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Tobias ECVS > Ch 103 - Lungs > Flashcards

Ch 103 - Lungs Flashcards

1
Q

How many sternebrae does a dog have?

A

9

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2
Q

List the muscle that cover the thoracic wall from internal to external

A
  • Serratus dorsalis and ventralis
  • Scalenus
  • External abdominal oblique
  • Latissimus dorsi
  • pectoralis
  • Cutaneous trunci
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3
Q

List the lung lobes

A

Left:
- Left cranial (subdivided into cranial and caudal)
- Left caudal

Right:
- Cranial
- Middle
- Caudal
- Accessory

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4
Q

Where are the pulmonary arteries and vein located in relation to the associated bronchus?

A
  • Artery: craniodorsal
  • Vein - Caudoventral
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5
Q

What muscles can be engaged to aid inspiration and expiration?

A

Inspiration:
- external intercostal
- sternocleidomastoid
- scalenus
- serratus ventralis

Expiration:
- Internal intercostals
- Abdominal rectus

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6
Q

What can alter lung complicance?

A
  • Fibrosis
  • Oedema
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7
Q

What cells produce surfactant?
What is its function?

A
  • Alveolar type II cells
  • Indirectly increases lung compliance by reducing surface tension
  • Prevents collapse of small alveoli
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8
Q

What structures contribute to inspiratory resistance and expiratory resistance?

A

Inspiratory:
- Nares 79%
- Small airways 15%
- Larynx 6%

Expiratory:
- Nasal 74%
- Laryngeal 3%
- Small airways 23%

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9
Q

What controls ventilation?

A
  • Chemoreceptors in respiratory centre in medulla
  • Peripheral chemoreceptors in carotid and aortic bodies
  • Stretch receptors in the airway and lung parenchyma stop inspiration
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10
Q

What is hypoxic ventilation drive?

A

An increase in ventilation if PaO2 is below 60mmHg

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11
Q

What is Ficks law?

A

The rate of transfer of a gas through a sheet of tissue is proportional to the surface area available for diffusion, diffusion coefficient of the gas, difference in gas partial pressures and inversely proportional to the tissue thickness

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12
Q

How does the diffusion coefficient compare between CO2 and O2

A

CO2 is 20x greater

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13
Q

What can cause the oxygen dissociated curve to shift to the right?

A
  • Increased temp, PCO2, 2,3-DPG
  • Decreased pH
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14
Q

What can cause a high V/Q and a low V/Q

A
  • High V/Q - PTE
  • Low V/Q - atelectasis, pneumonia, severe pulm oedema
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15
Q

What are common post-op problems to monitor for after a thoracotomy?

A
  • Hypotension
  • Hypothermia
  • Hypoventilation
  • Electrolyte imbalance
  • Shock
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16
Q

What are the two thoracoscopic options?

A
  • Intercostal (4th-9th ICS)
  • Transdiaphragmatic (Manubrium, 9th-10th ICS)

Most commonly 5mm 0-30 degree telescope with 3-4 trocars

17
Q

What is the sensitivity of CT scan in the diagnosis of cause of spontaneous pneumothorax?

A

42-58%

18
Q

What imaging technique can be used for diagnosis of bronchoesophageal fistula?
What breeds are overrepresented?

A
  • Contrast oesophogram with water soluble iodine
  • Toy-breeds and small terriers
19
Q

What bacteria are most commonly isolated from lung lobes abscesses?

A
  • E.Coli
  • Klebsiella pneumoniae
  • Staph
  • Strep
  • Pseudomonas
  • Fusobacterium
20
Q

What is the maximum volume of lung which can be acutely removed?

A

50%

21
Q

What is the surgical outcome after lung lobectomy for lung abscess?

A
  • Mortality 20% (14% if 1 lobe removed, 60% if three removed)
  • 54% of survivors has resolution of their pneumonia
  • MST 96m with resolution of pneumonia vs 10m
22
Q

What breeds are overrepresented for bronchiectasis?

A
  • American Cocker Spaniels
  • Min Poodles
23
Q

Name these suture patterns for closure of a lung laceration

A
  • A - Interrupted lembert mattress pattern
  • B - Haemostatis mattress sutures (1) and simple continuous
24
Q

What breeds are predisposed to lung lobe torsion?

A
  • Large dogs with deep narrow chests (right middle and left cranial)
  • Pugs (left cranial)

May be assoc with chronis resp disease, chylothorax, trauma, d-hernia, thoracic surgery, neoplasia

25
Q

When may air bronchograms be seen with lung lobe torsions?
What % will be emphysematous?

A
  • first 2-3 days
  • After this air is absorbed and replaced with fluid
  • 97% emphysematous
26
Q

What is the prognosis for lung lobe torsion?

A
  • 50% in one study
  • 61% in another
  • Pugs have more favourable outcomes, 11/12 survived
27
Q

What is the most common type of pulmonary neoplasia?
What conditions can be seen with pulmonary neoplasia?

A
  • Carcinomas of bronchial or alveolar origin
  • Hypertrophic osteopathy or lung-digit syndrome (17.9% of cats)
28
Q

What should be used for lung FNA?
What is the diagnostic rate?

A
  • 22-25g needle under u/s guidance
  • DIagnostic in 80% (sen 77%, spec 100%)
29
Q

What factors are associated with prognosis for pulmonary neoplasia

A
  • Clinical signs (545 vs 240d)
  • LN involvement (452 vs 26d)
  • Better prognosis for solitary, well-differentiated carcinoma less than 5cm in diameter
  • Malignant pleural effusion worse prognosis
  • SCC worse prognosis (50% survival 8m)

In cats, degree of differentiation most prognostic
- moderately differentiated 698d
- poorly differentiated 75d

30
Q

How should you suture a partial lung lobectomy?

A
  • Continuous overlapping haemostatic, pneumostatic suture pattern (1-2 layers)
  • Oversewn with simple continuous
31
Q

What stapler can be used for partial lung lobectomy?

A
  • 2.5mm staples typically used for partial lung lobectomy
  • In thoracoscopy the Endo-GIA staple, which can be inserted through a 12mm cannula (available 2.0-2.5-3.5-4.8mm staples with 30-45-60mm in length)
32
Q

What structure needs to be broken down for a caudal lung lobectomy?

A

Pulmonary ligament : pleural fold between the caudal edge of the hilus and the mediastinum)

33
Q

How should a mainstem bronchus be ligated?

A
  • Pre-placed horizontal mattress sutures
  • Oversewn
34
Q

What staplers can be used for total lung lobectomy?

A
  • TA-V3 (2.5mm staples)
  • TA55 (3.5mm staples)
35
Q

In which dogs is an open thoracotomy recommended for lung lobectomy over thoracoscopic?

A
  • Dogs weighing less than 10kg
  • Mass over 8cm
36
Q

Removal of what % of lung is fatal?
What % volume is within the left and right lung?

A
  • Acute removal of 60% is fatal - should remove a maximum of 50% acutely
  • Left lung 42%
  • Right lung 58%

Dogs undergoing staged lobectomies over 6m period can survive with equivalent of 1.5 caudal lung lobes

37
Q

What changes are seen in the contralateral lung and myocardium after a pneumonectomy?

A
  • Decreased compliance, vital capacity and perfusion
  • Right ventricular hypertrophy and increased pulm vascular resistance and residual lung capacity
38
Q

What causes compensatory improvement of oxygen transport after over 50% pneumonectomy?

A
  • Recruitment of physiologic reserves of diffusion capacity
  • Remodelling of existing alveoli-capillary structures
  • Growth of new alveoli-capillary units

Tobias ECVS (110 decks)

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