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Small Animal Surgery > Final > Flashcards

Final Flashcards

1
Q

Review Card: Anatomy of the Kidney

A

Make sure to Preserve the Venous Drainage for the Left Ovarian Vein

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2
Q

What is the Arterial and Venous Supply of the Kidney?

A

Kidneys Supplied by a Single Renal Artery that Arises from the Aorta

The Renal Veins empty into the Caudal Vena Cava

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3
Q

Surgical Disease of the Kidney Described Below:

Calculi/Stones within the Kidney

41% of Nephroliths are Calcium Oxalate

Can Develop Uremia and Hydronephrosis

Clinical signs- Mainly Asymptomatic

A

Nephrolithiasis

*Calcium Oxalate- No Medical Managment

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4
Q

What are the Most Common Nephroliths?

A

Calcium Oxalate

*41% of Nephroliths are Calcium Oxalate

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5
Q

What Clinical Signs are Associated with Nephroliths?

A

Absent/Asymptomatic- Most Common

Depression, Anorexia, Hematuria, Pain

*Nephroliths are Commonly Incidental Findings

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6
Q

Best way to Diagnose Nephrolithiasis

A

Survey Radiographs

*Most Nephroliths are Radioopaque- Plain Radiographs are normally Diagnostic

*Prior to Surgery perform a Full Check of Renal Function- Excretory Urography, GFR, and Ultrasound

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7
Q

What Parameters do you use to Determine the Best Managment for Nephroliths?

A

Type of Calculi

Anatomical Location

Clinical Effects

*Ex. Struvite Calculi can be Managed Medically, while Calcium Oxalate Calculi cannot

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8
Q

When is Surgery for Nephroliths Indicated?

A

Obstruction

Infection Associated with Calculi

*In Patients with Asymptomatic Nephrolithiasis, we may just Monitor Renal Function and Manage Medically

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9
Q

Name Two Surgical Treatment Options for Nephroliths

A

Nephrolithotomy

Pyelolithotomy

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10
Q

Surgery for Nephrolithiasis Described Below:

Ventral Midline Celiotomy

Retract Mesocolon/Mesoduodenum

Isolate Kidney and Vessels

Rumel Tourniquet or Bulldog Vascular Clamp on Isolated Vessels to Temporarily Occlude Venous Supply

Make Sagittal Incision and** **Remove the Stone

Culture Renal Pelvis, Flush Renal Pelvis and Ureter with Heparinized Saline

Catheterize Ureter to Ensure Patency and Submit Stones for Analysis

A

Nephrolithotomy

*Cutting into the Kidney, Opening it and removing the Stones

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11
Q

What Instruments can be used to Occlude the Renal Vessels during Nephrolithotomy

A

Rumel Tourniquet

Bulldog Vascular Clamp

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12
Q

How do you Close the Surgical Site following Nephrolithotomy

A

Sutureless Closure- Hold for 5 Minutes, Forms Fibrin Seal, Suture Capsule Only with Simple Continuous Pattern

or

Horizontal Mattress Pattern- Through Capsule and Cortex of Kidney

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13
Q

How Long can you Occlude the Renal Vessels for during Nephrolithotomy?

A

20 Minutes

*Vascular Clamp Time is 20 minutes! No longer than 20 Minutes or else you will develop Damage to the Kidney

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14
Q

Surgery for Nephrolithiasis Described Below:

Can be used to Remove Calculi when Proximal Ureter and Renal Pelvis are Dilated

A

Pyelolithotomy

*Making an Incision into the Renal Pelvis to Remove a Stone

*Have to have Swelling/Dilation for you to have Access to Renal Pelvis

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15
Q

What are Advantages of a Pyelolithotomy over a Nephrolithotomy?

A

Pyelolithotomy- Does NOT Require Occlusion of Blood Supply and does NOT Damage Nephrons

*Better to use Pyelolithotomy when Stones are Located in Renal Pelvic Area because it has Advantages over Nephrolithotomy

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16
Q

What is Post Operative Managment of a Nephrolithotomy

A

Post op Radiographs- Look for Calculi

Monitor Urine Output, Renal Enzymes/Electrolytes

Provide Diuresis- Helps Maintain Renal Perfusion, Helps Minimize Clot Formation

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17
Q

How can you Diagnose Renal Trauma?

A

Contrast Excretory Urography

Ultrasound

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18
Q

How do you Treat Minor, Moderate, and Severe Renal Trauma?

A

Minor Trauma (Ex. Bruising)- Conservative Treatment

Moderate Trauma (Ex. Capsular Tears, Bleeding)- Surgical Intervention by Suturing Tears, Hemostatic Agents (Gelfoam), Omentalization (Omental Patching)

Major Trauma (Shattered Cortex and Capsule)- Nephrectomy or Nephroureterectomy

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19
Q

What are the Indications for Performing a Nephroureterectomy

A

Severe Infection (Ex. Pyelonephritis)

Severe Trauma

Obstructive Calculi with Persistent Hydronephrosis

Neoplasia

Transplant

*Nephroureterectomy- Removal of the Kidney and Ureter

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20
Q

What are the Indications for a Partial Nephrectomy

A

Trauma/Focal Hemorrhage/ Neoplasia in a Patient with CONTRALATERAL Renal Compromise and we want to preserve as much Renal Tissue as Possible

Compromised GFR in Other Kidney

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21
Q

What are the Disadvantages of Performing a Partial Nephrectomy over a Nephrouretectomy?

A

Partial Nephrectomy- Higher Incidence of Post Operative Hemorrhage

*Risk of Hemorrhage is MUCH high than Performing a Total Nephrectomy

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22
Q

Progressive Dilation of the Renal Pelvis and Atrophy of the Renal Parenchyma

A

Hydronephrosis

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23
Q

Clinical Signs of which Kidney Disease:

A

Hydronephrosis

*Kidney will Feel like a Tumor Mass- Palpable Mass

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24
Q

How do we Diagnose Hydronephrosis?

A

Abdominal Radiographs

Ultrasound

Excreatory Urogram

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25
Q

Treatment for Hydronephrosis

A

Releave Primary Cause/Obstruction < 1 week: Complete Resolution

Releave Primary Cause/Obstruction > 4 Week Duration: May Retain 25%

Severe Parenchymal Damage (> 4 Week Duration): Nephroureterectomy

*If its Caught early (< 1 Week) and you are able to Releave the Primary Obstruction, Often the Kidneys will regain full Function

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26
Q

Treatment for Pyelonephritis

A

Severe/Non Responsive Cases- Nephrouretectomy

*Typically if we can Treat Pylonephritis Medically or Surgically we will go ahead and do that. Ex. If caused by Obstructive Uropathy (Nephrolithiasis) you will remove the Stone

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27
Q

How is Giant Kidney Worm (Dioctophyma Renale) often Diagnosed?

A

Urinalysis- Eggs in Urine (If Caught Early)

Necropsy- Often Diagnosed on Necropsy

*Once the worm matures it Migrates through the Kidney thus causing Significant Damage of the Cortex and the Medulla. These worms tend to Proliferate and cause damage very Quickly

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28
Q

Treatment for Giant Kidney Worm (Dioctophyma Renale)

A

Nephrectomy- Removal of Affected Kidney

Nephrotomy- Manually Remove the Worms

*If Unilateral then remove the one Kidney. If its causing Significant Damage to the Kidney, its best to Remove the Entire Kidney (Nephrectomy)

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29
Q

Most Common Benign and Malignant Kidney Tumors in the Dog and Cat

A

Benign- Renal Adenoma (Both Dogs and Cats)

Malignant in Dogs- Renal Cell Carcinoma

Malignant in Cats- Lymphosarcoma

*Most Renal Neoplasia is Aggressive Metastatic Types of Tumors

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30
Q

Most Common Renal Neoplasia in the Canine

A

Renal Cell Carcinoma

*Mean Survival Time 6-8 Months

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31
Q

How to Manage Renal Cell Carcinoma in Canine

A

Nephroureterectomy and Chemotherapy

*Remove the Kidney and use Chemotherapeutic Protocols

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32
Q

Best way to Diagnose Renal Cell Carcinoma

A

Renal Biopsy

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33
Q

Most Common Renal Neoplasia in the Feline

A

Renal Lymphoma (Lymphosarcoma)

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34
Q

Treatment for Renal Lymphoma in Felines

A

Chemotherapy

*Renal Lymphoma- Not Surgically Treated

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35
Q

Renal Neoplasia Described Below:

Congenital Neoplasia

Part of the Developing Kidney

More Common in YOUNG Dogs and Cats (< 1 Year)

Mean Survival Time- 6 Months

A

Embryonic Nephroblastoma

*YOUNG Dogs and Cats

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36
Q

How do Nephroblastoma’s Develop?

