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Sugery > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What are the clinical signs of pyloric obstruction?

A 
Projectile vomiting
Undigested mucus and bile
Rapid fluid loss
Electrolyte loss (H+, Cl-, Na+, K+)
Hyponatremia, hypochloremia, alkalosis
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2
Q

What are treatment options for gastric foreign bodies?

A

Spontaneous passage
Induction of vomiting
Endoscopy
Surgery

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3
Q

What are the two layer closures you would use for a gastrotomy?

A

Cushing- submucosa
Lembert- seromuscular- submucosa

Use absorbable suture

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4
Q

What are the breed incidences for GDV?

A 
Large/giant breeds:
Great Dane
St. Bernard
Weimeraner
Irish setter
Gordeon setter
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5
Q

What are the proposed etiologies for GDV?

A 
Diet
Overeating
Post-prandial exercise
Anatomic factors
Delayed gastric filling
Bacterial fermentation (clostridia)
Aerophagia
Hypergastrinemia
Gastric myoelectric dysrhythmias
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6
Q

What are the clinical signs for GDV?

A 
Restlessness, discomfort, pain
Hypersalivation
Nonproductive vomiting/retching
Abdominal distention
Hyperpnea (>30rpm)
Shock
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7
Q

What is the pathophysiology of GDV?

A

Dilation precedes volvulus
Angulation of gastroesophageal junction
Volvulus - 270 degree clockwise rotation
Dilation alone - 90 degree counterclockwise

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8
Q

Does ability to pass a stomach tube distinguish between GD and GDV?

A

No

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9
Q

What percent of dogs with GDV end up in DIC?

A

40%

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10
Q

What is the initial management of GDV?

A

Decompression (orogastric intubation or trocharization)

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11
Q

T/F? In all cases of GDV, surgical intervention should be recommended even if distention is relieved and the stomach is shown to be in a normal position

A

TRUE

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12
Q

Is it okay to medically manage a GDV and then take to surgery 24-48 hours later?

A

NO

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13
Q

What are the objectives of GDV surgery?

A

Reposition stomach
Evaluate GI tract
Prevent recurrence

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14
Q

How can you assess gastric wall viability?

A 
Color
Temperature
Peristalsis- pinch test*
Thickness
Fluorescien
Surface oximetry
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15
Q

What are the advantages of tube gastrostomy?

A

Rapid, easy procedure
Creates a permanent adhesion
Allows for gastric decompression
Allows tube feeding

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16
Q

What are the advantages and disadvantages of incisional gastropexy?

A

Advantages:
Rapid, easy procedure
Does not enter stomach lumen

Disadvantages:
No post-op alimentation
No good clinical follow up

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17
Q

What characterizes a simple complete obstruction?

A

Ischemia and devitalization -> decreased fluid absorption

Bowel wall edema -> fluid accumulation

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18
Q

What are the 3 types of mechanical intestinal obstruction and what commonly causes them?

A
  1. Luminal: foreign body, polypoid mass
  2. Intramural: neoplasia, fungal granuloma
  3. Extramural: adhesions, strangulated hernia
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19
Q

What type of obstruction results in rapid dehydration?

A

Duodenal

Loss of salivary, gastric, pancreatic duodenal secretions

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20
Q

What type of obstruction will result in more chronic signs?

A

Low jejunal obstruction

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21
Q

What is the size of a normal dog, cat, and ferret intestine?

A

Dog: 1.6 x the height of the body of L5

Cat: 12mm

Ferret: 5-7mm

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22
Q

What do you see on radiographs with linear foreign body?

A

Pleated bowl/accordion pattern

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23
Q

How can you diagnose foreign body on ultrasound?

A

Dilated, fluid-filled SI loops

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24
Q

What is the pinch test?

A

Tests viability of intestine

See if pinch incites peristalsis

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25
Q

What are the advantages and disadvantages of enterotomy?

A

Advantages:
Less risk of surgical dehiscence
Retain absorptive capacity

Disadvantages:
Wrong guess- perforation and peritonitis

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26
Q

Where do you make incision in foreign body enterotomy?

A

Aboral side of foreign body

Foreign body may have partially or fully eroded through mucosa. Making incision over foreign body may impede healing.

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27
Q

What suture type and pattern do you use for enterotomy?

A

4-0 PDS

Simple interrupted or continuous

May want to use cushing for animals with pre-existing peritonitis

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28
Q

What are the two enterotomy techniques used for linear foreign body removal?

