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Sugery > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What are the 4 characteristics of a good surgeon?

A

Honesty
Diligence
Wisdom/humility
Compassion

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2
Q

What does the suffix “-centesis” mean?

A

To pierce

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3
Q

What does the suffix “-desis” mean?

A

A binding

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4
Q

What does the suffix “-ectomy” mean?

A

To excise

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5
Q

What does the suffix “-ostomy” mean?

A

Stoma, mouth

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6
Q

What does the suffix “-otomy” mean?

A

To incise

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7
Q

What does the suffix “-pexy” mean?

A

Fixation

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8
Q

What does the suffix “-plasty” mean?

A

Formed or shaped

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9
Q

What does the suffix “-orrhaphy” mean?

A

Suture

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10
Q

What is the least traumatic method for incising tissue?

A

Scalpel

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11
Q

What are the two scalpel handle grips and what are they used for?

A

Fingertip grip - large incision

Pencil grip- small incisions

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12
Q

What are the advantages and disadvantages of using scissors?

A

Disadvantages- increased tissue trauma due to shearing force

Advantages- ease of cutting, improved visibility and control

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13
Q

What type of scissor tip improves control and visibility?

A

Curved

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14
Q

What is the purpose of tissue forceps and what grip should you hold them with?

A

Purpose - tissue manipulation with non-dominant hand

Use pencil grip!

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15
Q

What does needle holder size depend on?

A

Needle size, not surgeon size

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16
Q

Moving your hand closer to the tip of an instrument decreases _____ but increases ____.

A

Leverage; control

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17
Q

What are the 3 grips used to hold needle holders?

A

Thumb-third finger or “tripod” grip
Palm grip
Thenar-eminence grip

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18
Q

What are the two classifications of retractors?

A

Self-retaining

Hand-held

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19
Q

What is the purpose of using suction tips?

A

To remove blood or fluid from operative site

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20
Q

To avoid corrosion, what should you do to instruments before cleaning?

A 
Hinged instruments- open them
Rinse under distilled or tap water (NOT saline)
Hand scrub remaining soil
Use instrument milk
Separate delicate instruments
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21
Q

What are Halsted’s Principles?

A 
Gentle handling of tissue
Meticulous hemostasis
Preservation of blood supply
Strict aseptic technique
Minimum tension on tissues
Accurate tissue apposition
Obliteration of deadspace
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22
Q

What are the shock fluid doses for dogs and cats?

A

Dogs- 90ml/kg

Cats- 60ml/kg

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23
Q

What will a 25% decrease in blood volume result in? 40%?

A

25%- tachycardia, decreased BP

40%- severe shock, death

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24
Q

What is primary hemostasis?

A

Platelet plug
vWB factor
Fibrin plug

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25
Q

What is secondary hemostasis?

A

Coagulation cascade (extrinsic, intrinsic, and common pathways)

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26
Q

What does PTT and PT test?

A

PTT- extrinsic and common pathways

PT- intrinsic and common pathways

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27
Q

What might influence an animals ability to coagulate?

A 
Drugs (aspirin, rodenticide toxicity)
Acquired conditions (liver disease, DIC)
hereditary conditions (vWB deficiency)
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28
Q

What should be done first in hemostasis?

A

Apply pressure

Use pressure pads for 1-5 minutes

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29
Q

What do hemostatic forceps do?

A

Crush vessel

Injured vessel activates native coagulation mechanism

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30
Q

What sized vessels would you use ligation for hemostasis?

A

Vessels >2mm

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31
Q

What is the most secure form of hemostasis?

A

Vascular ligation

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32
Q

What do vascular forceps do?

A

They are atruamatic and are used when vessel needs to be preserved

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33
Q

What topical agents are used in hemostasis?

A

Gelfoam
Surgicell
Bone wax
Epinephrine

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34
Q

What is electrosurgery?

A

High frequency AC current applied to tissue

Tissue resistance generates heat which causes cut, coagulation, dessication, etc.

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35
Q

What type of electrosurgery requires a grounding unit?

A

Monopolar

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36
Q

What are the disadvantages of monopolar electrosurgery?

A

Peripheral tissue injury
Improper grounding may result in thermal burns
Cannot us in wet field
Cannot use near heart, spinal cord, etc.

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37
Q

What are the advantages of bipolar electrosurgery?