A

Embryogenesis

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37
Q

Treatment Indicated for Embryonic Nephroblastoma

A

Nephroureterectomy and Chemotherapy

*However, these tumors are NOT very Amenable to Treatment

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38
Q

Clinical Signs of ______:

A

Renal Neosplasia

*Commonly able to Palpate a Large Mass in the Paralumbar Area

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39
Q

How do you Diagnose Renal Neoplasia?

A

Abdominal Radiographs- Can be Very Diagnostic for Renal Neoplasia

Abdominal Ultrasound- Even MORE Diagnostic for Renal Neoplasia (Confirms Kidney Mass in 85% of Patients)

*Very Rare that you have to do more advanced Diagnostics than Radiograph or Ultrasound to Diagnose Renal Neoplasia

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40
Q

What Parameters are used to Determine if a Renal Biopsy is Indicated?

A

Suspected Neoplasia

Nephrotic Syndrome

Renal Cortex DIsease

Non Diagnosed Acute Renal Failure (ARF)

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41
Q

Contraindications of Performing a Renal Biopsy

A

Coagulopathies

Hypertension

Severe Chronic Hydronephrosis

*ALWAYS collect Coagulation Profiles on Patients prior to Renal Biopsy. If the patient is not clotting Properly the Renal Biopsy could be Disasterous

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42
Q

Kidney Biopsy Technique Described Below:

A

Percutaneous

*Best for Skinny/Small Dogs and Cats

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43
Q

Kidney Biopsy Technique Described Below:

A

Ultrasound Guided (_P_referred Method)

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44
Q

Kidney Biopsy Technique Described Below:

A

Keyhole

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45
Q

Kidney Biopsy Technique Described Below:

A

Wedge/Incisional Biopsy

*Surgical Method of Obtaining a Biopsy- Need to Occlude Vasculature

*Taking a Larger/Very Good Diagnostic Sample

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46
Q

Common Complications/Risks of Performing Renal Biopsy

A

Severe Hemorrhage (IMPORTANT)

Hematuria- Resolves in 2-3 days

Hydronephrosis

*Hemorrhage is a HUGE possible Complication- Make sure Patients haven’t recently been treated with blood thinners or NSAIDs

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47
Q

Indications for ______ in Felines:

A

Renal Transplant

*Mainly used in Chronic Renal Failure Cats or Patients with Acute Irreversible Renal Failure associated with a Toxin

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48
Q

Contraindications to Renal Transplants

A

Viral Positive (FELV, FIV)

Cardiac Disease

Neoplasia

Fractious

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49
Q

Special Considerations taken for Renal Transplants

A

Cost (Extremely Expensive)

Frequent Visits

Immunosuppression Therapy- LIFELONG

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50
Q

Prognosis for Renal Transplant in Felines

A

25% of Patients do NOT survive to Discharge (Don’t Leave Hospital)

Mean Survival Time- 613 Days

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51
Q

Breed, Sex and Clinical Signs of which Surgical Disease of the Ureter:

Breed Predisposition: Siberian Husky

Young Female Canines

Clinical Signs:

Incontinence

Fails to House Train

UTI/Urine Scalding

A

Ectopic Ureter

*Ectopic Ureter: Failure of One or Both Ureters to Terminate in the Normal Location

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52
Q

How do you Diagnose Ectopic Ureter?

A

Excretory Urography (Fluoroscopy)

CT

Ultrasound

Cystoscopy

*We use a Combination of Diagnostics to Confirm the Presence and Location of Ectopic Ureters

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53
Q

Two Different Classification of Ectopic Ureters. Which Classification is the Most Common?

A

Extramural: Ureter Enters into Neck, Urethra or Vagina

Intramural: Ureter Enters Normally but Exits Abnormally (MOST COMMON)

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54
Q

Treatment for Ectopic Ureter

A

Neoureterocystostomy

*Two Types: Side to Side, End to Side

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55
Q

Neoureterocystostomy Technique for Treatment of Ectopic Ureter Described Below:

A

Side To Side

*Best to Remove Remnant Ureter that may Contribute to Incontinence

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56
Q

Prognosis Following Treatment for Ectopic Ureter

A

90% Improvement when add Medications Following Neoureterocystostomy

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57
Q

What are the Two Types of Ureteroceles

A

Intravesicular (Normal)

Ectopic (Neck/Urethra)

*Ureterocele- Dilation of Distal Ureter due to Persistent Membrane over the Ureteral Oriface where it empties into the Bladder. Persistent Membrane can create Hydroureter or Obstruction

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58
Q

Clinical Signs of Ureterocele

A

UTI / Incontinence

Azotemia (If Obstruction)

*High Incidence of Urinary Tract Infections with Ureteroceles

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59
Q

How do you Diagnose Ureterocele?

A

IV Urography

*Contrast media will outine the Persistent Membrane- Cobra Head Sign

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60
Q

Treatment for Ureterocele

A

Intravesicular: Uretercelectomy

Ectopic: Neoureterocystostomy with Ureterocelectomy

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61
Q

What are the Causes of Ureteral Trauma

A

Iatrogenic (#1 Cause)

*Most Common Cause- During an Ovariohysterectomy where the Surgeon accidently Clamps Down/Ligates the Ureter

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62
Q

How do you Diagnose Ureteral Trauma?

A

Uroretroperitoneum or Uroabdomen

Radiographs

IV Urography- Localize Lesion

*Obviously if there is Urine Leakage into the Abdominal Cavity, there must be a Leaking area at the Level of the Crush Site

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63
Q

What are the Four Treatment Options for Ureteral Trauma?

A

Nephroureterectomy- Removal of Ureter and Kidney

Ureteroureterostomy- Ureteral Anastomosis

Neoureterocystostomy- Replant Ureter in Different Location in the Bladder

Urinary Diversion- Divert Urine from going across the Surgical Site to allow better chance of healing

*Urinary Diversion is usually done in Conjunction with one of the Other Surgical Procedures

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64
Q

Surgical Procedure used to Treat Ureteral Trauma Described Below:

Disadvantages- Extermely Difficult with High Incidence of Complications

A

Ureteroureterostomy (Ureteral Anastomosis)

*Disadvantages: Very Difficult with High Incidence of Complication

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65
Q

Surgical Procedure used to Treat Ureteral Trauma Described Below:

Catheterize Through Cystotomy

Avoids Engaging Back wall with the Suture

Suture under Magnification

A

Ureteroureterostomy

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66
Q

What Two Methods are Available for Urinary Diversion After Ureteral Surgery

A

Ureteral Stent

Nephrostomy Tube

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67
Q

Method Available for Urinary Diversion After Ureteral Surgery Described Below:

A

Ureteral Stent

*Urinary Diversion is Provided after every Surgical Procedure used to Correct Ureteral Trauma in order to Prevent Urine Flow through the Surgical Site

Allows Urinary Diversion to allow the Anastomosis Site to Heal following Ureteroureterostomy (Ureter Anastomosis)

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68
Q

Method Available for Urinary Diversion After Ureteral Surgery Described Below:

A

Nephrostomy Tube

*Suture Kidney to the Body Wall and then Feed the Tube Out of the Body wall to Create a Urinary Diversion without any urine going through the Anastamosis Site

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69
Q

What Procedures can be used if you have Loss of Length of the Distal or Proximal Ureter

A

Transureteroureterostomy- Used When Proximal Ureteral Length is Insufficient to Reach the Bladder. Bring Segment across Midline and Anastomosis to Other Ureter

