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SA Surgical Diseases and Techniques > Final Exam New Info > Flashcards

Final Exam New Info Flashcards

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1
Q

What are the goals of the disease modifying surgeries used for correction of hip dysplasia?

A

(To stop the tendency of the joint o subluxate, to restore hip congruity, and to save the joint from OA development)

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2
Q

The disease modifying surgeries used for correction of hip dysplasia (JPS, TPO, DPO) have to be performed in a narrow time window, most importantly prior to the development of what and when does that development begin on average?

A

(Prior to the development of OA which usually begins at around 7 months of age in a hip with DAR laxity)

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3
Q

In which direction will the acetabulum orient itself after a juvenile pubic symphysiodesis?

A

(Medially and ventrally → these directions of growth improves coverage and congruency)

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4
Q

Performing a JPS increases/decreases (choose) the acetabular angle of the pelvis.

A

(Increased)

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5
Q

When should a JPS be performed?

A

(As soon as the early diagnosis is reliable, 3 months of age or younger has a risk of false negative, 3.5-4 months the diagnosis is more reliable, and waiting for 4.5-5 months is only appropriate for giant breed dogs)

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6
Q

Listed below are the criteria that are evaluated for a JPS, give the values that would support the choice for surgery:

A - Age
B - Ortolani sign
C - Angle of reduction
D - Angle of subluxation
E - Dorsal acetabular rim angle
F - Dorsal acetabular erosion
G - Distractive index
H - Clinical signs

A

A - Age (3.5-4.5 months, giant breeds closer to 5.5 months)
B - Ortolani sign (positive → indicates there is laxity of the hip)
C - Angle of reduction (15-40 degrees)
D - Angle of subluxation (0-10 degrees, maybe up to 15?)
E - Dorsal acetabular rim angle (up to 12 degrees)
F - Dorsal acetabular erosion (should be none, if there is erosion indicates OA)
G - Distractive index (0.4-0.7)
H - Clinical signs (should be none, if there are c/s indicates OA)

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7
Q

What are the radiographic changes that can indicate if a dog has a history of a JPS procedure?

A

(Pubic symphysis fusion, broad and short pubic rami, widened obturator foramina, irregular pubic profile, and detectable acetabular fossae)

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8
Q

What are the potential complications associated with the JPS procedure?

A

(Urethral damage, skin burns, lack of efficacy, and ethical consequences)

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9
Q

What procedures make up a triple pelvic osteotomy?

A

(Osteotomy of the body of the ilium, pubic osteotomy, and ischial osteotomy)

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10
Q

What procedures make up a double pelvic osteotomy?

A

(OSteotomy of the body of the ilium and a pubic osteotomy)

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11
Q

How do you choose the angle of your DPO plate?

A

(Go between the angle of reduction and the angle of subluxation, most commonly used is 30 degrees)

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12
Q

One of the drawbacks of a DPO is the risk of transforming an apparently happy puppy into a disabled dog, in what two ways can this occur?

A

(Severe complications with implant failure and/or potentially severe neurological iatrogenic damage)

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13
Q

What were the main issues with TPOs which is why DPOs became so popular?

A

(Collapsed pelvic canal, over-correction leading to externally rotated stifles when walking (duck walking), and implant complications/failures)

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14
Q

The pathophysiology of patellar luxation is due to a limb deformity that results in a misalignment of what muscular mechanism?

A

(The quadriceps mechanism)

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15
Q

Which of the bellies of the quadriceps muscle does not originate from the proximal femur and instead on the ilium?

A

(The rectus femoris)

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16
Q

Give the patellar luxation grade for the following definition:

Alignment of the quadriceps mechanism is normal, patella cannot be luxated from groove

A

(Normal)

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17
Q

Give the patellar luxation grade for the following definition:

Patella can be luxated medially when joint in full extension, clinical signs typically absent

A

(Grade 1)

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18
Q

Give the patellar luxation grade for the following definition:

Spontaneous luxation occurs with non-painful, “skipping” lameness, mild skeletal deformities are present

A

(Grade 2)

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19
Q

Give the patellar luxation grade for the following definition:

Patella is luxated permanently but can be reduced, more severe bony deformities present

A

(Grade 3)

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20
Q

Give the patellar luxation grade for the following definition:

Permanent, non-reducible luxation of the patella

A

(Grade 4)

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21
Q

Medial/lateral (choose) luxation of the patella is the most common direction of patellar luxation.