A

More precise
Can use in wet field
No risk of distant injury

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38
Q

What is Ligasure?

A

Bipolar vessel-sealing device
Senses tissue impedance and automatically adjusts energy and output
Can seal vessels up to 7mm

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39
Q

What is the infection rate for clean procedures?

A

<5%

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40
Q

What are the two methods of sterilization?

A

Physical and chemical

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41
Q

What are the most common methods of physical sterilization? Chemical sterilization?

A

Physical- heat (dry and wet), radiation, filtration

Chemical - ethylene oxide, gluteraldehyde, H2O2 plasma

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42
Q

In steam sterilization, what is pressure used for?

A

To achieve high temperatures

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43
Q

What are the standard temp/pressure/time settings for steam sterilization?

A

250 F, 15 psi, for 15 minutes

262 F, 20 psi for 5 minutes

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44
Q

What has the longest shelf life for wrapping sterilized instruments?

A

Polypropylene peel pouches (12 months)

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45
Q

What should you not autoclave?

A 
Plastics
Suture material
Electronics
Powders
Glassware
Liquids
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46
Q

What is ethylene oxide?`

A

Colorless, odorless, toxic gas used in chemical sterilization
Must aerate objects for hours to days
Temperature range 84-150 F
Can manipulate concentration, humidity, and temperature

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47
Q

What is cold sterilization?

A

Sterilization by immersing items in gluteraldehyde

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48
Q

What is sterilization by radiation?

A

Sterilization using lethal ionization (gamma radiation most popular)
Used in commercially sterile products

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49
Q

What are the different types of indicators?

A

Physical
Chemical
Biological

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50
Q

Preparation of the surgical site prior to surgery includes what?

A

Wide clip

Antiseptic scrub

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51
Q

What is the difference between antiseptic and disinfectant?

A

Disinfectant is for inanimate objects

Antiseptic is for person/animal

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52
Q

What are the most common types of antiseptics?

A

Chlorhexidine
Iodophors (betadine)
Alcohols

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53
Q

What are some advantages and disadvantages of chlorhexidine solution?

A 
Advantages:
Non-irritating
Good residual activity
Not affected by organic matter
Effective against a wide array of microbes

Disadvantages:
Allergies/irritation from chronic exposure
Ototoxicity
Corneal toxicity

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54
Q

What are some advantages and disadvantages of iodophores?

A

Advantages:
Cheap
Effective against a wide array of microbes

Disadvantages:
Can cause dermal irritation
Decreased activity in organic matter
Unreliable residual activity
Stains
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55
Q

What are some advantages and disadvantages of alcohols?

A

Advantages:
Very rapidly acting
Cheap

Disadvantages:
Decreased activity in organic matter
Poor residual activity
Drying effects on skin
Rapid heat dissipation
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56
Q

To minimize trauma to tissue, what needle point is typically used?

A

Tapered point or diamond point

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57
Q

When would you use a straight needle vs. curved needle?

A

Straight: external procedures
Curved: tighter, smaller areas

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58
Q

What is the difference between simple continuous and running suture patterns?

A

Simple continuous- only advances with new bite

Running- advancement with new bit AND across tissue

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59
Q

What is the difference between a cushing and connell suture pattern?

A

Connell penetrates into lumen, cushing does not.

Connell has “L” for lumen

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60
Q

What does the strength of a surgical knot depend on?

A

Material used
Length of cut ends
Configuration of knot

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61
Q

Pulling ____ rather than ___ will minimize suture friction

A

horizontally; vertically

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62
Q

The ideal suture material is what?

A

Bioinert
Easily sterilizable without consequences
Handles well and produces secure knots
Cheap

63
Q

How is suture classified?

A

Absorbable vs non-absorbable
Multifilament vs monofilament
Natural vs synthetic
Coated or impregnated

64
Q

Sutures are absorbed through what two methods?

A

Enzymatic degradation or hydrolysis

65
Q

What is the difference between multifilament and monofilament?

A

Multi- flexible, handles well, has capillary action, superior knot security

Mono- stiff, has memory, non-capillary, poorer knot security, more easily damaged

66
Q

What is the difference in absorption rates for natural vs synthetic sutures?

A

Absorption rate is more variable with natural sutures

67
Q

You would expect moderate to marked tissue reaction with what kind of suture?

A

Natural

68
Q

What is cat gut?

