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Surgical Disease Final Exam > exam 1 material > Flashcards

exam 1 material Flashcards

1
Q

define absorbable suture

A

loss of tensile strength within 60-90 days

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2
Q

define non-absorbable suture

A

retains tensile strength >60 days

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3
Q

describe catgut/chromic gut

A

natural, completely absorbed in 2-3 weeks, high reactivity, chromium gut has chromium salt added to decrease reactivity, accelerated loss of tensile strength in infected wounds

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4
Q

name some uses for catgut/chromic gut

A

ligation of small vessels, rapidly healing tissue like mucosa, gingeva

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5
Q

describe monocryl

A

poligelecaprone 25, monofilament, synthetic, absorbable, 50% loss of tensile strength at 1 week

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6
Q

uses for monocryl

A

subcutaneous tissue, bladder

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7
Q

decribe vicryl

A

polygalactin 910, braided multifilament, synthetic, 50% tensile strength lost at 2-3 weeks

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8
Q

describe vicryl rapide

A

vicryl treated with irradiation that loses 50% strength at 5 days

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9
Q

when should you not use braided suture

A

infected wounds and delicate tissue

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10
Q

describe PDS

A

polydiaxanone suture, monofilament, synthetic, longest lasting of absorbables, 50% strength at 5-6 weeks

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11
Q

describe silk

A

natural, braided multifilament, high reactivity, 56% tensile strength at 12 weeks

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12
Q

describe prolene

A

polypropylene, monofilament, resistant to degradation, non-absorbable, low tissue reactivity

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13
Q

uses for prolene

A

tendons, ligaments, joint capsule, fascia, things you want to hold as long as possible

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14
Q

describe nylon

A

polyamide, usually monofilament, non-absorbable, 50% tensile strength at 12 weeks in acidic environment

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15
Q

most common feline cutaneous neoplasm that likes the ear

A

basal cell tumor

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16
Q

second most common feline cutaneous neoplasm

A

mast cell tumor

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17
Q

who can benefit from lateral ear canal resection? what does it acheive?

A

mildly affected patients with chronic ear infections, no stenosis, no boney changes. allows owner to get drops directly into the horizontal canal

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18
Q

who can benefit from vertical ear canal resection

A

when vertical ear canal is affected, but horizontal is clear. uncommon

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19
Q

what are the indications for total ear canal ablation

A

unresponsive chronic otitis externa, stenotic canals, failed previous resections, neoplasia, soft tissue extension of infection

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20
Q

what procedure must be paired with a total ear canal ablation

A

lateral bulla osteotomy

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21
Q

what is the goal of lateral bulla osteotomy? what is special about this procedure in cats?

A

improves drainage by removing secretory epithelium. cat bulla has 2 chambers and both must be treated

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22
Q

what procedure can be done for otitis media

A

TECA with LBO

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23
Q

how do you remove a nasopharyngeal polyp? bulla polyp?

A

traction and VBO, respectively

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24
Q

what procedure can be done for otitis interna

A

establish drainage usually with VBO. signs may or may not improve

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25
Q

where do large breeds vs brachycephalics usually get entropion

A

lateral canthus and medial canthus, respectively

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26
Q

who can benefit from temporary tacking for entropion

A

young animals or those with high anesthetic risk or spastic entropion

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27
Q

what is the most common surgical technique for permanent correction of entropion

A

hotz-celcus

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28
Q

what techniques may be combined for entropion involving the lateral canthus

A

holz-celcus and lateral wedge resection

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29
Q

what are indications for tarsorrhaphy

A

proptosis, lagophthalmos

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30
Q

how are proptosis and exophthalmus different

A

proptosis involves the eyelid entrapped behind the globe
exophthalmus has the globe pushed forward but no entrapment of lids

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31
Q

what are good prognostic indicators for vision following proptosis

A

menace, dazzle, consensual PLR

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32
Q

what are indications for enucleation with a proptosis case

A

ruptured globe, optic nerve avulsion, 3 or more extraocular muscles severed, complete hyphema

