What can be mistaken as an inguinal hernia in obese cats?
Caudal fat pad
How many hiatuses are in teh diaphram
3
What is an important position doe diaphragm surgery?
Reverse Trengelenburg’s
What is the most dangerous part of anesthesia in diaphragm surgery?
Induction
What is overall prognosis of diaphragmatic hernias?
82-89% survival
What needs to be done before surgical intervention of perineal hernias?
Appropriate medical management of constipation adn obstipation
What can be done to medically manage constipation or obstipation?
Enemas
Lactulose
Miralax
What is a surgical emergency for perineal prolapse?
Bladder prolapse with obstruction
What is the most commonly utilized method for surgical treatment?
Transposition of the internal obturator
What is the most common complication of surgical repair?
Temporary surgical incontinence
What is first step in removing a LN?
Determinign the sentinel lymph node with contrast CT
What is the gold standard in determining if metastasis is present?
LN biopsy
What are 2 commonly removed LNs?
Mandibular and popliteal
How should you position for a popliteal LN removal?
Hanging limb
What is a concern with LN removal?
Seeding of cancer cells
What is something to look out for in mandibular LNs?
2-5 nodes in the area, remove them all
Which direction are LNs excised?
In longitudinal direction
What is a tool that is very useful for LN excision?
electrocaudery
Where does the liver get teh majority of the blood? oxygen?
80% from portal vein
20% from hepatic artery
Both provide 50% of oxygen
What dogs typically get extra-hepatic PSS?
Toy breed dogs
What is gold standard diagnosis of PSS?
CT
What are 2 medical managements for PSS?
Lactulose
Restrict protein
(Maybe antibiotics and omeprazole)
What is MST with medical management?
3 years
What is MST with surgery?
11 years
Where do you amputate for a total caudectomy?
Sacrococcygeal joint
What is sterile definition?
Removal of ALL microbial life
What is asepsis?
Inhibition of microbial growth
Bacteriostatic NOT bactericidal
What is a disinfectant?
Bactericidal agents intended for inanimate objects
Bactericidal!
Is an ultrasonic cleaner antibacterial?
No!
What temp do autoclaves reach?
13 minutes at 120C (250)
What temp do flash sterilizations occur?
3 minutes at 131C (270F)
What chemical is used for chemical sterilization?
Ethylene oxide
What much occur after ethylene oxide sterilization?
Aeration (take 24 hours)
How are items sensitive to heat sterilized?
Radiation
How many microbes does 1 person bring into a room?
10^3-10^4
What are antiseptics?
Chemicals which are applied to living tissues to suppress or eliminate bacterial growth and development on living tissues
How long must skin be in contact with antiseptic?
5 minutes
Is Chlorohex a better Gram + or Gram -
Game +
Explain the dirty scrub
Antiseptic scrub applied for 5 minutes
Scrub until sponges are visually clean
How much of the skin is exposed with draping?
2cm
Fold is placed DOWN
When do you put on the light handles?
Only after the top drape is in place
What is capillarity?
Process by which fluid and bacteria are carried into the interstices of a multifilament suture
What is relative knot security?
Force required to untie or break a knot as compared to the force required to break an untied strand of suture (knots weaken suture up to 50%!)
What is the accepted rule of knot tensile strength?
Should not need to exceed tensile strength of tissue
What are the 3 primary properties of suture material?
Absorbable v non absorbable
Natural v synthetic
Monofilament v multifilament
How does natural suture break down?
Phagocytosis
How does synthetic suture break down?
Hydrolysis
What is monocryl?
Poliglecaprone
What is PDS?
Polydioxinone
Where is braided suture never place?
Below the skin
What is chatter?
Tissue drag from multifilament suture
What is the slowest healing tissue?
Fascia
What is the only tissue that returns to 100% strength?
Bladder
Whats the general rule for highly collagenous tissue?
50% strength in 50 days
What is the general rull for parenchymal tissue?
> 80% strength in 14-21 days
Should you resterilize?
No
Where should you grasp a needle?
2/3rds
When do you use a cutting needle vs tapered?
In tougher collagenous tissue (Skin and intradermal)
When do you use a taper needle?
Soft tissues (parenchymal tissue)
What is the most common mass in the perianal region?
Adenoma
Are adenomas or adenocarcinomas more superficial/pedunculated in perianal masses? Which have a poorer prognosis?
adenomas
Adenocarcinomas
What is treatment for perianal fistulas?
Cyclosporine and tacrolimus
What are the 4 classification of surgery sterility?
Clean
Clean/contaminated
Contaminated
Dirty
What is a clean surgery?
Elective, no breaks in aseptic technique: TPLO, spay/neuter
What is clean/contaminated
Entry into a hollow viscus without gross contamination
Minor breaks in aseptic technique (head hits light)
What is contaminated
Traumatic wounds (penetrating wound, laceration)
Major breaks in aseptic technique (glove tears while holding something)
What is dirty?