Renal Descensus- Mobilize Kidney and Suture Caudally to Lumbar Musculature

Nephrocystopexy- Suturing the Kidney to the Cranial Edge of the Bladder

Psoas Hitch- Fixes the Bladder in a More Cranial Position

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70
Q

Surgical Procedure used when Proximal Ureteral Length is Insufficient to Reach the Bladder but Long enough to Cross Midline

A

Transureteroureterostomy

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71
Q

Surgical Procedure used when there is Significant loss of Distal Ureter

A

Bladder Wall Flap

*Lengthening Bladder Tissue so that it can reach the Ureter

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72
Q

Most Common Indication for Ureteral Surgery

A

Ureterolithiasis

*Stones within Ureter- Primarily Calcium Oxalate

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73
Q

What are the Clinical Signs of Ureterolithiasis

A

Asymptomatic (Most Common)

UTI, Hematuria

Anorexia, Lethargy, Pain

*If the Stones are not causing a significant Obstruction Process the patients are commonly Asymptomatic

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74
Q

How do you Diagnose Ureterolithiasis

A

Plain Radiographs

*Most are Radiopaque Calcium Oxalate

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75
Q

Since Most Ureterolithiasis cases are ______, Medical Dissolution is NOT an Option

A

Calcium Oxalate

*Can only Treat Struvites via Medical Dissolution

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76
Q

Presurgical Considerations for _______:

Cannot Predict how Long Ureter Obstructed: 1 Week Obstruction GFR < 65% (Cannot Predict how Well Kidney will Recover)

Most Cats have Preexisting Interstitial Nephritis unrelated to Obstruction

If Azotemic with Unilateral Obstruction = Bilateral Renal Disease

High Complication Rate with Surgery

A

Ureterolithiasis

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77
Q

Treatment Options for Ureterolithiasis

A

Cystotomy and Retrograde Flushing and Removal via Pyelithotomy (Ideal Procedure)

Ureterotomy- Difficult with High Incidence of Leakage/Dehisence

*If you have a Stone in the Ureter it would be IDEAL to do a Cystotomy Incision, Place a Catheter into the Ureteral Orifice and try to Push the Stone into the Renal Pelvis- Flush Saline and Dislodge the Stone

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78
Q

Advantages and Disadvantages of Permanent Ureteral______:

Advantages:

Decreased Morbidity

Shorter Hospitilization

Less Complications

Disadvantages:

Specialized Equipment

Steep Learning Curve

A

Permanent Ureteral Stenting

*Due to the High Complication Rate with Ureteral Surgery, Ureteral Stenting is becoming more Common

*Rather than Remove the Actual Stone or Obstruction, you Bypass the Ureteral Obstruction with Permanent Ureteral Stent- Leads to Less Complications

Indications for Ureteral Stenting- Stone, Tumor, Stricture, Blood Clot

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79
Q

Method of Permanent Ureteral Stenting Described Below:

Place Guide Wire into Ureteral Orifice

Place Catheter over Guide Wire and Inject Contrast Media in order to Visualize Renal Pelvis

Remove Ureteral Catheter and feed Stent over the Guide Wire and Place the Stent into the Renal Pelvis

A

Endoscopic Placement

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80
Q

Method of Permanent Ureteral Stenting Described Below:

Perform Cystotomy Incision and Place Catheter into Renal Pelvis using Fluoroscopy

Guide Stent into Renal Pelvis

A

Surgical Stenting

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81
Q

Method of Permanent Ureteral Stenting Described Below:

Placing one End of Catheter into Kidney (Renal Pelvis)

Kidney Catheter is Placed onto Shunting Port

A Seperate Catheter is Placed into the Bladder

The Opposite End of the Bladder Catheter is Attached to the Shunting Port

A

SUB (Subcutaneous Ureteral Bypass)

*Feed Renal Catheter and Bladder Catheter through the Abdominal Wall and connect both of them to the Shunting Port. Secure the Port to the Abdominal Wall

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82
Q

Review Card: Anatomy of the Bladder

Trigone- Region Between Urethral and Ureteral Openings

Nerve Supply: Hypogastric Nerve (Sympathetic) and Pelvic Nerve (Parasymphathetic)

Blood Supply: Caudal Vesicular (Primary), Prostatic/Vaginal Artery

A
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83
Q

Types of ______ Abnormalities:

Persistant Urachus

Vesicouracheal Diverticulum

Urachal Cyst (Rare)

Urachal Sinus (Rare)

A

Urachal

*Urachal- Embryonic Conduit Providing Communication between Bladder and Allantoic Sac that Atrophies at Birth

Persistant Urachus- Persistance of a Tube between the Bladder and Umbilicus

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84
Q

Urachal Abnormality Described Below:

Persistance of a Tube between the Bladder and Umbilicus

Clinical Signs:

Urine Dribbling From Umbilicus

Omphalitis (Inflammation of Umbilicus)

Ventral Abdominal Dermatitis

UTI

A

Persistant Urachus

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85
Q

How do you Diagnose Persistant Urachus

A

Place Contrast In Umbilicus and Take Radiograph

*You will see Contrast Travel from Umbilicus up into the Bladder

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86
Q

How do you Treat Persistent Urachus

A

Surgical Removal of Urachal Tube

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87
Q

Most COMMON Urachal Abnormality

A

Vesicouracheal Diverticulum

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88
Q

Urachal Abnormality Described Below:

Most Common Urachal Abnormality in Canine Patients

External Opening at the level of the Umbilicus is Closed while the Internal Opening is Open

Patients with Recurrent Urinary Tract Infections

A

Vesicouracheal Diverticulum

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89
Q

How do you Diagnose Vesicouracheal Diverticulum

A

Positive Contrast Cystography

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90
Q

Treatment for Vesicouracheal Diverticulum

A

Partial Cystectomy and Diverticulectomy

*Remove that section of the Bladder Wall and suture it back together

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91
Q

What are the Causes of Bladder Rupture

A

Mainly Trauma (HBC)

Severe Cystitis

Neoplasia

Urethral Obstruction

Iatrogenic- Ex. Catheterization, Cystocentesis

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92
Q

True/False: In Any Case of Abdominal Trauma, consider Bladder Rupture until you can Rule it out

A

True

*Palpable Bladder and Normal Urination does NOT rule out Bladder Rupture

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93
Q

How do you Diagnose Bladder Rupture

A

Positive Contrast Urethrocystogram (Most Reliable)- Leakage of Contrast Material into Abdomen

Abdominocentesis (Confirm Diagnosis)- Urine in Abdominal Cavity

Plain Radiographs: Obscured Serosal Detail, Free Abdominal Fluid, Absence of Bladder

Ultrasound: Helps Determine Source of Injury and Visualize Defects in Bladder Wall

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94
Q

When Performing an Abdominocentesis to Confirm Bladder Rupture, What do you expect to find with Regards to Creatinine and Urea Levels

A

Creatinine in Peritoneal Fluid > Serum Creatinine

Urea in Peritoneal Fluid = Serum Urea

*Once Creatinine in Abdominal Fluid is Higher than Serum Creatinine you have confirmed the presence of Urine in the Abdominal Cavity

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95
Q

How do you Treat Bladder Rupture

A

Surgical Repair Immediately if Stable- Debride Tear and Necrotic Tissue and Close Bladder Wall

Omentalize or Serosal Patching- Better Seal Bladder Defect

*Make sure to Explore the Entire Abdominal Cavity

*If Patient is Unstable, then Stabilize First with Fluids and Abdominocentesis (Decompress Abdominal Cavity)

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96
Q

What are the Indications for Tube Cystotomy

A

Any Need for Urinary Diversion- Bladder or Urethral Surgery/Trauma, Neurological Bladders

*Often Times we Divert urine with a Tube Cystostomy- Do this Procedure to help Keep the Bladder Decompressed

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97
Q

How to Perform a ______:

Ventral Midline Incision

Purse String Suture in Bladder

Make Stab Incision in Bladder and place 6-16 fr Foley or Mushroom Tip Catheter

Create Hole in Abdominal Wall and feed Catheter through Hole

Perform Cystopexy- Hold Bladder in place

Attach Collection Bag to End of Catheter to Monitor Urine

A

Tube Cystostomy

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98
Q

Potential Complications for Performing a ______:

A

Tube Cystostomy

*Patient always has to have an E Collar on whenever you place these Tubes otherwise they will Grab the Tubes and pull them out