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33
Q

how are eye meds applied after tarsorraphy

A

medial canthus left open

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34
Q

what structures are removed in enucleation

A

globe, third eyelid and gland, conjunctiva, eyelid margins with meibomian glands

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35
Q

what are the indications for enucleation

A

-blind, painful eye
-ocular congenital defects resulting in chronic problems
-severe intraocular infections with significant globe destruction and source or systemic infection
-extensive intraocular tumors
-extensive intraocular inflammation that is uncontrolled and/or blind
-extensive trauma
-end-stage glaucoma

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36
Q

what are the two approaches to enucleation

A

subconjunctival - faster and less pain
transpalpebral - preferred for severe infection and large neoplasia

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37
Q

how much of the eyelid margin is removed to include the meibomian glands

A

5-8mm

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38
Q

what are the layers of closure for enucleation

A

orbital cone, subQ, skin

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39
Q

are eyelid tumors more aggressive in dogs or cats

A

cats. remove as soon as you see it or it will just get harder
dog eyelid tumors usually benign

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40
Q

what size tumors are able to be removed with wedge or house resection

A

involving <1/3 of lid length

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41
Q

what are the layers of a wedge resection or lateral canthotomy closure

A

tarsoconjunctival later and skin layer
use figure 8 for margin of skin closure

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42
Q

what is the normal size of the kidneys

A

2-2.5 x length of adjacent vertebrae

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43
Q

how much kidney function is lost in an azotemic patient

A

> 75%

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44
Q

why are we moving away from renal needle biopsy and nephrotomy

A

damage to kidney

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45
Q

why is pyelolithotomy preferred over nephrotomy

A

no occlusion of renal blood flow, no damage to renal parenchyma
but moving away from this as well

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46
Q

where should you ligate ureters during a nephrectomy

A

close to the bladder to decrease risk of infection of blind stump

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47
Q

why should ureter surgery be preformed by specialists

A

prone to leakage and stricture

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48
Q

what is neouteterocystotomy for

A

treatment of ectopic ureters

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49
Q

what is ureterotomy for

A

removal of calculi

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50
Q

what do you have to be careful of at the bladder trigone

A

ureters enter there, so avoid suturing this area
also, a lot of cell regeneration occurs there, so be careful in general

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51
Q

why do you have to be careful with the lateral ligaments of the bladder

A

ureters and umbilical arteries live there

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52
Q

what is the blood supply to the bladder

A

cranial vesicular artery in 50% of adult dogs (branch of umbilical artery), caudal vesicular artery (branch of urogenital a.), internal pudendal veins

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53
Q

what is the innervation to the bladder

A

hypogastric (sympathetic, retention), pelvic (parasympathetic, bladder emptying, pudendal (somatic, to external urethra sphincter)
must preserve nerves during surgery to preserve bladder function

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54
Q

how do you ensure no leakage after closing cystotomy

A

retrograde flush

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55
Q

how long for cystotomy site to heal

A

14-21 days

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56
Q

which direction should you flush when doing cystotomy for calculi

A

normograde and retrograde. finish with retrograde

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57
Q

what must you do after stone removal surgery

A

post-op radiographs! 15-20% have residual stones

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58
Q

how much of the bladder can be removed

A

75%

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59
Q

what are the preferred locations of urethrostomy in dogs and cats

A

scrotal in dogs, perineal in cats

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60
Q

should you place a catheter after perineal urethrostomy

A

no!

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61
Q

what is the quantitative definition of infection

A

10^5 bacterial organisms/gram

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62
Q

how long does it take a normal skin wound to heal

A

7-14 days

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63
Q

what percent of clean surgeries become contaminated? infected?