Purulent material encountered
Perforated viscus
What is the time frame for giving antibiotic for surgery?
90 minutes
OR if there is an implant
OR contaminated Sx
OR dirty Sx
What is cefazolin given for?
Skin 47min half life
What is unasyn given for?
GI 60 min half life
How do you redose antibiotics in surgery?
Based on half life
What are the 3 goals for onco surgical intent?
Curative intent
Palliative intent
Cytoreductive intent
What is intralesional surgical dosing?
Just removing part of the tumor to potentially allow movement of a limb
Most of macro and micro dx will be left behind
What is marginal surgical dosing?
Tumor excised just outside capsule
Micro dx likely left behind
** YOU ARE ONLY AS WIDE AS YOUR NARROWEST MARGIN
What are 2 primary tumor sampling methods?
FNA
Biopsy
What is the difference between incisional and excisional biopsy?
Incisional just removes a piece for diagnosis, excisional removes the whole thing
What do you put a mass into for pathology review? What the ratio of sample to formalin?
Formalin
1:10
What do you ink on a sample?
Lateral margins, areas of special interest, and deep margin
What is the residual tumor classification?
R0 = no tumor at inked edge
R1 = micro dx at inked edge
R2 = macro dx at inked edge
**What is the major blood supplies of the spleen
All arise from celiac artery
Splenic artery
Left gastroepiploic artery
Short gastric
What is a tool that cuts and seals vessels up to 7mm?
Ligasure
Where do you ligate the splenic artery?
Distal to pancreatic arteries as to not disrupt blood flow to pancreas
What has an increased risk in splenectomies?
GDV (5.3x)
How many layers of closure is there for pinnectomy?
Just one
DONT INCLUDE CARTILAGE IN CLOSURE
How do you close the dead space of the ear with sutures?
4-0 Nonabsorbable mattress pattern through both layers of cartilage!
How long do you need to bandage the incision and drain?
2weeks with concave surface facing up!
Is bandage required for punch biopsy repair?
No
What does TECA stand for?
Total ear canal ablation
What must be performed with every TECA?
Removal of tympanic bulla (TECA +LBO)
What important nerves are in this area?
Fascial nerve
VIII (vestibulococclear)
With TECALBO, who is much more likely to get Horner’s?
Cats
What is goal of ventral bulla osteotomy?
Removal of aural poly via ear canal
What is the most common indication for ventral bulla osteotomy?
Nasopharyngeal polyp cats>dogs
How do you prep a limb for toe amputation?
Towel clamp through nail hanging
How do you do a bier block?
Toes up to remove blood
Place tourniquet
Middle of dorsal paw to block superficial branches of radial nerve
Where is the toe amputated?
Proximal phalangeal joint
What are the 4 mechanisms of wounding?
Friction
Shear
Tension
Compression
What are the 4 phases of wound healing
Hemostasis
Inflammation
Proliferative
Remodeling
What are the primary cell types of phase 2 healing?
Neutrophils and macrophages
What is primary cell type in phase 3 of healing?
Fibroblasts
What is something that increases the risk of wound healing complications?
Endocrinopathies (diabetes mellitus, cushings)
Steroids
Hypoproteineinemia
What is the difference between contaminations, colonizations, and infection
Class 1:Contamination: Microbes are present
Class 2: Colonization: Microbes are replicating but not invading
Class 3: Infection: Microbes are invading and replciating
How mich infection is required to cause an actual infection?
10^5
What should be performed at the debridement step of wound healing?
Deep tissue culture
Should you forefully close a wound?
NO! when in doubt, wait it out
What bandage is good for the limbs?
Modified Robert Jones
What bandage is good for thoracic or abdominal wounds?
Cross your heart
What bandage is good for basically all others?
Tie over
What 3 things about a primary layer should you consider?
Debridement, moist wound healing, topical antimicrobial
How do you apply adherent primary layer?
Under sedation
What can be used for all wound types?
Non-adherent moist wound healing types
How often do you need to change adherent primary layers?
Every 24 hours
What is primary wound closure?
Direct apposition of wound edges
What is delayed primary wound closure?
within 3-5 days post-wounding
What is second intention healing?
Healing via contraction and reepithelialization
What is secondary wound closure?
Appositional closure of a wound >3-5 days post wounding
What suture should you use on fascia closure?
0, 2-0. or 3-0
How can you fix dog ears on suture?
Elliptical incision
How to fix a step defect?
Suture no perfectly opposed
With an advancement flap. how long can the length be?
No more than 2x the width
Where should you exit a passive drain?
Never through the incision, always a separate stab incision
If incision is dorsal, what type of drain do you use?
Suction drain
What should you never do to a drain?
NEVER flush any drain
ON EXAM: NEVER EXIT A DRAIN THROUGH THE WOUND OR SURGICAL INCISION
How long should a patient have a drain?
1-14 days
3-5 is most common
youre done