A

Multiple enterotomy technique

Catheter passage technique

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29
Q

What are the advantages and disadvantages of intestinal anastamoses?

A

Advantage: removes all questionable tissue

Disadvantages: 
Longer surgical time
Greater risk of leakage
Greater potential for stricture
Potentil weightloss and diarrhea
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30
Q

What suture would you use on intestinal anastamoses?

A

Moncryl
Maxon
PDS

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31
Q

What should you always do after suturing an intestinal resection and anastamoses?

A

SEAL WITH OMENTUM

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32
Q

What animals most commonly get intussusception?

A

Young dogs and cats

Most often associated with worms

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33
Q

What is the most common part of intestinal for intussusception?

A

Ileo cecal colic

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34
Q

What are the clinical signs of intussusception?

A

Inappetence
Vomiting
Tenesmus
Melena

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35
Q

How do you diagnose intussusception on ultrasound?

A

Bulls-eye/target sign

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36
Q

What surgical techniques are used to prevent recurrence of intussusception?

A

Enteropexy- (Most of the time this is not done, no good data to show that this will prevent recurrence)

Enteroplication

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37
Q

What is the prognosis of intestinal volvulus?

A

Grave
95% mortality rate
Survivors may have short bowel syndrome
Must retain >20% bowel

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38
Q

What are the clinical signs of megacolon?

A 
Constipation
Obstipation
Tenesmus
Dyschezia
Hematodyschezia
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39
Q

What is idiopathic megacolon in cats and how do you medically manage it?

A

Mid to older age cats
No sex predilection
Inability of smooth muscle to contract

Give lactulose and cisapride

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40
Q

What is peritonitis?

A

Inflammation of peritoneum

Aseptic or septic

Primary or secondary

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41
Q

When is the most common time of dehiscence of GI surgery?

A

3-5 days post-op

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42
Q

What is septic peritonitis?

A

Bacterial contamination -> influx of protein rich fluids

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43
Q

What is the difference between bacteremia and septicemia?

A

Bacteremia: bacteria in bloodstream
Septicemia: body’s response to bacteremia

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44
Q

What is the criteria for systemic inflammatory response syndrome?

A 
Dogs (2 or more of criteria):
Temp >104 or <100.4
HR >120
RR >20
WBC > 18000 or <5000
Cats (3 or more criteria):
Temp >103.5 or <100
HR >225 or <140
RR >40
WBC >19500 or <5000
Bands >5%
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45
Q

Does a lack of superficial infectious rule out septic peritonitis?

A

NO

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46
Q

What is the best way to diagnose septic peritonitis?

A

Abdominocentesis

4 quadrant technique
Needs to be done sterily

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47
Q

How do you treat septic peritonitis?

A 
Antimicrobials: based on C + S, give ASAP!
Debride
Lavage
Omental/serosal patching
Drains (open or closed)
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48
Q

What is the prognosis for peritonitis?

A

Ultimately depends on underlying cause

High mortality rate

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49
Q

What is MIS?

A

Minimally invasive surgery

Any surgery that is less invasive and/or results in less tissue trauma compared to open surgery

Endoscopy, laparoscopy, thoracoscopy

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50
Q

What are the different methods of peritoneal access in laprascopic ove/ohe?

A

Veress needle
Modified hasson
Mini-laparotomy

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51
Q

What is the safest laparoscopy technique and why?

A

Modified Hasson

Make incision first and then insert camera

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52
Q

What is the Veress laparoscopy technique?

A

Has blunt, spring-loaded obturator that can retract to expose cutting needle

Protects from lacerating viscera

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53
Q

What is a threaded cannula?

A

Used in laparoscopic surgery to make a port for instruments
Prevents slipping in/out

Screw-in, rubber reducer valves, +/- insufflation

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54
Q

What are the 3 components of the tower in laparoscopic surgery?

A
  1. Light: xenon
  2. Video control unit
  3. Insufflator
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55
Q

What is used for insufflation in laparoscopic surgery and why?

A

CO2

Soluble, not flammable, no emboli

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56
Q

What is triangulation in laparoscopic surgery?

A

The orientation of instruments and self with monitor

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57
Q

What are different curves in instruments used for in laparoscopic surgery?

A

Looking around corners, getting different views

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58
Q

What are the indications for laparoscopy?

A

Elective procedures
Client requests
Decreases patient morbidity
Hospital reputation

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59
Q

What are contraindications of laparoscopy?