A

(Medial)

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22
Q

If the femur has a varus deformity, the patella will luxate medially/laterally (choose).

A

(Medially, if a valgus deformity with luxate laterally)

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23
Q

What are the goals of a patelloplasty in cases of patellar luxation?

A

(Adaption of the patellar shape to the trochlear groove → chronic patellar luxation causes erosion, flattening, and fibrosis of the patella and results in incongruency with the trochlear groove and patelloplasty is indicated at that point)

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24
Q

When performing a tibial tuberosity transposition in a case of a medially luxated patella, you should move the tibia lateral/medial (choose).

A

(Lateral, and vice versa)

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25
When performing the desmotomy and imbrication of the femoropatellar ligaments in the case of a medially luxated patella, you release the medial/lateral (choose) femoropatellar ligament via the desmotomy and imbricate the medial/lateral (choose) femoropatellar ligament.
(For a medially luxated patella, you want to release the medial ligament and imbricate the lateral ligament, and vice versa for a lateral luxation)
26
What is the primary adverse outcome of patellar luxation that you are trying to avoid when making decisions about surgical correction?
(Patellafemoral degenerative joint disease)
27
Why is an early diagnosis of patellar luxation the key to a better outcome, especially if surgery is pursued?
(Because surgery can only correct one lameness and one luxation score so if you catch it at a grade ½, much better than a 3/4)
28
What are the layers of the esophagus?
(Adventitia, muscularis, submucosa, and mucosa)
29
Why is esophageal surgery associated with higher instances of complications, especially dehiscence?
(Lack of serosa, lack of omentum, and under constant motion → lots of tension)
30
How can a surgeon minimize the higher instance of complications related to esophageal surgery?
(Gentle tissue handling, minimize contamination, using appropriate suture material, judicious use of electrocautery, and accurate apposition of tissues)
31
What is the optimal suture choice for esophageal surgeries?
(Monofilament, non-reactive, slowly absorbed → PDS, sutures placed 2mm from cute edge and 2-3 mm apart, two layer closure is optimal but single is fine as long as you ensure you have the submucosa)
32
Give the hiatal hernia type based on the description below: The gastroesophageal junction slides orally into the thorax, this changes the pressure on the gastroesophageal junction leading to the clinical signs associated with hiatal hernias
(Type I)
33
Give the hiatal hernia type based on the description below: The fundus of the stomach herniates between the abdominal esophagus and the esophageal hiatus
(Type II)
34
Give the hiatal hernia type based on the description below: A combination of type I and type II hiatal hernias
(Type III)
35
Give the hiatal hernia type based on the description below: Other organs are herniating through the esophageal hiatus while the gastroesophageal junction stays in its normal anatomic position
(Type IV)
36
What are the surgical treatment options for hiatal hernia?
(Phrenoplasty (reduction of the size of the hiatus), esophagopexy (pexy the esophagus to the diaphragm to keep it in place), and left gastropexy (pexy fundus to the left body wall, this will minimize sliding of both stomach and the esophagus))
37
What is the main potential complication associated with surgical correction of hiatal hernias?
(Persistent regurgitation → could be d/t esophagitis or megaesophagus (which could be d/t hiatus over-reduction or nervous dysfunction), reherniation, or hiatus over-reduction)
38
What type of incision is made into the stomach when performing a gastropexy?
(Seromuscular)
39
What layers are incised in the body wall when performing a gastropexy?
(The peritoneum and the IAO)
40
What is the best approach for a cervical esophageal surgery?
(Ventral midline cervical incision)
41
When performing a cervical esophageal surgery, what two muscles/muscle groups will be encountered if you are seeking access to the cranial or middle esophagus?
(The platysma first then the sternohyoid muscles, if you need access to the caudal esophagus then you will also encounter the sternocephalic muscles)
42
What are some of the indications for amputation?
(Neoplasia, severe trauma or disability, peripheral nerve problems resulting in a non-functional limb, compromised vascular supply, and intractable infection)
43