A

Absorbable, natural,”twisted”
Made from sheep intestinal mucosa and bovine intestinal serosa
Formaldehyde-treated collagen
50-100% loss of tensile strength within 2-3 weeks

69
Q

What is monocryl?

A

Synthetic, absorbable, monofilament
Strong but rapidly loses strength - 50% loss of tensile strength in 1-2 weeks
Used for bladder, SQ tissues, vessel ligation

70
Q

What is biosyn?

A

Synthetic, absorbable, monofilament

Complete absorption is rapid - 50% of tensile strength within 2-3 weeks

71
Q

What is vicryl?

A

Synthetic, absorbable, multifilament
Used for intradermal, small vessel ligation, oral surgery
50% loss of tensile strength within ~2 weeks

72
Q

What is dexon?

A

Like vicryl but with slightly greater knot security

73
Q

What is PDS II?

A

Synthetic, absorbable, monofilament
Most popular suture in vet med
Slowly absorbed- 50% loss of tensile strength in 5-6 weeks

74
Q

What is Maxon?

A

Like PDS with greater memory

75
Q

What are the absorbable sutures?

A 
Cat gut
Monocryl
Biosyn
Vicryl
Dexon
PDS II
Maxon
76
Q

What are the non-absorbable sutures?

A

Silk
Nylon
Prolene
Stainless steel

77
Q

What is silk?

A

From silkworm cocoon
Natural, non-absorbable, multifilament
Vessel ligation (PDA, portosystemic shunt)

78
Q

What are braided synthetic non-absorbable sutures?

A

Very strong
Cheap
Some not even sterile
Tissue trauma

79
Q

What is nylon?

A

Synthetic, non-absorbable, monofilament
Memory/stiffness/knot security is not the best
Skin is most common use

80
Q

What is prolene?

A

Synthetic, non-absorbable, monofilament
Strong with good handling
Least likely of non0absorbable sutures to potentiate infection or induce thrombi
Skin, tendon, ligament, herniorrhaphy

81
Q

What is stainless steel suture?

A

Cheap, autoclave, strong
Poor handling
Cycle to failure

82
Q

What are the functions of skin?

A 
Maintain hydration and thermoregulation
Defense against pathogens and chemicals
Vitamin D synthesis
Sensory
Storage
Insulation
83
Q

What are the 3 layers of skin?

A

Epidermis
Dermis
Hypodermis

84
Q

Why is the benefit of the parallel vascular supply in the hypodermis of animals?

A

Better for wound healing

85
Q

What is the timeline of wound healing?

A
  1. Coagulation (<5 minutes)
  2. Inflammation (0-24 hours)
  3. Debridement (2-5 days)
  4. Proliferation (4-21 days)
  5. Maturation (21 days - 2 years)
86
Q

What are some markers of inflammation?

A 
Vasodilation (redness, heat)
Leukocytes and serum (swelling)
Platelets 
Neutrophils
Macrophages
87
Q

What are some markers of debridement?

A

Removal of necrotic tissue and debris by macrophages (“lag phase”)

88
Q

What are some markers of proliferation?

A 
Fibroblast influx
Macrophages
Agiogenesis (VEGF)- Granulation tissue formation
Epithelialization
Contraction (myofibroblast)
89
Q

What are some markers of maturation?

A

Collagen remodeling

90
Q

What dose the wound healing curve look like?

A

Lag phase- debridement (macrophages)
Log phase- fibroblasts
Tissue tensile strength inverse to suture tensile strength

91
Q

What are examples of intrinsic wound factors?

A 
Hypoporteinemia
Anemia
Malnutrition
Uremia
DM
92
Q

What are examples of extrinsic wound factors?

A

Mechanism
Foreign material
Irradiation
Antiseptics

93
Q

What are the different types of wound classifications?

A
  1. Based on time and contamination

2. Based on surgical factors

94
Q

What is the clinical significance of wound classifications?

A

Let’s you know how to close the wound and when

95
Q

Wound classification based on time and contamination

A

Class 1: 0-6 hours, minimal contamination, primary closure
Class 2: 6-12 hours, moderate contamination, probably shouldn’t do a primary closure
Class 3: >12 hours, gross contamination, never close!