A

Lack of experience or comfort in surgeon or staff
Instrumentation missing
Advanced/exploratory procedures

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60
Q

What is the goal insufflation pressure for cats and dogs during laparoscopy?

A

Cats: <8 mmHg
Dogs: <12mm Hg

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61
Q

What are the physiologic effects of insufflation?

A

Pressure against diaphragm and vena cava ->
Decrease in thoracic compliance and venous return ->
Decreased cardiac output and tidal volume ->
Hypoventilation, hypoxemia, acidemia

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62
Q

What are the sources of pain during laparoscopy?

A

Incisions
Peritoneal CO2 (acidosis, desiccation)
Stretching of diaphragm

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63
Q

How can you decrease pain from laparoscopy?

A 
NSAIDs
Local nerve blocks
Evacuate residual CO2
Humidify gas 
Limit insufflation pressure
Limit duration of surgery
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64
Q

When do pyometras typically occur?

A

High progesterone
Low estrogen, LH

(Diestrus)

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65
Q

What is the best method for laparoscopic OVE

A

2 port lap

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66
Q

What type pf table do you use for laparoscopic procedures?

A

Tilt table

Use gravity to help move viscera

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67
Q

What local analgesia is used in laparoscopic OVE prior to port placement?

A

Bupivicaine 1mg/kg prior to port placement

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68
Q

Where do the ports go for laparoscopic OVE and OHE?

A

OVE:
Camera 1cm caudal to umbilicus
Instruments 2-4cm cranial to umbilicus

OHE:
Camera 1cm caudal to umbilicus
Instruments 2-4cm cranial to umbilicus or 1/3 distance fro umbilicus to pubis

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69
Q

What is ligasure?

A

Bipolar electrosurgery that compresses and denatures tissue to create a seal
Good for >7mm vessels
Can hold up to 3x systolic pressure

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70
Q

What are specimen bags used for in laparoscopic procedures?

A

Neoplastic tissue to prevent seeding elsewhere when removing tissue

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71
Q

What layers do you close close in the port incisions in laparoscopic OVE?

A

5 mm incision: SQ and skin

10mm incision: linea, SQ, skin

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72
Q

What are possible complications of laparoscopic OVE?

A 
Splenic laceration/hemorrhage
Pedicle hemorrhage
SQ emphysema
Loss of insufflation
Dropped ovary or pedicle
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73
Q

What are indications for prophylactic gastropexy?

A

At-risk dogs:
Relative with GDV, large breed, deep chest

Great danes, Irish wolfhound, standard poodle

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74
Q

What side is the lap-gastropexy done on?

A

Right

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75
Q

What are possible complications of lap gastropexy?

A 
Seroma (very common)
Splenic laceration/hemorrhage
Serosal tearing
Loss of insufflation
Dropped stomach

Conversion to keyhole technique is possible

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76
Q

What are the benefits of MIS?

A 
Less pain
Less tissue trauma
Less analgesics
Less infection
Precision and safety
Reputation
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77
Q

What are the advantages/disadvantages of standing castration (equine)?

A

Advantages: inexpensive, fast, avoids anesthesia

Disadvantages: dangerous, uncomfortable

Not recommended for mules, donkeys, ponies, AMH

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78
Q

What are the advantages/disadvantages of recumbent castration (equine)?

A

Advantages: IV anesthesia, better access, safe for surgeon

Disadvantages: Time consuming

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79
Q

What is a closed castration and what are the advantages/disadvantages?

A

Skin incision only

Advantages: removes a lot of tunic (reduces swelling)

Disadvantages: Need careful dissection not to cut into tunic

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80
Q

What are the two types of emasculators for equine castration and what is “the rule”?

A

Serra: 2 handles
Reimer: 3 handles

Rule: “nut to nut”- puts crushing edge on top and cutting edge on bottom

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81
Q

What is included in the aftercare of equine castration?

A

Walking exercise at least 2x daily (reduces swelling)
Hydrotherapy
NSAIDs
Antibiotics rarely used
Digital opening of incision (rarely needed)

82
Q

What are possible complications following equine castration?

A 
Swelling (edema
Infection
Hemorrhage (testicular a. Or pampiniform plexus- mostly seen in donkeys/mules)
Evisceration (bowel or omentum)
Severe pain
Unaltered behavior
Hydrocele
Urethral transection
Peritonitis
83
Q

In a unilateral cryptorchid stallion, why would you not want to remove the descended testicle only?