A

100% contaminated
2-5% infected

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64
Q

what are good go-to antibiotics for surgical site infection

A

cephalexin as 1st line
clavamox as 2nd line

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65
Q

define clean surgery

A

do not enter organs and no current infection

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66
Q

define clean contaminated surgery

A

enter hollow viscous organ without spillage

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67
Q

define contaminated surgery

A

spilled contents from hollow organ during surgery

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67
Q

define dirty surgery

A

enter surgery with active infection
ex: pyometra, cystotomy w/ UTI, pyoderma

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68
Q

what endocrinopathies increase risk of surgical site infection

A

hyperadrenocorticism, hypothyroidism

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68
Q

what are the most important factors in preventing surgical site infection

A

aseptic technique and maintaining healthy tissue

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69
Q

what NRC surgical classifications should you give perioperative antibiotics to?

A

clean-contaminated, contaminated, and dirty
not clean!

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70
Q

what are halsted’s principles

A

gentle tissue handling, meticulous control of hemorrhage, strict aseptic technique, preserve blood supply to tissues, eliminate dead space, appose tissues accurately with minimal tension

71
Q

what NRC surgical classifications should you give therapeutic antibiotics to?

A

dirty (contaminated is controversial)

71
Q

what are the key points to prophylactic antibiotics

A

target expected bacteria, ensure peak tissue concentration at the time of incision and throughout period of contamination, discontinue within 24 hours of surgery

72
Q

T/F: aseptic scrubbing gets rid of all bacteria on the skin

A

F - 20% remains after scrub b/c bacteria live in hair follicles

73
Q

what is the suggested perioperative antibiotic for most surgeries? when should it be given?

A

cefazolin 30-60 min prior to incision and redosed every 90 min

74
Q

what is the rule of thumb for redosing antibiotics during surgery

A

time dependent antibiotics should be given every 2 half lives as long as incision is open

75
Q

T/F: postoperative antibiotics are not indicated for prophylaxis

A

T - prophylactic antibiotics should be discontinued within 24 hours of surgery
exceptions - some implants where infection would be disastrous, devitalized tissue or dead space you can’t eliminate

76
Q

what are the main cells active in the inflammatory phase of healing and what do they do

A

1 - platelets form blood clot and send signals to attract neutrophils
2 - neutrophils kill bacteria, debride necrotic tissue, and attract macrophages
3 - macrophages are the “master conductors”, day 3-5, phagocytosis

76
Q

what are the classic signs of inflammation

A

heat, redness, swelling, loss of function

77
Q

what are the gross characteristics of the inflammatory phase of healing? how long does this last?

A

cardinal signs of inflammation, purulent exudate, more exudate than wounds in proliferative phase, necrotic tissue, lasts 5-6 days

78
Q

if necrotic skin is present, what stage of healing is the wound in

A

inflammatory

79
Q

what cells are key to the proliferative phase of healing

A

fibroblasts

80
Q

what are the gross characteristics of the proliferative phase of healing? when does this phase begin?

A

glanulation tissue (angiogenesis and collagen), epithelialization, contraction. starts around day 4

80
Q

T/F: granulation tissue is prone to infction

A

false. HIGHLY resistant to infection

80
Q

what cells are responsible for wound contraction

A

myofibroblasts

81
Q

describe contraction vs contracture

A

contraction is a normal process that shrinks wounds
contracture is contraction that occurs over joints or natural orifices and is a pathologic process

82
Q

what happens during the maturation phase of wound healing

A

closed wound strengthens, but never reaches the original strength

83
Q

neutrophils need oxygen to work. below what level impairs their function

A

below 40 mmHg

83
Q

does the center of a wound in the inflammatory phase have increased or decreased oxygen

A

decreased b/c larger gap between vessels

84
Q

does the center of a wound in the proliferative phase have increased or decreased oxygen

A

granulation tissue has increased capillary density, so increased oxygen

85
Q

how can the doctor control the phases of healing

A

debride to shorted the inflammatory phase

86
Q

why does poor tissue oxygenation delay wound healing

A

neutrophils rely on oxygen, so increased risk of infection
collagen production requires oxygen, so shower proliferation

87
Q

when you see a patient with a fresh wound, how do you decide to give antibiotics or not

A

contamination becomes infection in 6 hours. if you get to the wound before 6 hours, you can lavage and prevent infection. after 6 hours, should give antibiotics

87
Q

what should you use to clean a wound

A

same solutions you use for surgical prep. not scrub! nothing with bubbles b/c hey inhibit fibroblasts

87
Q

what is the best way to debride a wound

A

surgically!