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99
Q

Indications for Performing a Cystopexy

A

Tube Cystostomy

Perineal Hernia

Urinary Incontinence associated with Pelvic Bladder

Cystopexy- Surgical attachment of the urinary bladder to the abdominal wall or to other supporting structures

In Patients with Perineal Hernias- the Bladder is one of the Structures that tends to Herniate. Cystopexy helps to prevent the Bladder from Herniating

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100
Q

How to Perform a ______:

Cranial Traction of Urinary Bladder

Suture Bladder Wall to Abdominal Wall

Two Lines of Suture

A

Cystopexy

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101
Q

Most Common Types of Cystic Calculi (Stones in the Bladder)

A

Struvite

Calcium Oxalate

*Struvite and Calcium Oxalate account for over 90% of Cystic Calculi

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102
Q

Clinical Signs associated with ______:

Hematuria, Straining and Discomfort

Palpation of Large Thickened Bladder

Sometimes Palpate Large Calculi

Urinary Tract Infection (76%)

A

Cystic Calculi

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103
Q

How do you Diagnose Cystic Calculi

A

Plain Radiographs- May see Radiopaque Stones within Bladder (Struvite, Calcium Oxalate). If Stones are Radiolucent (Cystine and Urates) then more Diagnostics are Required

Double Contrast Cystography or Ultrasound- Equally Effective for Detecting Radiolucent Stones within the Bladder (95% Effective)

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104
Q

What are the Non-Surgical Treatment Options for Cystic Calculi

A

Voiding Hydropropulsion

Transurethral Cystoscopy

Dietary Modification

Electrohydraulic Lithotripsy

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105
Q

Non-Surgical Treatment Option for Cystic Calculi Described Below:

Must be Very Small Calculi (Smaller than Urethral Diameter)

Place Patient under Anesthesia

Inject Saline into the Bladder- Distend Bladder

Hold Upright

Express Bladder

Re-Radiograph

A

Voiding Hydropropulsion

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106
Q

Non-Surgical Treatment Option for Cystic Calculi Described Below:

Use of Cystoscope to Remove Small Stones

Stones must be Smaller than the Diameter of the Urethra

Grab Stones and Manually Remove them out of the Bladder

A

Transurethral Cystoscopy

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107
Q

Non-Surgical Treatment Option for Cystic Calculi Described Below:

ONLY works for Struvite Stones

Cannot be Obstructed

A

Dietary Modification

*Alter the Diet to help Dissolve the Stones

*Diet Modification DOES NOT work on Calcium Oxalate Stones

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108
Q

Non-Surgical Treatment Option for Cystic Calculi Described Below:

Passage of a Cystoscope

Electrode Wire and Spark Generator to Break apart Stone

A

Electrohydraulic Lithotripsy

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109
Q

When is Surgery Indicated for Cystic Calculi

A

Urinary Tract Obstruction

No Medical Options

Other Retrieval Methods Failed

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110
Q

Most Common Surgical Procedure used to Remove Cystic Calculi

A

Cystotomy

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111
Q

Surgical Procedure for Cystic Calculi Described below:

Caudal Ventral Midline Approach

Moistened Lap Sponges

Empty Bladder (Compression/Small Needle and Syringe)

Place Stay Suture in Lateral Aspect and Apex of Bladder

Make Stab Incision at Apex of Bladder and Extend Incision with Scissors

Evert Bladder Walls to Allow Full Inspection

Remove Calculi with Instrument

Pass Urethra Catheter and Flush to Ensure Patency

A

Ventral Cystotomy

*Ventral Cystotomy Approach is Preferred over Doral Approach

*Submit Urine, Stones, and Mucosal Tissue for Culture

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112
Q

What is the Layer of Strengh when Closing a Cystotomy Incision

A

Submucosa

*Layer of Strength of the Bladder

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113
Q

Following a Cystotomy, the Bladder Requires a Water Tight Closure.

What are the Common Suture Patterns used to Close the Bladder?

A

One or Two Layer Inverting Pattern- Cushing Followed by Lembert

Simple Continuous in the Submucosa followed by Cushing Pattern

*Inverting Pattern will Create Fibrin Seal and assist us with Water Tight Closure- Serosa to Serosa Contact Encourages Fibrin Seal

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114
Q

Following Cystotomy, after closing the Bladder, make sure to perform a ______

A

Leak Test

*Compress Neck of Bladder and Inject Saline and look for any leakage at the incision site

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115
Q

What is Polypoid Cystitis

A

Benign Polyps that Develop within the Mucosa of the Bladder

*Rare Condition that Mimics a Neoplastic Condition

When the Polyps rupture the Patients will have Bloody Urine

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116
Q

How do you Diagnose Polypoid Cystitis

A

Biopsy

*Biopsy confirms Polypoid Cystitis

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117
Q

Treatment for Polypoid Cystitis

A

Surgery- Resect Affected Tissue

*Usually Curative after you Resect the Polyps since it is a Benign Condition

118
Q

Most Common Bladder Tumor in the Dog

A

Transitional Cell Carcinoma (TCC)

*97% Malignant and has an affinity for the TRIGONE area

119
Q

Most Common Bladder Tumor in the Cat

A

Transitional Cell Carcinoma

*Most Common Bladder Tumor in Cats, and the Second most Common Urinary Tract Tumor in Cats

120
Q

Most Common Urinary Tract Tumor in Cats

A

Renal Lymphoma

121
Q

How does Transitional Cell Carcioma (TCC) differ in the Dog and Cat?

A

Most common Older FEMALE Dogs

Most Common in Middle Aged MALE Cats

Dogs: Affinity for TRIGONE area of Bladder

Cat: Affinity for APEX of Bladder

*Felines- More Ammenable for Surgery because the TCC is in the Apex of the Bladder

Canine- Less Amenable for Surgery because the TCC is found within the Trigone Area

KNOW THESE DIFFERENCES- On Exam

122
Q

Predisposing Factors for ______ in the Bladder:

Obesity

Insecticide Exposure

Herbicide Exposure

Cyclophosphamide (Anti-Cancer Drug)

A

Transitional Cell Carcinoma (TCC)

*Carcinogen Exposure- Insecticides and Herbicides. Patients that have been exposed to Insecticides and Herbicides have shown an Increased Incidence of the Development of TCC

123
Q

Breed Predisposition for Transitional Cell Carcinoma

A

Older Scottish Terriers

124
Q

Physical Exam Findings in Patients with ______:

A

Transitional Cell Carcinoma

*Often we can Palpate a Large Mass in the Caudal Abdomen in the Area of the Bladder

*Since there is such High Metastatic Potential you are going to look for Metastatic Disease- Ex. Lymphadenopathy

125
Q

How do you Diagnose Transitional Cell Carcinoma?

A

Cystoscopy (Very Diagnostic)- Can Visualize and Biopsy Mass

Ultrasound (Very Diagnostic)- Determines Degree of Bladder Invasiveness, Evaluate Abdomen for Metastatic Disease and LN Involvment

Bladder Tumor Antigen Test (BTAT)- High Risk of False Positives

*30% of Urine Cytology will pick up TCC

126
Q

Name the Advantages and Disadvantages of the Bladder Tumor Antigen Test (BTAT) used to diagnose Transitional Cell Carcinoma

A

Advantage- Best used as Routine Screening Test for Older Patients

Disadvantage- High Incidence of FALSE POSITIVES

*Very Poor in Differentiating Patients with Lower Urinary Tract Disease versus Transitional Cell Carcinoma (False Positives)

127
Q

Treatment for Transitional Cell Carcinoma (TCC) of the Bladder

A

Combination Protocol- Chemotherapy and Partial Cystectomy

*Chemotherapy and Partial Cystectomy on their Own did not Increase the Mean Survival Time of the Patient. Only in Combination do they Increase the Survival Time

128
Q

Urethral Condition Described Below:

Most Common Developmental Abnormality of Male Genitalia

Incomplete Formation of Penile Urethra

Urethral Orifice can occur anywhere along Penis

A

Hypospadias

129
Q

Treatment for Hypospadias

A

If Asymptomatic- Leave it alone

If Clinical Signs- Reconstruction Procedure

*Most of the Time these patients are Asymptomatic and we just leave it alone. Only Perform Surgery if the Patient is developing Urine Scolding and other Clinical Signs