A

Cryptorchid testicle will still produce testosterone

Will behave like stallion but look like gelding

84
Q

What species have intra-abdominal testicles?

A

Elephant

Rock hyrax

85
Q

What are common penile diseases of horses?

A

Squamous cell carcinoma

Penile paralysis

86
Q

What is a common site of metastasis of equine penile squamous cell carcinomas?

A

Lungs

87
Q

What is penile reefing?

A

Segmental posthetomy used to removed neoplastic lesions using two parallel circumfrential incisions

88
Q

What is penile amputation (equine)?

A

Amputation to sib-ischial area where urethra is cut open and exteriorized

89
Q

What is an episioplasty (caslick’s operation) (equine)?

A

Procedure done for mare that have age-related, poor peritoneal conformation

Prone to pmeunovagina (“wind sucking”)

Combined with other treatments for urine pooling and perineal injuries

Creates better seal and prevents air/feces from being pulled into vagaina

90
Q

What is urethral extension (mares)?

A

Procedure done for mare that have age-related, poor peritoneal conformation

Poor conformation leads to incomplete emptying or urine

Urine can flow back into uterus and predispose mare to infections

91
Q

What are types of 3rd degree perineal lacerations mares can experience, what are the risk factors, and how are they treated?

A

Rectovaginal laceration
Rectovaginal fistula

Foals feet push straight up and break through vaginal and into rectum

Risk factors- first foal, unassisted delivery

Tx: not considered an emergency. Clean, give analgesics and antibiotics. Wait 30 days to surgically close.

92
Q

What is the purpose of ovariectomy in mares and what surgical techniques are used?

A

To remove granulose cell tumor or make a “jump” mare

laparoscopy, flank, oblique paramedian, ventral midline

All approaches: HEMORRHAGE

93
Q

When is cesarean section indicated in mares?

A

After other approaches have been considered (assisted vaginal delivery, controlled vaginal delivery, fetotomy)

Usually to save mare, foal is usually dead

Time (<90 min to save foal)

Hemorrhage from uterine incision

94
Q

What is controlled vaginal delivery (mares)?

A

Delivery of foal under general anesthesia

95
Q

How do you diagnose a lesion as neoplastic?

A 
FNA
Tru-cut biopsy
Incisional biopsy: take a fragment of mass out
Excisional biopsy: remove entire mass
Presumptive diagnosis
96
Q

When would you take an incisional biopsy and what techniques are used?

A

FNA non-diagnostic
Easy to access mass
Diagnosis will change surgery done

Needle-core biopsy (Tru-cut or Jamshidi)
Wedge biopsy
Punch biopsy

Principle: the structure of the tumor remains intact, no seeding go the tumor or disruption of fascial planes around tumor

97
Q

Where would you want to get a biopsy of a bone lesion?

A

Center of bone, endosteum

98
Q

What are the margins for mass cell tumors? Vaccine tumors (sarcomas)?

A

Mass cell tumor: 3 cm margin, 1 fascial plane

Vaccine tumor: 5 cm margin, 2 fascial planes

99
Q

When should biopsy be done?

A

For diagnosis of neoplastic vs non-neoplastic disease

Results will change treatment

Results may lead to -/+ aggressive treatment

Results may change what owners want to do

100
Q

When should you not biopsy?

A

Diagnosis is certain

Emergency situations

High risk/complex location

Results will not change treatment

101
Q

What are the two methods of bone biopsy?

A

Jamshidi needle

Michel trephine

102
Q

What dictates where you should get your sample from when getting a biopsy?

A

Type of tumor-

Large soft tissue masses: center may be necrotic
Bone masses: periphery may be necrotic

(Where the blood supply comes from)

103
Q

What are principles of oncologic surgery?

A

Excise all biopsy and fistulous tracts

Early vascular ligation

Wide margins

Gentle manipulation

Avoid contamination of healthy areas

Avoid (if possible) use of grafts/flaps

Pre-treat animals with diphenhydramine (MCT)

Avoid using drains

104
Q

What are the different prognoses when only surgery is used for tumor removal?

A

Spleen hemangiosarc: 1-2 months

Osteosarc: 3-5 months

Oral melanoma: 7-8 months

Oral squam cell: 7-11 months

AGASACA: 18 months

105
Q

What animals are predisposed to needing airway surgery?