87
Q

what is autolytic debridement

A

done by the body and takes weeks

88
Q

if in doubt, cut it out. but…

A

if it’s skin, leave it in.
(dead skin reveals itself after a few days. be more aggressive with debridement of subQ and muscle)

89
Q

what is the most effective way to reduce bacterial numbers on the surface of a wound

A

lavage
saline ideal, but may use any IV fluid or tap water
may add chlorhexidine solution or povidone iodine solution

90
Q

what is the ideal pressure for lavage

A

8 psi

91
Q

what is primary wound closure

A

closing the wound the day you meet it

92
Q

what is delayed primary wound closure

A

closing days later, but before granulation tissue

93
Q

what is secondary wound closure

A

closing skin over granulation tissue

94
Q

what is second intention healing

A

allowing the wound to heal by contraction and epithelialization

95
Q

when should you not use primary closure

A

dirty/infected wounds, if waiting for new tissue to declare itself dead, burns, bite wounds, gunshot wounds, snake bites, too much tension

96
Q

what are the goals of the primary bandage layer during the inflammatory phase

A

debridement and reduce bacterial contamination

97
Q

what are the goals of the primary bandage layer during the proliferative phase

A

don’t disrupt new tissue, hold cells and cytokines in. want something non-adherent and occlusive

98
Q

what general type of wound dressings are recommended

A

moist wound healing dressings

99
Q

describe telfa + triple antibiotic in terms of debridement, antibacterial, non-adherent, and occlusive

A

no debridement
very antibacterial
is non-adherent
is occlusive

100
Q

describe petroleum infused gauze in terms of debridement, antibacterial, non-adherent, and occlusive

A

no debridement
no antibacterial
is non-adherent
is occlusive

101
Q

describe honey/sugar in terms of debridement, antibacterial, non-adherent, and occlusive

A

yes debridement
pretty antibacterial
is non-adherent
+/- occlusive

102
Q

describe hydrogel in terms of debridement, antibacterial, non-adherent, and occlusive

A

no debridement
no antibacterial
pretty non-adherent
pretty occlusive
uncommonly used

103
Q

describe polyurethane foam in terms of debridement, antibacterial, non-adherent, and occlusive

A

no debridement
no antibacterial
pretty non-adherent
is occlusive
basically bandaids/probably won’t stay on

104
Q

describe calcium alginate in terms of debridement, antibacterial, non-adherent, and occlusive

A

yes debridement
no antibacterial
pretty non-adherent
is occlusive

105
Q

which specific dressing is more desirable during the inflammatory phase

A

honey/sugar b/c has debridement and antibacterial properties

106
Q

how often do you change bandages during the inflammatory phase? proliferative phase?

A

inflammatory - once per day for 2-5 days
proliferative - once you see the granulation tissue, slowly space out the changes. skip one day then if it looks good skip 2 days and so on. max of every 5 days

107
Q

what are the down sides of second intention healing

A

takes a long time, alopecic, thin, shiny, fragile

108
Q

when should topical antibiotics be used on wounds

A

generally indicated during inflammatory phase
not necessary and may be detrimental during proliferative phase

109
Q

when can systemic antibiotics be used for wounds

A

indicated with infected tissue, controversial for contamination in inflammatory phase, not indicated for healthy wound during proliferative phase

110
Q

how much fluid can be picked up with abdominocentesis

A

5-25 mL/kg

111
Q

how do you determine if abdominal fluid is hemorrhagic or not

A

compare PCV/TS to serum. closer to serum level = more likely hemorrhage.
for DPL, >2-5% is diagnostic. do not need to compare with serum

112
Q

what values are higher in free fluid than in serum? lower? what type of effusion is associated with each change?