130
Q

Protrusion to Urethral Mucosa through Orifice

A

Urethral Prolapse

*Associated with some form of Straining

131
Q

Clinical Signs associated with which Urethral Disorder:

Bleeding from Prepuce

Licking

Red-Purple Mass

A

Urethral Prolapse

132
Q

Urethral Prolapse is most Common in Young Male _____ Dogs

A

Brachycephalic

*Most Urethral Prolapses occur in Brachycephalic Breeds that Strain while Breathing, which leads to the Prolapse

133
Q

Treatment for Urethral Prolapse in Asymptomatic Patients

A

Reduce with Aid of Large Catheter

Place Purse String Suture- Leave for 5 Days

*Tie Purse String to help Prevent it from Prolapsing again

134
Q

Two Adjunctive Treatments done in Patients with Urethral Prolapse

A

Surgical Correction of Airways

Castration

*Brachycephalics are more Prone to Urethral Prolapse due to Straining while Breathing. If the Airways are corrected, so that they are not straining to breathe so much then Prolpase will not recur

135
Q

Treatment for Urethral Prolapse in Symptomatic Patients

A

Urethropexy- If Tissue is Viable

Resection and Anastomosis- Tissue is NOT Viable

136
Q

What Suture Material is best for Urethral Surgery

A

Monofilament Absorbable (PDS)

*AVOID Braided Absorbable (Vicryl)

137
Q

What Causes Urethral Obstruction in Dogs and Cats

A

Mucus Plugs

Crystals or Stones

Neoplasia

Strictures

*Most common cause of Urethral Obstruction in male Dogs is Calculi

138
Q

Where is Urethral Obstruction Most Common in Male Dogs and Cats?

A

Male Dogs: Ischial Arch or Caudal to Os Penis

Male Cats: Distal 1/3 of Urethra

139
Q

How do you Diagnose Urethral Obstruction

A

Contrast Urethrography

Plain Radiographs- Radiopaque Calculi, Large Distended Bladder

140
Q

In Patients with Urethral Obstruction, you want to administer _____ right away in order to Decrease the Urea/BUN Concentrations

A

Fluids

*Fluids will help to Improve Metabolic Acidosis

141
Q

Three Methods used to Temporarily Relieve Urethral Obstruction in a Dog or Cat due to Calculi

A

Catheter

Hydropropulsion

Cystocentesis

*Initially try to Relieve the Obstruction Non-Surgically

142
Q

Non-Surgical Method used in CANINE Patients to Temporarily Relieve Urethral Obstruction due to Calculi:

A

Retrograde Hydropropulsion

*Place Catheter as far up the Urethra as possible and attempt to Inject Saline under pressure in order to distend the Urethra in an attempt to Flush the stone back into the Bladder- Much easier to do Surgery on the Bladder rather than the Urethra

143
Q

Surgical Technique to Relieve Urethral Obstruction due to Calculi if Hydropropulsion was NOT Successful

A

Urethrotomy

*If Hydropropulsion was Successful the Calculi would be in the Bladder and we would Perform a Cystotomy

If Hydropropulsion was NOT Successful then we must perform a Urethrotomy- Cutting into the Urethra and Removing the Stone at the Location where the Obstruction has occured

Indications- Calculi that cannot be Hydropropulsed

144
Q

Where would you Perform a Urethrotomy in Canine Patients

A

Prescrotal

*Very Superficial Area with Less Cavernous Tissue

145
Q

Surgical Technique to Relieve Urethral Obstruction due to Calculi Described Below:

Place Urethral Catheter

Ventral Midline Incision between Base of Scrotum and Caudal Penis

Retract Retractor Penis Muscle

Incise Urethra and Remove Calculi

Flush Urethra

A

Prescrotal Urethrotomy

*Most Common Surgical Technique used in Canine Patients

146
Q

Two Available Methods for Closure Following Prescrotal Urethrotomy

A

4\0 Monofilament Absorbable- Suture Urethra Closed

Second Intention (Preferred)- Advantage: Less Risk of Stricture, Disadvantage: Profuse Hemorrhage

147
Q

Why is Perineal Urethrotomy a Less Preferred Surgical Method to Relieve Urethral Obstruction?

A

Increased Risk of Infection

Difficult Procedure

148
Q

Surgical Formation of a Permanent Opening of the Urethra at a New Site

A

Urethrostomy

149
Q

Preferred Locations for Urethrostomy in Dogs and Cats

A

Canine- Scrotal

Feline- Perineal

*Canine- Scrotal Urethrostomy is Preferred because it is More Superficial, Less Hemorrhage, and Less Urine Scold

150
Q

In a Scrotal Urethrostomy, which Structures should be Draped in your Surgical Field?

A

Abdomen

Scrotum

Prepuce

151
Q

In a Scrotal Urethrostomy, How Long should the Urethral Incision be?

A

2.5-4cm Long

152
Q

In a Scrotal Urethrostomy, What is the Most appropriate Suturing Method?

A

4\0 Absorbable/Non-Absorbable Monofilament

Take Bites at Edge of Cavernous Tissue- Avoid Cavernous

*AVOID Cavernous Tissue- Only Engage Urethral Mucosa and Skin

153
Q

Complications of a Scrotal Urethrostomy

A

Hemorrhage

Dehiscence

Urine Scald

Stricture

UTI

154
Q

What is the Disadvantage of a Canine Prescrotal Urethrostomy

A

Higher Incidence of Urine Scald

155
Q

When is a Perineal Urethrostomy in a Cat Indicated?

A

Frequent Obstruction

Strictures

Trauma

*Perineal Urethrostomy- Commonly done Procedure in Feline Patients. Usually performed in Cats where Medical Treatment for Recurrent Obstructions (Mucous Plugs or Crystals) isn’t Working

*After Multiple Attempts of Medically Preventing Recurrence of Urethral Obstruction, we end up doing this Salvage Procedure of removing part of the Proximal Urethra

156
Q

What are the Goals of Perineal Urethrostomy in Cats?

A

Mobilization of Urethra

Creation of Wide Urethral Orifice

157
Q

What Gland/Area of the Urethra do you dissect to when Performing a Perineal Urethrostomy in a Cat

A

Bulbourethral Gland/Pelvic Urethra

*Dissect to the Level of the Bulbourethral Gland- Anatomical Landmark to know you are within the Pelvic Urethra

158
Q

When Performing Perineal Urethrostomy, how can you check if the Urethral Orifice is Wide Enough?

A

Mosquito Hemostat to Hinge

*To Ensure that you have a Wide enough Opening, take a pair of Mosquito Hemostats and place it into the Urethra and it should and it should reach all the way up to the Hinge Section of the Hemostat

159
Q

Complications of a Perineal Urethrostomy in a Cat

A

Hemorrhage (Common)

Urinary Tract Infection (Common)

Stricture

Subcutaneous Urine Leakage: Improper Suturing

*Complication Rate- 25%

160
Q

Creation of a Urethrostomy on the Ventral Body Wall Cranial to the Pubis

A

Antepubic Urethrostomy

161
Q

Indications for which Type of Urethrostomy Procedure:

Recurrent Pelvic Urethral Obstruction

Failed Perineal Urethrostomy that cannot be Revised

A

Antepubic Urethrostomy

162
Q

Complications associated with Antepubic Urethrostomy

A

Urine Scalding- Big Problem

UTI

Incontinence

163
Q

Clinical Signs of Urethral ______:

A

Trauma

*Most of the TIme with Urethral Trauma the patient will show Straining with Hematuria

*There may be Leakage into Adjacent Subcutaneous Tissue- Urine accumulating and Causing Necrosis of that Tissue

164
Q

How do you Diagnose Urethral Trauma

A

Positive Contrast Urethrogram

165
Q

Treatment for Urethral Trauma

A

Incomplete or Small Laceration- Heal with Urinary Diversion and Urethral Catheter (Conservative Managment)

Complete Laceration- Anastomosis or Repair with Urinary Diversion

166
Q

What are the Causes of Urethral Strictures

A
167
Q

Patients with Urethral Strictures won’t show Clinical Signs until _____% of the Urethra is Narrowed

A

60%

168
Q

How do you Diagnose Urethral Strictures?