A

Brachycephalic breeds
Beagles
Cocker spaniels
Poodles

106
Q

What is the common presenting complaint of animals needing airway surgery?

A

Episodic or continuous respiratory distress/strenuous breathing

Gagging/regurgitation

Cyanosis or collapse

107
Q

What are the components of brachycephalic airway disease?

A 
Stenotic nares
elongated soft palate
Everted laryngeal saccules
Laryngeal collapse/stenosis
Hypoplastic trachea
Enlarged tonsils
108
Q

What diagnostic should always be included in work up of airway disease?

A

Radiographs

109
Q

What are pre-surgical considerations for airway surgery?

A

Tracheostomy site preparation

Reduce swelling- pre-op steroids?

110
Q

What is the goal of the caudal wedge technique in airway surgery?

A

Lifts and lateralizes nares

111
Q

What suture pattern would you use for ellongated palate resection and why?

A

Simple continuous

Compresses vessels

112
Q

What is the Co2 laser used for in airway surgery?

A

Hemostasis

113
Q

What is a folding flap palatoplasty?

A

Soft palate surgery used to opens choanal area

Removes 50-60% of palatine muscle using electrocautery

Brings free caudal edge of palate cranial and suture to open wound bed

Keeps suture line away from tip of epiglottis

Increased diameter of nasophharynx and reduces snoring

Good for dogs with thickened palates: nose breathers (french bulldogs)

Good for revisions (pugs)

114
Q

What causes laryngeal paralysis and what is the treatment?

A

Heriditary or idioiopathic (most common)

Older, large breed dogs (labs, st bernard, irish setter)

Bilateral paralysis

Tx: arytenoid lateralization (tieback)

Causes increased risk of aspiration pneumonia

115
Q

What are indications for temporary tracheostomy?

A 
Trauma to larynx
Laryngeal collapse
Post surgery for brachiocephalic airway syndrome
Laryngeal paralyisis
To allow surgical access to oral cavity
116
Q

Where is a tracheostomy done?

A

Between 3rd and 4th cartilaginous ring of trachea

Transverse incision

117
Q

What is required for post-op management of tracheostomy surgery?

A

Observation
Oxygen
Suction q2-4 hrs with whistle tip catheter
Tracheostomy tub kit ready

118
Q

What causes collapsing trachea?

A

Miniature or toy breeds
~7 years old
Etiology unknown
Cartilage is hypocellular and deficient in glycoprotein and GAG content
Often concurrent main stem bronchus collapse occurs

119
Q

What is a classic clinical sign for tracheal collapse and what diagnostic procedures would you use to diagnose it?

A

“Goosehonk” cough, severe respiratory distress, and cyanosis

Radiographs, fluoroscopy (best), tracheoscopy, transtracheal wash and culture

120
Q

How do you treat tracheal collapse?

A

Medical- antitussives, sedatives, anabolic steroids

Surgical- external rings (cervicotracheal collapse) or intraluminal stents (thoracic collapse, most common)

121
Q

What is the #1 need in thoracic surgery?

A

Ventilation

122
Q

What are common sutures used in thoracisc surgery and what are they used for?

A

Prolene for tiebacks (non-absorbable)

PDS or Maxon for rib approximation

Silk- vessel ligation

123
Q

What are hemoclips commonly used for?

A

Bleeding vessels
PDA
Lung lobectomy (cats)
Thoracic duct ligation

124
Q

What are the two surgical approaches to the thoracic cavity and when would each be used?

A 
Lateral/intercostal thoracotomy (PDA surgery)
Median sternotomy (removal of large masses)
125
Q

What is an important landmark to remember with thoracic surgeries?

A

Scalenius m. Inserts on 5th rib

126
Q

What suture material do you use to close lateral thoracotomy? Midline sternotomy?

A

Lateral- PDS/ Maxon

Midline- need to close sternum
Dogs >10kg: 22-24 ga wire
Cats/dogs <10kg: 1 or 2 polypropylene suture

127
Q

What vessels do you have to ligate and what suture pattern do you use to close lunglobectomy?

A

Pulmonary a. followed by pulmonary v. (Non-absorbable suture)

Horizontal mattress (prolene, PDS)

128
Q

How do you handle traumatic pneumothorax vs spontaneous pneumothoax?

A

Traumatic: can put chest tube
Spontaneous: need to figure out cause- median sternotomy allows for exploration of entire chest

129
Q

What are the functions of upper airway vs lower airway?