A

higher - creatinine (urine), potassium (urine), bilirubin (bile), lactate (septic)
lower - glucose (septic)

113
Q

how much fluid can be detected with diagnostic peritoneal lavage

A

1-5 mL/kg

114
Q

how long does it take for a bilious effusion to show clinical signs? what are your first steps as a clinician?

A

4-6 weeks before detection
stabilize patient first. not emergent surgery

115
Q

what are your steps as a clinician treating uroabdomen

A

drain with peritoneal catheter abdominocentesis and urinary catheter, stabilize patient, then surgical repair

116
Q

what are your steps as a clinician treating hemoabdomen

A

find the source, conservative management (fluids, blood products, compressive bandages, stabilization, keep them calm, pain meds, monitor PCV), intervene surgically if medical management not working. fix them before DIC (petechiae, requiring too much blood, coagulation issues)

117
Q

what are your steps as a clinician treating septic abdominal effusion

A

find the source (likely a ruptured hollow viscous organ), stabilize patient, EMERGENCY SURGERY

118
Q

define true hernia vs false hernia

A

true hernia - contents contained within an anatomical hernial sac
false hernia - contents lack a hernial sac

119
Q

what type of hernias are traumatic hernias

A

false hernia

120
Q

what does incarcerated mean

A

stuck in a spot

121
Q

what does strangulated mean

A

stuck and constricted, cutting off blood supply

122
Q

T/F: traumatic hernias are emergent

A

false - most traumatic hernias are not emergent. stabilize and evaluate entire patient

123
Q

how long can you postpone surgery on a traumatic hernia

A

3-5 days to allow declaration of nonviable tissues

124
Q

when are hernias emergent?

A

penetrating wounds, incarcerated or strangulated tissues, other injuries warranting emergent intervention (severe hemorrhage, septic abdomen, pneumoperitoneum)

125
Q

what is primary vs secondary peritonitis

A

primary has no inciting cause. secondary does

126
Q

is prognosis better or worse with aseptic peritonitis

A

worse because no pathogen to treat

127
Q

what type of peritonitis is most common

A

secondary generalized septic

128
Q

what body system is the most likely to cause peritonitis

A

GIT

129
Q

what clin path changes will be seen with peritonitis

A

marked neutrophilia (toxic), anemia, hypoproteinemia, hyper/hypoglycemia, electrolyte abnormalities (Na and Cl low with vomit, K low with anorexia), azotemia, liver enzyme elevation

130
Q

what will be seen on abdominal radiographs with peritonitis

A

lack of serosal detail, ground glass appearance, gas behind diaphragm

131
Q

with peritonitis, neutrophils will be high or low?

A

usually high but can be very very low with overwhelming inflammation

132
Q

name some negative prognostic factors with peritonitis

A

refractory hypotension, cardiovascular collapse, respiratory distress, DIC, plasma lactate >2.5 mmol/L, ionized hypocalcemia, MODS

133
Q

T/F: NSAIDs are sufficient for pain control with peritonitis

A

false. need opioids like methodone

134
Q

what antibiotics should be used for peritonitis

A

cefoxitin and ampicillin sulbactam, empirical treatment usually accurate, but always good to culture

135
Q

how should the small intestine be closed

A

full thickness, single later, appositional

136
Q

what kind of hemostats are used to handle intestines

A

doyans

137
Q

where should you cut for R&A

A

near a main artery branch for better blood supply to the wound edge. this may be farther from the spot you planned to cut

138
Q

in addition to careful apposition of intestines during R&A, what else needs to be closed

A

the mesentery to prevent strangulation

139
Q

what should be added to saline for intra-op peritoneal lavage

A

nothing! just warm saline

140
Q

after peritonitis surgery, the abdomen flushes out well and mild inflammation is present. how should you close?

A

consider primary closure

141
Q

after peritonitis surgery, the abdomen still has extensive fibrin tags, debris, necrosis, or severe peritoneal inflammation OR you don’t know the cause of the peritonitis. how should you close?