96
Q

Wound classification based on surgical factors

A

Clean (SSI 5%)
Clean-contaminated (SSI 10%)
Contaminated (SSI 30%)
Dirty (Already infected)

97
Q

In what type of wound classification warrants antibiotic use?

A

Anything besides class 1, clean wounds

98
Q

What do you use to lavage a wound?

A

0.9% saline
Pressure cuff 300 mmHg
16-22 ga needle
Liberal volume

99
Q

What should you use to wet a wet-to-dry bandage?

A

Hypertonic saline

100
Q

What are the two types of drains?

A

Active - vacuum

Passive - gravity

101
Q

How long should a drain stay in?

A

3-5 days

Longer than this indicates something is wrong, wound is infected, etc.

102
Q

What are the types of wound closure?

A 
Primary (<6 hours)
Delayed primary (after 6 hours but before granulation)
Late secondary (after granulation)
Second intention (no surgical closure, dependent on wound healing)
103
Q

What are the layers incised to perform a celiotomy?

A 
Skin
SQ tissue
Linea Alba
Retroperitoneal fat
Peritoneum
104
Q

What are the holding layers in celiotomy closure?

A

Linea Alba

External Rectus Abdominus Fascia

105
Q

Why should you avoid large bites of muscle when closing celiotomy?

A

Muscle necrosis loosens closure

106
Q

What type of suture would you want to use to close fascia?

A 
Absorbable, monofilament, long retention of tensile strength
PDS, Maxon, Vicryl
Non-absorbable used when slow healing is anticipated
Stainless Steel, Nylon
Size:
<5kgs - 3-0
5-15kgs - 2-0
20-40kgs - 1
Horse - 3
107
Q

What are some general guidelines to follow during skin closure?

A

Keep tissues hydrated
Avoid undermining
Avoid excess manipulation

108
Q

Closing the subcutaneous layer functions to what?

A

Minimize deadspace

109
Q

What type of suture would you want to close SQ layer?

A

Monofilament, absorbable, small diameter (1-2 sizes smaller than linea)
PDS, Vicryl, Maxon, Monocryl
Does not require prolonged retention of tensile strength

110
Q

What type of suture would you use for cutaneous layer?

A

Monofilament, non-absorbable or absorbable
Reverse cutting needle
Nylon, prolene, fluorofil
Cut ends 8-10mm for ease of removal

111
Q

What are some indications for intradermal patterns in skin closure?

A

Clean wound
Healthy patient
Minimal to no tension
Mass removal or elective spay/neuter

112
Q

What type of suture would you use for intradermal sutures?

A

Absorbable, monofilament
Vicryl, PDS, Monocryl
Small diameter
Reverse cutting needle

113
Q

What are some pros and cons of using staples?

A

Pros - decreased operative time

Cons- increased cost, not suited for wounds under tension or thin skin

114
Q

What is included in pre-operative care?

A

Signalment/presenting complaint/history
Physical exam
Diagnostics (BW, imaging, etc)
Treatment/stabilization (IV access, fluids, oxygen)

115
Q

What are the classifications of surgical risk?

A

Minimal
Moderate
High
Extreme

116
Q

What are the ASA classifications?

A

I - normal, healthy patient
II- non-clinical systemic disease
III - systemic disease with clinical signs
IV - severe, potentially life-threatening disease
V - moribund, not expected to survive 24 hours

117
Q

What are the indications for a blood transfusion?

A

PCV < 20-25%

>30% blood loss

118
Q

What are some examples of blood products?

A 
Fresh whole blood
Packed red cells
Fresh frozen plasma
Frozen plasma
Cryoprecipitate
119
Q

When should peri-operative prophylactic antibiotics be given?

A

<60 minutes but >30 minutes from start of Sx

120
Q

What are some advantages of laparotomy?

A

Full thickness intestinal biopsies
Organ biopsy/excision
Ability to address/obtain hemostasis
Option for therapeutic intervention

121
Q

?What are some disadvantages of laparotomy?

A

Increased morbidity (pain, anesthetic risk, cost, dehiscence, infection)

122
Q

What are some therapeutic indications for laparotomy?

A 
Free gas
Dilated SI
Foreign body
Herniation
GDV
Abdominocentesis (blood, urine, bacteria, bile)
123
Q

What is in the cranial quadrant of the abdomen?