A 
Upper:
Conduct for airflow
Olfaction
Phonation
Thermoregulation
Filters and conditions air
Protects lower airway

Lower: gas exchange

130
Q

What are the primary structures of resistance in upper airway?

A

oral cavity

Nasal valve
Rostral nasopharynx
Larynx

131
Q

In upper airway dysfunction, what results from increased resistance? Increased turbulence?

A

Incesed resistance -> decreased ventilation -> poor performance

Increased turbulence -> increased noise

132
Q

What types of endoscopy is performed on horses when assessing airway?

A

ALWAYS DO UNSEDATED

Resting or exercising (gold standard)

Oral endoscopy or sinoscopy

133
Q

What are important structures seen on radiographs of horse head and what is important to remember?

A

Paranasal sinuses
Dental arcades

Beware of superimposition

134
Q

When using ultrasound for assessing a horse’s airways, what is a limiting factor?

A

Bone

135
Q

What is a main advantage of CT or MRI when assessing a horse’s airways/head?

A

No superimposition

CT is method of choice

136
Q

What are problems of nasal passage (horses)?

A 
Epidermal inclusion cysts (atheromas)
Redundant alar folds
nasal lacerations
nasal septal disease
Engorgement of nasal mucosa (Horner's)
Wry nose
137
Q

Which of the horses sinuses are paired?

A 
Frontal
Caudal maxillary
Rostral maxillary
Dorsal conchal
Ventral conchal
Sphenopalatine
138
Q

What are common diseases of the paranasal sinuses in horses?

A 
Sinusitis
Sinus cyst
Ethmoid hematoma
Neoplasia
Trauma
139
Q

What are the different kinds of sinusitis seen in horses and how are they treated?

A

Primary: strep; lavage (trphine), abx +/- sx debridement

Secondary: dental dz; address underlying cause!

Diagnose with endoscopy and rads
Sinocentesis for culture and sensitivity

140
Q

What are the landmarks for trephination of the frontal sinus (horses)?

A

Draw a line from midline to medial canthus

60% of distance from midline along this line and 0.5 cm caudal to the line

141
Q

What are the landmarks for trephination of the caudal maxillary sinus (horses)?

A

2 cm ventral to the medial canthus

142
Q

What are the landmarks for trephination of the rostral maxillary sinus (horses)?

A

Draw a line from medial canthus to infraorbital foramen

1cm ventral to this line and midway between canthus and rostral extent of facial crest

143
Q

What is the most common type of sinus neoplasia in horses and what is the prognosis?

A

Squamous cell carcinoma

Poor; often dx late in disease process

144
Q

What is a progressive ethmoid hematoma?

A

Mass arising from ethmoids or sinus of horses

Results in mild, intermittent epistaxis or facial deformation/airway obstruction (rarely)

Dx by endoscopy

Tx: intralesionsal formalin, laser photoablation, sx

145
Q

T/F? The pharynx has no rigid support?

A

True

146
Q

What are common diseases of the pharynx in horses?

A 
Lymphoid hyperplasia
Dorsal displacement of soft palate
Pharyngeal collapse
Palatal instability
Pharyngeal cicatrix

Foals:
Cleft palate
Choanal atresia
Nasopharyngeal dysfunction

147
Q

What is the common clinical sign of dorsal displacemtn of the soft palate in horses and how is it diagnosed and treated?

A

CS: noise during expiration

Dx: exercising endoscopy

Tx: laryngeal tie forward

148
Q

What is recurrently laryngeal neuropathy n horses and how is it diagnosed and treated?

A

Demyelination and axonopathy of the RLN

Paresis leads to paralysis of intrinsic laryngleal muscles

Inspiratory obstruction and noise at exercise (commonly left side)

Affects large horses (TB, draft)

Dx: resting endoscopy, laryngeal u/s/

Tx: prosthetic larygnoplasty (tie back)

149
Q

What is the difference between lateral vs medial compartments of gutteral pouches in horses?

A

Lateral: smaller, contains ex.carotid a., maxillary a., facial n.

Medial: larger, contains int. Carotid, cranial cervical ganglion, sympathetic trunk, CN 9-12, ventral straight muscles

150
Q

What is gutteral pouch mycosis (cause, dx, tx)?

A

Rare but life-threatening fungal infection of gutteral pouch in horses

Commonly caused by Aspergillus spp.

Dx: endoscopy
Tx: Medical tx fungus, NSAIDs, nutritional support

151
Q

What are common diseases of the trachea in horses?