A

Cystoscopy- See Stricture within Urethra

Urethrogram

169
Q

Treatment for Urethral Strictures

A

Urethral Dilators

Balloon Dilation

Resection and Anastomosis (Severe Strictures)

170
Q

Review Card: Dental Terminology

A
171
Q

Very Important Anatomic Landmark shown by the Red Line

A

Mucogingival Line

*Junction between the Gingiva (Soft Tissue of the Oral Cavity that supports the Teeth) and the Oral Mucosa

172
Q

Review Card: Dental Anatomy

A
173
Q

The Dentin of the Tooth is the Dense Body-Like Matrix layer beneath the Enamel and the Cementum. It is a _____ Layer sensitive to Heat or Cold because the Dentinal Tubules allow Indirect Access to the Nerves in the Pulp Chamber

A

Porous

174
Q

Review Card: Radiographic Anatomy of Tooth

Portion of the Pulp that is BELOW the Crown = Root Canal

Portion of the Pulp that is ABOVE the Crown = Pulp Chamber

A
175
Q

Only Visible Part of the Periodontium in a Normal Mouth

A

Gingiva

176
Q

Potential Space Between Tooth and Gingiva

A

Gingival Sulcus

177
Q

Collagenous Connective Tissue Structure Extending from Cementum to Periosteum of the Tooth

A

Periodontal Ligament

178
Q

Functions of the _______:

Attaches Teeth to the Alveolus

Absorbs Shock from the Impact of Occlusal Forces and Transmits them to Alveolar Bone

Supplies Nutrients to Alveolar Bone and Cementum via Arterioles

Isolates the Tooth from the Surrounding Bone and, IMPORTANTLY, the Osteoclasts that Remodel the Surrounding Bone

A

Periodontal Ligament

179
Q

If the ______ Ossifies, due to Trauma or Excess Vit. D, then Osteoclasts can invade the Tooth and Remodel it into Brittle Bone Rather than a Flexible Tooth full of Dentinal Tubules. This Causes the Roots to Essentially Disappear and the Crown to Break off since the Tooth Doesn’t Flex when it chews on something solid

A

Periodontal Ligament

*Vitamin D is Toxic to the Periodontal Ligament Fibers

180
Q

True/False: This is a Mass/Tumor in the Oral Cavity

A

False

*This is Incisive Papilla- Overlies the Vomeronasal Organ

181
Q

Perminant Bud Arises from the Deciduous Bud in Utero. Therefore if there is No _____ Tooth, there will be NO Corresponding Permanent Tooth

A

Deciduous Tooth

182
Q

Part of the Tooth that is < 0.1 mm to 0.6 mm Thick and that is NOT Replaced if Damaged

A

Enamel

183
Q

Part of the Tooth that Consists of Blood Vessels, Nerves and Connective Tissue

A

Pulp

*As the Animal Ages the Pulp Chamber becomes Progressively Smaller

184
Q

Normal ______ Process:

As the Root Lengthens, the Deciduous Tooth will Erupt. Soon after the Tooth is Fully Erupted the Root will Begin to Undergo Resorption. At the Same time the Permanent Tooth Bud starts its development and Erupts as the Deciduous Tooth is Shed

A

Eruption

185
Q

Review Card: Anatomical Numbering System

Place the Number of the Tooth on the Corresponding Side of the Letter

As a Superscript if in the Maxilla and a Subscript if in the Mandible

_If Deciduous Teeth use Small Case Lette_rs

Ex. Maxillary Canine of Right (C1)

Ex. Second and Third Premolar on Left (<span>2,3</span>P)

A

Incisor = I

Canine = C

Premolar = P

Molars = M

186
Q

Review Card: Triadan System

First Number = Quadrant the Tooth is In

Second and Third Number = Number of the Tooth Itself

Canine Incisor is ALWAYS 04

First Molar is ALWAYS 09

KNOW THE RULE OF 4 AND 9

A

Examples:

Right Maxillary Middle Incisor = 102

Left Maxillary Canine = 204

Left Mandibular 4th Premolar = 308

Right Mandibular 1st Molar = 409

187
Q

Dental Disorder Described Below:

Caused by Failure of the Primary Tooth’s Root to undergo Resorption

Cause Displacement of Permanent Teeth that can lead to Orthodontic Problems or Soft Tissue Trauma

Canine Teeth and Incisors Most Commonly

A

Retained Decidious Teeth

188
Q

Two Clinical Problems that Arise from Retained Decidious Teeth

A

Malocclusions

Periodontal Disease

189
Q

With Retained Decidious Teeth, Permanent Teeth usually Erupt Lingual to the Decidious Teeth. The Primary Exception is the Maxillary Canine which Erupts _____ to Its Deciduous Counterpart

A

Mesial (Rostral)

190
Q

Most Common Malocclusion caused by Retained Decidious Teeth:

Mandibular Adult Canines Erupt LINGUAL to Decidious Canines

A

Base Narrow Canines

*Canines have come in Too Far Lingually and they are Impacting on the Soft Tissue entrapped there

191
Q

Treatment for Retained Decidous Teeth

A

Extract Decidious Teeth that are Retained

192
Q

Dental Disorder Described Below:

“Extra Teeth” most commonly seen in Premolar Area

Can Interfere with Normal Occlusions, Cause Overcrowding, Malposition, Malocclusion or Incomplete Eruption of Adjacent Teeth

A

Supernumerary Teeth (Polyodontia)

193
Q

Dental Disorder Described Below:

Missing Teeth

Genetic Defect (Never Developed)

Premolars are Most Commonly Affected

Predisposed Breeds- Mexican Hairless and Chinese Crested Dogs

A

Adontonia/Hypodontia (Missing Teeth)

*Rule of Thumb- If Deciduous Tooth is Congenitally Absent, the Adult Tooth will also be missing

194
Q

Normal Occlusion Described Below:

A

Scissor Bite

195
Q

Class of Malocclusion Described Below:

Malpositioned Teeth

Jaw Length Normal

A

Class 1

*Some Teeth are within an Improper Position

196
Q

Class of Malocclusion Described Below:

Mandibular Brachygnathisim

Upper Jaw is Longer than the Lower Jaw (Parrot Mouth)

A

Class 2

*Mandible is too short- Mandibular Brachygnathism

197
Q

Class of Malocclusion Described Below:

Mandibular Prognathism

Mandible is Longer than the Maxilla (Underbite)

A

Class 3

*Ex. Bulldogs

198
Q

Class 1 Malocclusion Described Below:

Teeth are Misaligned due to too many Teeth (Supernumerary Teeth) or the Jaw is too small for the Normal Number of Teeth

A

Crowding

*Not enough room for all the teeth to fit in the normal alignment

199
Q

Most Common Class 1 Malocclusion:

Mandibular Adult Canines Erupt LINGUAL to Decidous Canines

A

Base Narrow Canines

200
Q

Class 1 Malocclusion Described Below:

One or More Maxillary Incisors are Displaced Towards the Palate

A

Anterior Cross Bite

*The Maxillary Incisors should be Rostral to the Mandibular Incisors

201
Q

Class 1 Malocclusion Described Below:

Maxillary Premolars are Lingual to Mandibular Premolars

A

Posterior Cross Bite

202
Q

Class 3 Malocclusion Described Below:

Incisor Crowns Meet Instead of the Mandibular Incisors being Directly Behind the Maxillary Incisors

Considered Prognathism

Leads to Abnormal Wear on Incisors- Attrition

A

Level Bite

203
Q

Malocclusion Described Below:

Elongation of One Half of the Hed so there is Unequal Arch Development

Midline of the Mandible and Maxilla do NOT Line Up

A

Wry Mouth

204
Q

Treatment for Malocclusions Described Below:

Certain Teeth Extracted or have their Crown Height Reduced to Prevent Trauma to other Teeth or Soft Tissue Structures in the Mouth

A

Interceptive Orthodontics

205
Q

Treatment for Base Narrow Canine Malocclusion:

Acrylic Material Placed Inside the Maxilla

A

Incline Planes

206
Q

Impacted Teeth can result in _____ Formation and Should be Extracted in most Cases