A

Diaphragm
Liver, gallbladder
Stomach
Pancreas

124
Q

What is in the mid-abdomen

A

Spleen
Intestine
Mesenteric lymph nodes

125
Q

What is in the caudal quadrant of the abdomen?

A

Colon
Bladder
Prostate/Uterus

126
Q

What is in the abdominal gutters?

A

Kidneys
Ureters
Adrenal
Ovaries

127
Q

In LA GI surgery, where should the initial incision be made?

A

Midline alone linea alba

10-12 inches long

128
Q

In LA GI surgery, what are examples of non-ischemic and ischemic diseases?

A

Non-ischemic: obstruction, non-strangulating displacements

Ischemic: strangulating lesions, infarction

129
Q

In LA GI surgery, what can be exteriorized from abdomen?

A

Jejunum
Apex and body of cecum
Middle of small colon
Most of large colon

130
Q

In LA GI surgery, what cannot be exteriorized from abdomen?

A 
Stomach
Duodenum
Part of ileum
Base of cecum
Small colon
R Dorsal colon
Transverse colon
131
Q

What are clinical signs associated with enteroliths in horses?

A

Low-grade, recurrent colic

132
Q

In right dorsal displacement of the colon, the pelvic flexure moves _____.

A

Cranial

133
Q

What is the treatment for nephrosplenic entrapment/left dorsal displaced colon?

A

IV phenylephrine and mild exercise
Rolling
Surgery
“Cure by trailer ride”

134
Q

What is GR trocar?

A

Instrument used to prevent recurrence of nephroplenic entrapment- barbed suture to prevent from moving backwards

135
Q

Strangulating lipomas are most common in what part of equine intestine?

A

Small intestine

136
Q

Cribbers are more prone to what disease?

A

Epiploic foramen entrapment

137
Q

What is the difference between inguinal hernias in adult horses vs foals?

A

Adult: acquired, very painful, needs emergency surgery
Foals: congenital, no strangulation, not painful, usually will go away with time

138
Q

How do you assess viability of tissue with fluorescein?

A

Strangulated/ischemic tissue does not take up dye and will not fluoresce

139
Q

How much of the equine SI be removed safely?

A

<40 feet

140
Q

How can you avoid over-inversion of intestine during surgical anastamoses in equine GI surgery?

A

Cut intestine at 60 degrees
Use lembert suture
Suture close to edge of tissue

141
Q

What are some predispositions that quarter horses have? Broodmares? Foals?

A

Quarter horses - HYPP
Broodmares - osteopenia
Foals - ascarid impaction

142
Q

What is the risk of death for healthy horses undergoing anesthesia?

A

1/1000

143
Q

Risk of anesthesia in horses depends on what?

A

Primary disease

Overall health

144
Q

When do you fast LA before surgery?

A

Horses - only with specific procedures where decreased GI fill is needed, NEVER in neonates
Ruminants - fast for 48 hours, NPO 24 hours, no fasting in neonates

145
Q

What should you consider in a location for field procedures (LA)?

A 
Shade
Soft ground
Sufficient space for recovery
Relatively clean
Away from other animals
146
Q

What are some potential consequences of improper positioning of LA during surgery?

A

Myopathy (from ischemia)

Neuropathy (from excessive pressure on nerves)

147
Q

What are some guidelines for positioning LA during anesthesia?

A

Thick padding
Entire body on pad
Remove halter or other tack
Lateral: Dependent forelimb pulled forward
Dorsal: keep hindlimbs flexed, shoulder trough well padded

148
Q

When is the most dangerous time for equine patients during anesthesia?

A

Recovery

149
Q

What are some potential post-anesthetic complications that horses experience?

A

Impaction colic
Increased risk of GI disease/colitis (from NSAID, antimicrobial therapies)
If has cast or splint- pressure sores

150
Q

What are some common complications of LA surgery?

A 
Anesthesia complications (myopathy, neuopathy)
Hemorrhage
Airway obstruction
Infection
Dehiscence
Post-op colic
Laminitis
151
Q

What muscles are at risk for myopathies in LA surgery?

A

Masseter
Triceps
Gluteal

152
Q

What nerves are at risk for neuropathies in LA surgery?

A

Facial n

Radial n

153
Q

What is the risk of fractures or ST injury in post-anesthetic period for LA?

A

2/1000

154
Q

Chances of infection following LA surgery increase with ____.

A

length and type of surgery

Sugery (4 decks)

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