A

Collapse
Stenosis
Perforation
Foreign body

152
Q

Where do you perform tracheotomy and tracheostomy in horses?

A

Tracheotomy:
longitudinal incision at level of junction of prox and mid 1/3 of neck
Transverse incision between rings, <50% circumference

Tracheostomy: 2-5 tracheal rings

153
Q

What are indications for thoracic surgery in horses?

A 
Pleuritis
Pleuropneumonia
Pulmonary abscess
Trauma
Diaphragmatic hernia
154
Q

What are common thoracic surgical procedures done in horses?

A

Rib fracture repair (foals)
Rib resection and thoracotomy
Thoracoscopy

155
Q

What are clinical signs of urethral obstruction and rupture in cattle?

A

Urethral obstruction: abdominal pain, distended bladder on rectal

Rupture urethra: distended bladder on rectal, ventral swelling, cellulitis, uremic smell

156
Q

What is the main difference in clinical signs between ruptured urethra and ruptured bladder?

A

Ruptured bladder will have no abdominal pain and abdominal distention

157
Q

What are the goals of treatment of urolithiasis?

A

Steers: Perineal urethostomy with epidural anesthesia (dissect down to penis and transect)- salvage for market

Pet goats/pigs: treat with surgery

158
Q

What is the cause of urolithiasis?

A

Concentrated diets
Imbalance in Ca:P ratio
Lack of water
high urine pH

159
Q

Why are males more prone to urolithiasis?

A 
Sigmoid flexure and vermiform appendage (urethral process)
Narrowed urethra (early castration)
160
Q

What are the clinical signs of urethral obstruction in goats?

A

Early signs:
Restlessness or anxiety
Tail twitching

Progressive:
Excessive vocalization
Stretching/arched back
Forceful urination
Reduced urine flow
Bloody urine
Crystals on preputial hairs
Advanced:
Swelling/pain of urethra
Ventral edema
Sudden cessation of clinical signs
Abdominal distention
Anorexia
Anorexia
Depression
Weakness
Death
161
Q

What is the best way to diagnose urolithiasis in goats?

A

CT!

162
Q

What is the initial management for urolithiasis in goats?

A 
Massage or manipulation of urethral process
Exteriorization of penis
Sedate with diazepam
Removal of urethral process
Passage of catheter
163
Q

How do you medically manage urolithiasis in goats?

A

Promotion of urethral relaxation (diazepam, ace, AVOID xylazine)

Ammonium chloride, walpoles solution: acidify urine

164
Q

How can you surgically manage urolithiasis in goats?

A 
Urethral process amputation
Percutaneous catheter placement
Tube cystotomy
Bladder marsupialization
Perineal urethrostomy

Fluid of choice: NaCl

165
Q

What is the most common surgical procedure for urolithiasis in goats?

A

Tube cystotomy

Allows urethra to rest and complete recovery can occur in a ew months
Allows administration of urinary acidifiers
MUST change dieet!

166
Q

What are common complications of tube cystotomy?

A

Blockage of tube
Failure of balloon
Continued straining
Premature removal of tube

167
Q

What is bladder marsupialization?

A

Surgical management of urolithiasis in ruminants
“Permanent” solution after failed tube cystotomy
Minimally invasive technique, two inch incision
Approximately 4cm stoma is created for urine to drip out

168
Q

What are possible complications of bladder marsupialization?

A 
Cystitis
Pyelonephritis
Premature closure
Bladder prolapse
Urine scalding
169
Q

What is a perineal urethrostomy?

A

Salvage procedure for urolithiasis in ruminants
High rate of stricture
Incision ventral to anus, penile body freed from ischium, urethral mucosa spatulated

170
Q

What is the most common type of urolith in horses and where is it commonly found?

A

Calcium carbonate

Neck of bladder

171
Q

How can you surgically manage urolithiasis in horses?

A

Subischial urethrostomy
Lithotripsy
Laparocytotomy

172
Q

What is a patent urachus? How is it surgically and medically managed?

A

Persistent urachus (carrier urine from bladder to allantois) in foals
Not life-threatening
Can resolve without treatment

Medically managed with silver nitrate cautery

Surgically managed with umbilical resection

173
Q

What do the urachus, umbilical artery, and umbilical vein become in developed animal?

A

Urachus- scar at apex of bladder
Artery- round lig of bladder
Vein- falciform lig

174
Q

What is omphalophlebitis?