A

consider drainage options. use 2-3 drains because the omentum will clog the drains

142
Q

are malignant tumors in young dogs usually more or less biologically aggressive than older dogs

A

more aggressive

143
Q

T/F: palpation of regional lymph nodes can be used to determine if a cancer is metastatic

A

false - palpation alone can’t determine if metastatic. gives you a clue, but can feel normal and have metastatic dz

144
Q

what is important to remember about diagnosing mast cell tumors

A

they love lymph nodes. aspirate nodes even if palpate normally

145
Q

what is needed to grade a tumor

A

biopsy! not FNA

146
Q

when should you do a biopsy instead of just FNA

A

when info about tumor type and grade would result in a change in choice of treatment option, extent of treatment (margins), or owner’s willingness to treat

147
Q

what type of masses should not be FNA-ed

A

TCC b/c risk of seeding tumor
adrenal mass b/c sensitive area

148
Q

what type of needle-core biopsy is used for soft tissues? bone?

A

soft tissue - tru-cut
bone - jamshidi

149
Q

how can you improve diagnostic accuracy with needle-core biopsy

A

b/c it takes a small tissue sample, you should take multiple samples

150
Q

what techniques are used for incisional biopsy

A

wedge or punch biopsy

151
Q

T/F: oral tumor biopsy can be done with sedation and without local anesthetic

A

true. not usually painful

152
Q

what needs to be considered when doing an incisional biopsy

A

need to be able to resect biopsy scar en bloc with tumor b/c contaminated with tumor cells

153
Q

what needs to be considered before doing an excisional biopsy

A

resection does not have definitive margins, so it is diagnostic but may not be therapeutic. best to do FNA or needle core biopsy first!

154
Q

what should you plan for when doing an excisional biospy

A

plan that biopsy tract will have to be surgically removed if incompletely excised. DO NOT TAKE FASCIAL PLANE. only consider in areas with sufficient soft tissue coverage. NOT DISTAL LIMBS

155
Q

what factors are used in the WHO tumor stagins system

A

local tumor size/invasion, lymph node involvement, metastasis present

156
Q

what is the most common mistake in tumor removal surgery

A

using too low of a surgical dose

157
Q

what is radical resection

A

removal of a body part
ex: splenic hemangiosarc, limb amputation for OS

158
Q

what is wide resection

A

lateral and deep surgical margins to remove the complete tumor burden (gross and microscopic). precise amount depends on tumor type and biological behavior

159
Q

what lateral margins are recommended for wide margin resection

A

1 cm for most benign masses
2 cm for grade 1 or 2/low grade MCT
3 cm for soft tissue sarcomas
4-8 cm for intestinal tumors
5+ cm for feline injection site sarcomas

160
Q

what deep margins are recommended for wide margin resection

A

minimum of 1 fascial plane. 2 planes for feline injection site sarcomas

161
Q

what are natural tissue barriers? list examples

A

any tissue with resistance against tumor invasion
ex: muscle fascia, joint capsule, tendon, sheath, epineurium, cartilage, pleura, peritoneum

162
Q

what is marginal resection

A

incomplete excision of a tumor with residual microscopic disease

163
Q

what should be paired with marginal resection

A

adjuvant treatment for microscopic dz, like radiation

164
Q

what are your options following unplanned marginal resection

A
  1. no tx
  2. staging resection of surgical wound - take a small sliver and repeat until you got it all
  3. wide resection of surgical wound - get it all in 1 revision
  4. adjuvant tx, like radiation
165
Q

what is debulking/intralesional surgery

A

incomplete resection of tumor with residual gross disease. this is rarely acceptable treatment for cancer

166
Q

what should be avoided for cancer surgeries

A

directly grasping tumor with instruments, penetrating tumor capsule, drains, flaps without confirmation of complete margins

167
Q

what areas are considered contaminated during cancer surgery

A

biopsy tracts, subQ tissue undermined, donor sites and incisions for flaps, drain tracts

168
Q

what is the most common type of sectioning for histopath

A

radial

169
Q

what does histopath tell us about tumors

A

risk of local recurrence and mets, necessity of further tx, prognosis

Surgical Disease Final Exam (2 decks)

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