A

Dentigerous Cyst

207
Q

Dental Disease Described Below:

Damage to Ameloblasts during Enamal Development or Exposure of Enamel to Corrosive Material

Enamel Wears Down Over Time

A

Enamel Hypocalcification/Hypoplasia

*Overtime the Enamel is worn down and the teeth assume and Irregular Knob Shape with Dentin that stains Brown

208
Q

Distemer Virus Infection or other Diseases that cause High Fever during Permanent Tooth Development can cause Generalized or Focal Defects in _____

A

Enamel

209
Q

Treatment for Enamel Hypocalcification/Hypoplasia

A

Focal: Restore Defect with Composite

Cap Important Teeth to Prevent Wear

210
Q

In Tibetan Terriers, ______ occurs in addition to Generalized Enamel Defects

A

Root Abnormalities

211
Q

Dental Disease Described Below:

Drug that if Given to Pregnant Bitches and Given to Young Pups when Adult Teeth are Developting will lead to Yellow-Stained Teeth

Dentin is the Affected Layer

A

Tetracycline Staining

*No Treatment

212
Q

Dental Disease Described Below:

Pathologic Wearing due to Contact with Opposing Tooth (Malocclusion)

A

Attrition

213
Q

Treatment for Attrition

A

Orthodontic Correction

Crown Reduction

Extraction

214
Q

Dental Disease Described Below:

Abnormal Contact with Crown Surface by Foreign Object (Ex. Tennis Balls, Cages)

A

Abrasion

215
Q

Dental Disease Described Below:

Etiology- Bacteria Produce Organic Acids that, when in the Presence of Carbs, Decalcify Enamel and Dentin

Uncommon due to Scissor Bite, Pointed Crowns, and Diet

Appearance- Brownish Color, Leathery Consistency

A

Dental Caries (Cavities)

216
Q

Treatment for Dental Caries (Cavities)

A

Indirect or Direct Pulp Capping

Root Canal

Extraction (Most Common)

*Normally Dental Caries are Severe by the Time they are Reconized. Therefore Most Commonly the Tooth ends up being Extracted

217
Q

Dental Disease Described Below:

Infection that Can Result in Endodontic or Periodontic Lesions

A

Periapical Infection

*Classic Presentation- Draining Tract at the Medial Apect of the Eye

218
Q

Draining Tract Associated with The Teeth is called a ______

A

Parulis

*If the Parulis is at the Mucogingival Line- Most Likely to be Caused by Endodontic Disease

219
Q

Dental Disease Described Below:

Etiology: Focal Hyperplastic Gingiva in Periodontal Disease

Predisposed Breeds: Boxers

Can occur with Administration of Drugs- Cyclosporine, Calcium Channel Blockers

A

Gingival Hyperplasia

220
Q

Treatment for Gingival Hyperplasia

A

Gingivectomy/Gingivoplasty

Post Op Care- Twice Daily Rinses with 0.2% Chlorhexidine Solution

*Treatment- Remove Excessive Tissue to Return Sulcus Depth to Normal. Try to Recreate Normal Scalloped Contour

221
Q

Dental Disease Described Below:

Trauma to the Pulp

Discoloration of the Tooth- Purple/Grey

May be Reversible- But NOT Often (< 10%)

The Older the Patient the Less Likelihood the Pulp will Survive

A

Pulpitis

*Trauma to the Pulp has caused Bleeding. Blood Perculates out into the Dentinal Tubules leading to Purple Color of Tooth

*The Younger the Animal, the Greater the Likelyhood the Pulp will Survive

222
Q

Treatment for Pulpitis

A

Monitor- If Tooth is Still Alive

Root Canal or Extraction- If Tooth is Dead

*Pink Tooth = Still Alive

Grey Tooth = Dead

223
Q

Radiographic Findings in a Tooth with Pulpitis

A

Decreased Wall Size

Lucency around Apex

Apex Resorption

224
Q

Tooth Fracture Classification Described Below:

Microfractures in Enamel caused by Heavy Chewing

Staining of Teeth Often Occurs in Lines

NO Loss of Structure

A

Enamel Infraction (Abraction)

225
Q

Tooth Fracture Classification Described Below:

Tooth Fracture where the Pulp Chamber is NOT Exposed

A

Uncomplicated Crown Fracture

226
Q

Tooth Fracture Classification Described Below:

Crown Fracture where Pulp is Exposed

A

Complicated Crown Fracture

227
Q

Chewing on Hard Objects such as Nylabone can cause Shearing Forces of the Crown known as ______ that Extend into the Surface of the Root

A

Slab Fractures

*Slab of the Tooth is Fractured off- Most Common in Maxillary 4th Premolar

228
Q

Treatment for Uncomplicated Crown and Enamel Fractures

A

Indirect Pulp Capping

Crown Restoration

229
Q

Treatment for Complicated Fractures

A

Vital Pulpotomy

Root Canal

Extract Tooth

*If there is Minimal Periodontal Involvement, the Tooth can be Saved by Performing a Vital Pulpotomy or Root Canal and Placing the Dog on Antibiotics

*Root Canal- Take out all the Contents of the Tooth

230
Q

Diagnosis and Treatment of Disease that Affect the Tooth Pulp and Apical Periodontal Tissues

A

Endodontics

231
Q

Indications for _____:

A

Endotontics

232
Q

Endodontic Procedure Described Below:

Maintains a Viable Tooth that will Continue to Mature

Performed after Acute Pulp Exposure due to due to Trauma

Patients < 18 Months Old (Immature Tooth)

80% Initial Success when Performed < 48 Hours after Pulp Exposure

A

Vital Pulpotomy

*Removal of the Corroded Portion of the Pulp

233
Q

Endodontic Procedure Described Below:

Remove the Exposed and Contaminated Pulp from Crown with Dental Bur

Gently Flush the Access Site with Sterile Saline

Apply ProRoot MTA (Mineral Trioxide Aggregate) to Stimulate Dentinal Bridge Formation

Place Intermediate and Surface Restoration

Re-Radiograph at 3, 6, and 12 Months Post Op

A

Vital Pulpotomy

234
Q

Endodontic Procedure Described Below:

Goal is to Remove ALL the Pulp Contents, Disinfect the Pulp Cavity, Create a Seal at the Apex to Trap Remaining Bacteria in the Tooth

Mature Tooth (> 24 Months)

Maintains Tooth Function but Tooth is “Dead”

A

Root Canal

235
Q

Endodontic Procedure Described Below:

Access Pulp Cavity and Remove Dead or Infected Pulp

Clean and Shape the Canal with Endodontic Files

Flush Canal with Sodium Hypochlorite while Cleaning and Shaping

Obturate (Fill) the Canal: Seal Apex and Fill the Rest of Canal with Gutta Percha

Radiograph to Confirm Complete Obturation

Restore the Surface of the Crown at Fracture

A

Root Canal

236
Q

Dislocation of a Tooth out of its Alveolus WITHOUT being Totally Avulsed from the Mouth

A

Luxation

237
Q

The Total Separation of a Tooth from its Alveolus

A

Avulsion

238
Q

For Luxated/Avlused Tooth:

Re-Implantation should occur within 30 Minutes of Avulsion. While Awaiting Aplantation the Tooth Should be Kept in a Mixture of Saliva and _____

A

Milk

*After 30 Minutes Success goes down Exponentially

239
Q

Treatement for Tooth Luxation/Avulsion

A

Re-Seat in Alveolus and then Splint in Place (4 weeks)

Perform Root Canal when Splint is Removed if Tooth is Reattached

*Replace the Avlused Tooth into the Socket and then Place Acrylic Splint. A Root Canal is Performed Later when Reattachment of the Tooth is Verified

240
Q

Dental Disease Described Below:

Most Common Disease of Tooth Structure in Domestic Felines

Osteoclast Resorption is the Predominant Activity

A

Tooth Resorption

241
Q

Type of Tooth Resorption Described Below:

A

Type 1

242
Q

Type of Tooth Resorption Described Below:

A

Type 2

243
Q

Type of Tooth Resorption Described Below:

A

Type 3

244
Q

Clinical Signs in Cats with ______:

Very Localized Hyperplastic/Hyperemic Gingiva

Pain- Dropping Food, “Chattering”, Anorexia, Reluctance to have Mouth Examined

A

Tooth Resorption

245
Q

Treatment for Tooth Resorption

A

Type 1: Entire Tooth should be Extracted

Type 2: Extract Entire Tooth if Root Structure/Pulp Chamber are Intact. If Not Intact, Amputate Crown and Superficial Root and Leave Ankylosed Part of the Root since its being Reabsorbed anyway

Type 3: Combination of Above

246
Q

Dental Disease Described Below:

Etiology: Unknown but Possibly due to Calicivirus

Chronic Non-Responsive Inflammatory Oral Disease Characterized by a Distinct Infiltrate of Plasma Cells and Lymphocytes

Clinical Signs: Ptyalism, Dysphagia, Anorexia, Severe Marginal Gingivitis

A

Feline Gingivostomatitis

247
Q

Treatment for Feline Gingivostomatitis

A

Teeth Extraction- All Caudal Teeth or All Teeth (Most Effective)

Prophylaxis/Home Care

248
Q

Dental Disease Described Below:

Noted in Cats < 9 Months of Age

Clinical Signs:

Abundant Plaque and Calculus that Results in Gingivitis, Bone Loss, Gingival Resorption and Pocket Formation

A

Juvenile-Onset Periodontitis

249
Q

Treatment for Juvenile-Onset Periodontitis

A

Frequent Prophylaxis and Aggressive Homecare- May “Outgrow”

Extractions

250
Q

Dental Disease Described Below:

Severe Inflammation of the Paradental Tissue (Kissing Lesions)

Clinical Signs:

SEVERE Halitosis (Bad Breath)

Thick, Cloudy Saliva

Oral Pain and Difficulty Eating

A

Canine Ulcerative Paradental Stomatitis (CUPS)

251
Q

Treatment for Canine Ulcerative Paradental Stomatitis (CUPS)

A

Home Care: 1-2x’s Daily Brushing

Total Mouth Extractions

252
Q

Study and Treatment of Diseases affecting the Supporting Structures of the Tooth

A

Periodontics

253
Q

Dental Disease Described Below:

Most common Oral Disease

> 70-85% of Dogs and Cats

#1 Cause of Tooth Loss

More Common due to: Diet, Malocclusion

A

Periodontal Disease

254
Q

Diseases that Exacerbate Periodontal Disease:

Neutrophil Dysfunction

Diabetes Mellitus

Autoimmune Disease

Hyperadrenocorticism

Feline Viral Disease- Especially _______

A

Calicivirus

*Calicivirus in Cats can cause Issues within the Oral Cavity

255
Q

Three Etiologies of Periodontal Disease

A

Acquired Pellicle (Biofilm)- Thin Layer of Salivary Proteins that Form on Surface of Tooth and serves as Site for Bacterial Attachment

Plaque- Combinatinon of Bacteria, Food, Debris, and Oral Epithelial Cells

Calculus- Mineralized Plaque Containing Bacteria which Release Endotoxins that Cause Gingivitis

256
Q

Loosely Adhered ______ Plaque causes an Inflammatory Response which Results in Destruction of the Junctional Epithelium and Epithelial Attachment exposing the Periodontium. This in turn creates a Periodontal Pocket which allows apical migration of the Bacteria and Further Loss of the Periodontal Ligament and Alveolar Bone

A

Subgingival Plaque

257
Q

Pathophysiology of ______:

Gingival Recession

Destruction of Periodontal Ligament

Bone Loss

Mobility

A

Periodontal Disease

*Mobility of the Tooth caused by Destruction of Periodontal Ligament

258
Q

Clinical Signs of _______:

A

Periodontal Disease

*Accumulation of a Lot of Debris on the Surface of the Tooth

259
Q

Stage of Periodontal Disease Shown Below:

Gingival Tissue is Firm and Pink or Pigmented

Defined Stipling

Free Gingival has Knife-Like Edge

Minimal Sulcus Depth: 1-3mm in Dog, 0-1mm in Cats

A

Stage Zero (Normal)

260
Q

Stage of Periodontal Disease Shown Below:

Erythema

Gums Bleed When Probed

Loss of Stipling

Normal Sulcus Depth

Reversible- With Proper Treatment

A

Stage 1 (Gingivitis)

261
Q

Stage of Periodontal Disease Shown Below:

Gums Bleed when Probed

Minor Pockets

Minimal Bone Loss

Usually NO Mobility

Periodontitis can be Controlled but NOT Completely Reversed

A

Stage II (Early Periodontitis)

*CANNOT be Reversed, Only Controlled

262
Q

Stage of Periodontal Disease Shown Below:

A

Stage III (Moderate Periodontitis)

*Up to about 50% Bone Loss

263
Q

Stage of Periodontal Disease Shown Below:

A

Stage IV (Advanced Periodontitis)

* > 50% Bone Loss, Advanced Bone Mobility

264
Q

# 1 Preventative Method for Periodontal Disease

A

Mechanical Abrasion

*Good Home Care

265
Q

Treatment of Periodontal Disease

A

Home Care- Start Daily Tooth Brushing

Thorough Dental Cleaning

Dental Diets/Dental Hygeine Chews- Help Prevent Accumulation of Plaque and Tartar

Antibiotics- Clindamycin

266
Q

True/False: Antibiotics can cure Periodontal Disease

A

False

*Antibiotics DO NOT cure Periodontal Disease

267
Q

Dental Instrument Desribed Below:

Pointed Tip, Two Cutting Surfaces

Work Away from Sulcus

NEVER use Sharp Tip below the Gingival Margin

A

Scaler

*ONLY used Supragingivally- Above the Gum Line

268
Q

Dental Instrument Desribed Below:

Rounded Tip and Back with Flat Face

Used for Supra-or Subgingival Calculus Removal and Root Cleaning

A

Curette

269
Q

Dental Instrument Desribed Below:

Probe used to Measure Sulcus Depth

A

Periodontal Probe

270
Q

Dental Instrument Desribed Below:

Considered to be the Best Scaler in Vet Met

Creates Best Motion for Cleaning

A

iM3 42-12

271
Q

Review Card: Complete Dental Cleaning

1. Disinfect the Oral Cavity- Power Spray the Mouth with Chlorohexidine

2. Examine the Oral Cavity- Visual Inspection using Magnification. Look and Feel Under Tongue

3. Gross Calculus Removal- Hand Scaling

4. Subgingival Calculus Removal- CRITICAL STEP

5. Missed Calculus Detection- Air from 3 Way Syringe- You can see Inside Pockets this way. Residual Calculus will Appear Chalky White

6. Polish- ESSENTIAL STEP

7. Sulcus Irrigation- Flush Polish out of the Sulcus

8. Diagnostics- Periodontal Probing (Measure Sulcus Depth), Charting, Dental Radiographs

A
272
Q

Review Card: Calculus Index and Gingitivits Index

A
273
Q

True/False: Some Degree of Tooth Mobility is Normal and is Referred to as Physiologic Mobility and Represents the movement of a tooth within the Periodontal Ligament Space

A

True

*Movement in Excess of Physiologic Mobility is Referred to as Pathologic Mobility

274
Q

Grade that Represents Severe Mobility of a Tooth

A

3

275
Q

When Performing a Complete Dental Cleaning, _____ are Essential to Identify “Hidden” Lesions and Develop a Treatment Plan

A

Dental Radiographs

276
Q

Diagnosis based on this Radiograph

A

Periodontal Disease

277
Q

List the Pathologies seen in this Radiograph

A
278
Q

Diagnosis based on this Radiograph

A

Periodontal Disease

279
Q

Diagnosis based on this Radiograph

A

Periodontal Disease

280
Q

Diagnosis based on this Radiograph

A

Feline Buccal Bone Expansion

281
Q

The Branch of Denstistry that Deals with Tooth Extraction

A

Exodontics

282
Q

Indications for ______:

A

Exodontics (Tooth Extraction)

283
Q

Diagnosis based on this Pre-Extraction Radiograph

A

Dilaceration (Curved Root Tip)

284
Q
A
285
Q
A
286
Q
A
287
Q
A
288
Q
A
289
Q
A
290
Q
A
291
Q
A

Small Animal Surgery (4 decks)

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