A

Infected umbilical remnants

Outward signs of infection -> need to do U/S

175
Q

What is uroperitoneum and what can cause it?

A

Urine in peritoneal cavity

Can be caused by ruptured bladder, urachus, or ureter

176
Q

What are clinical signs of uroperitoneum and how is it diagnosed?

A 
CS: 
History and age (<6 days)
Males > females
Depression
Abdominal distention
Abnormal urination
Dx:
Abdominocentesis
Electrolytes- increased K+, creatinine, BUN***
Ultrasonography
Dye studies
Contrast studies
177
Q

What are electrolyte abnormalities for uroperitoneum and how do you medically manage it?

A

Increased K+, BUN, creatinine

Fluid therapy (0.9% NaCl)
Dextrose
Crystalline insulin
Sodium bicarb if acidotic

178
Q

What is the major concern when doing surgery/biopsy of kidneys?

A

Hemorrage

179
Q

What part of the kidney do you biopsy from and why?

A

Cortex

Only want glomeruli

180
Q

How do you manage a proximal uretal injury vs a distal uretal injury?

A

Proximal: CANNOT be re-routed to bladder. Need to remove.

Distal: CAN be re-routed to different spot on bladder

181
Q

What do you have to be careful about when manipulating lateral ligaments of bladder?

A

Large arteries and ureters

DON’T LIGATE UNLESS YOU HAVE TO

182
Q

What suture pattern do you use to close bladder?

A

Simple interrupted

183
Q

How long does it take the urethral mucosa to regenerate?

A

7 days

184
Q

How do you manage a minor urethral injury vs major urethral injury?

A

Minor: conservative management (indwelling catheter)

Major: requires surgery (anastomosis, urethrotomy, urethrostomy)

185
Q

What surgical techniques are used for ureteral obstruction?

A

Resection and preimplantation
Ureterotomy
Ureteral stenting
SUB subcutaneous ureteral bypass

186
Q

What is ureteral ectopia?

A

Ureter attaches to bladder at abnormal spot

187
Q

How long does it take for bladder mucosa to heal?

A

5 days

Full strength/thickness: 14-21 days

188
Q

What are the most common methods/procedure of small animal gonadectomy in US?

A

Ovariohysterectomy

Castration

189
Q

What are indications for gonadectomy in small animals?

A 
Pet overpopulation
Sex-based aggression
Mammary neoplasia
Pyometra
Uterine/ovarian neoplasia
Prostatic disease
Perineal herniation
Prostatic neoplasia
Testicular neoplasia
190
Q

When is the risk of mammary neoplasia reduced with gonadectomy?

A

If done before 1st or 2nd heat cycle in dog

If before 6 months of age in cats

191
Q

What percent of female dogs have a pyometra by 10 years of age?

A

25%

192
Q

What percent of male dogs experience bph by 5 years of age?

A

50%

193
Q

What are friction knots used for the vascular pedicles?

A

Strangle
Miller’s
Surgeon’s (less secure)
Modified miller’s (less secure)

194
Q

What are the terminal knots used on vascular pedicles?

A

Used for continuous subcuticular/intradermal patterns

Aberdeen
Square throws- 10x larger volumes

195
Q

What are possible complications of castration and ovariectomy?

A 
Castration:
Hemorrhage
Urethral/ureteral ligation
Prostatic ligation
SSI
Ovariectomy:
hemorrhage
Ureteral ligation
Ovarian remnant syndrome
Sphincter mechanism incontinence
196
Q

What are risk factors for ureteral/urethral ligation during small animal castration?

A

Urethral ligation:
Stray dissection, deep bites when closing

ureteral ligation:
Poor visualization/exposure

197
Q

What is the preferred approach to prostatic ligation?

A

Caudal midline celiotomy

198
Q

Which side is more common to have ovarian remnant syndrome?

A

Right

199
Q

What effects does castration have on a dog’s urethral sphincter mechanism?

A

Increased collagen
Decreased smooth muscle

(Especially in proximal urethra)

200
Q

What percent of spayed female dogs experience incontinence?

A

Up to 75%

Literature says ~12-20%

201
Q

In gonadectomy of small animals, what contributes to surgical site infection?

A

Traumatic tissue handling
Excessive dissection
Poor tissue apposition

202
Q

What is the best sterilization method for laparoscopic equipment?

A

Gas sterilization

Sugery (4 decks)

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