In what cases do abdominal rads become an important part of the staging process for neoplasia (beyond thoracic radiographs)?
(If a bony mass is at the diaphysis of a bone, if it is a limb soft tissue mass, or if it is a breed with high risk of histiocytic neoplasia)
44
If the periosteal reaction of a bony lesion you are evaluating for aggressiveness has a sharp demarcation, is it aggressive or non-aggressive?
(Non-aggressive, if there is a long transition zone that is aggressive)
45
If there is soft tissue swelling associated with a bony lesion, what about that soft tissue swelling can indicate if the lesion is aggressive?
(If there is mineralization → aggressive)
46
If a neoplasm that originates outside of the bone metastasizes to bone, where will the bony lesion more likely be located?
(The diaphysis, if it is a primary bone tumor it will be a metaphyseal lesion)
47
How much cortical bone loss needs to be present to see lysis on a radiograph?
(40%)
48
(T/F) Bone biopsies are likely to give a definitive diagnosis of the cause of the lesion you are biopsying and have a 80-90% accuracy.
(T)
49
Where should biopsies be taken from a bony lesion?
(Right smack dab in the middle)
50
What is the most common primary bone tumor in dogs?
(Osteosarcoma)
51
What is the saying pertinent to osteosarcomas and their typical location in the limbs?
(Away from the elbow, towards the knee)
52
(T/F) Cats have a lower rate of metastasis of osteosarcoma compared to dogs, who usually have micrometastases at the time of diagnosis in >90% of cases.
(T)
53
Why should transection of intrinsic muscles of the limb being amputated be avoided?
(It prolongs surgery time and increases morbidity by increasing blood loss and inflammation)
54
What is the origin and insertion of the triceps muscle?
(Origin → caudodistal scapula and proximal humerus, insertion → olecranon)
55
What is the purpose of ligating arteries and veins separately?
(Prevention of AV fistulas and your ligations will be more secure)
56
What are the reasons behind ligating the artery or the vein first?
(Artery → prevents loss/pooling of blood in tissues; vein → limits metastatic spread during surgical manipulation)
57
What effect does electrosurgery have on tissues in the body?
(Creates heat, protein denaturation, and tissue dehydration)
58
What are the pros and cons of electrosurgery?
(Pros → hemostasis, decreased surgery time, decreased pain, and increased visualization; cons → increased inflammation, decreased wound healing)
59
Give the maximum vessel size that can be ligated by the electrosurgery techniques listed below: A - Monopolar B - Bipolar C - Bipolar vessel sealing device
A - Monopolar (Up to 2mm vessels) B - Bipolar (Up to 3mm vessels) C - Bipolar vessel sealing device (up to 7mm vessels)
60
Why should you aspirate prior to injecting bupivacaine into what you think are nerves?
(Bc if it is a vein and you give it IV, it is cardiotoxic)
61
What are the pros and cons of removing the scapula when amputating the forelimb?
(Pros → easier, “faster, better margins for neoplasia; cons → “longer” bc more dissection (really based on experience), +/- chest more susceptible to trauma)
62
What are the pros and cons of disarticulating the shoulder joint when amputating the forelimb?
(Pros → “faster” bc there is less dissection; cons → muscle atrophy while leads to pressure sores)
63
Describe the skin incision for a thoracic limb amputation.
(Make a single linear incision from the proximal scapula to the shoulder joint then make a circumferential incision around the limb at the level of the shoulder joint → be conservative with you skin incision bc you can always remove more but cannot put it back)
64
What is the origin and insertion of the trapezius muscle?
(Origin → dorsal midline fascia, insertion → spina of the scapula)
65
What is the origin and insertion of the omotransversarius muscle?
(Origin → wing of the atlas, insertion → acromion (distal scapular spine))
66
What is the origin and insertion of the brachiocephalicus muscle?
(Origin → skull and neck, insertion → cranial humerus)
67
What is the origin and insertion of the deep pectoral muscle?
(Origin → sternum, insertion → greater and lesser tubercles (proximal-most aspect) of the humerus)
68
What is the origin and insertion of the superficial pectoral muscles?
(Origin → sternum, insertion → humerus)
69
What is the origin and insertion of the rhomboideus muscle?
(Origin → dorsal midline deep fascia of the neck and cranial thorax, insertion → dorsal border of the scapula)
70
What is the origin and insertion of the serratus ventralis muscle?
(Origin → transverse processes of C3-7 and the first 8 ribs, insertion → dorsomedial aspect (serrated face) of the scapula)
71
What is the origin and insertion of the latissimus dorsi muscle?
(Origin → dorsal midline thoracolumbar fascia, insertion → teres major tuberosity of the humerus (medial proximal humerus))
72
What nerves make up the brachial plexus from cranial to caudal (hint: S.S. MARMU)?
(Superscapular, subscapular, musculocutaneous, axillary, radial, median, ulnar)
73
What vessel is the main blood supply to the thoracic limb?
(The axillary artery)
74
Where would you find the lateral thoracic V.A.N.?
(On the ventral border of the latissimus dorsi, b/w the lat and the deep pectoral)
75
Where would you find the thoracodorsal V.A.N.?
(Medial to the latissimus dorsi)
76
What vessel can help you to find the superficial cervical lymph node so you can resect it with the limb in cases of neoplasia?
(The superficial cervical vein)
77
Where will you find the axillary artery and vein in relation to the scapula?
(Ventromedial)
78
You should aim to ligate the femoral artery and vein proximal to which branch?
(Proximal to the superficial circumflex iliac and lateral circumflex femoral branches, may not be possible but its the goal)
79
Which muscles is the caudal gluteal artery and vein deep to?
(Deep to the gluteal muscles, near the sciatic nerve)
80
Which 3 muscles make up the femoral triangle?
(Caudally belly of the sartorius, pectineus, and vastus medialis)
81
What is the origin and insertion of the sartorius muscle?
(Cranial part: origin → iliac crest, insertion → patella; caudal part: origin → tuber coxae, insertion → medial tibial crest)
82
What is the origin and insertion of the gracilis muscle?
(Origin → pelvic symphysis, insertion → proximal craniomedial surface of the tibia and the calcanean tuber)
83
What is the origin and insertion of the adductor magnus muscle?
(Origin → symphyseal tendon and pubic tubercle, insertion → caudal surface of the femur (specifically the lateral lip of the facies aspera))
84
What is the origin and insertion of the rectus femoris muscle?
(Origin → tuberosity just cranial to the acetabulum, insertion → patella and tibial tuberosity)
85
What is the origin and insertion of the pectineus muscle?
(Origin → iliopubic eminence, insertion → facies aspera of the caudal femur)
86
What is the origin and insertion of the tensor fasciae latae muscle?
(Origin → tuber coxae, insertion → fascia lata)
87
What is the origin and insertion of the biceps femoris muscle?
(Origin → sacrotuberous ligament and ischiatic tuberosity; insertion → cranial part: patella vis fascia lata, middle part: tibial crest, caudal part: calcanean tuberosity via calcanean tendon)
88
What is the origin and insertion of the superficial gluteal muscle?
(Origin → sacrotuberous ligament, insertion → proximal caudolateral femur)
89
What is the origin and insertion of the middle gluteal muscle?
(Origin → wing of ilium, insertion → greater trochanter of the femur)
90
What is the origin and insertion of the deep gluteal muscle?
(Origin → body of the ilium, insertion → greater trochanter of the femur)
91
What three nerves make up the lumbosacral plexus?
(Sciatic, femoral, and saphenous)
92
What muscle is the sciatic nerve deep to?
(The biceps femoris)
93
The saphenous nerve can be found lateral or cranial to which vessel in the femoral triangle?
(The femoral artery)
94
What vessel should you be aware of when incising the joint capsule of the pelvic limb?
(A branch of the lateral circumflex femoral artery)
95
What does local hypothermia, which is suggested for 24-72 hours post amputation, do to the healing area?
(Stimulates vasoconstriction, decreases nerve conduction, and decreases muscle spasms)
96
What does warm compressing the post amputation site, which is suggested after 72 hours post op, do to the healing area?
(Dilates capillaries, increases hydrostatic pressure, and increases local histamine release)
97
What are some alternatives to amputation and in what cases are none of them appropriate?
(None are appropriate when there is a pathologic fracture, options are radiation therapy, partial amp, limb spare, and cementoplasty)
98
What shape is a digit amputation skin incision?
(Inverted Y, done dorsal and ventral for digits 3 and 4, done medial and lateral for digits 2 and 5)
99
What joint should be disarticulated in digit amputations?
(Metacarpophalangeal joint or metatarsophalangeal joint)
100
(T/F) Digit amputations should always be bandaged.
(T, also should wear a cone)
101
What shape is a caudal tail amputation skin incision?
(A U shape, should be distal to the site of disarticulation and performed dorsally and ventrally, should dissect to the level of the vertebrae)

SA Surgical Diseases and Techniques (3 decks)

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