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TOBIAS VETERINARY SURGERY > HERNIAS 85, 86 > Flashcards

HERNIAS 85, 86 Flashcards

1
Q

name the pars of muscles that composes the diaphragm

A

pars lumbaris
pars sternalis
pars costal is (each side)

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2
Q

descrive the origin of the right and left crus of diaphragm

A

origin from paired lumbar muscles of diaphragm

each gives a crus, that further divides in two.

right crus is bigger

tendon arise from 3-4 lumbar vertebra and medial to psoas minor

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3
Q

name the structures that passes through the aortic hiatus

A

aorta, azigos, hemiazigos, lumbar cistern of the thoracic duct

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4
Q

what are the “foramina of Morgagni?”

A

also named sternocostal triangles.

situated between costal and sternal attachments of thoracic diaphragm

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5
Q

what structures pass through Morgagni foramina

A

cranial epigastric arteries

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6
Q

diaphragm blood supply

A

phrenic arteries, originate from phrenology-abdominal arteries.
anastomose with phrenic branches of 10-11-12 intercostal arteries

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7
Q

diaphragm innervation

A

PHRENIC NERVES

dog: ventral branches 5-6-7 cervical nerves
cat: 4-5-6 cervical nerves

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8
Q

surgical approach to diaphragmatic ernia

A

median celiotomy

9 intercostal toracotomy: side of the hernia!! (not peritoneo pericardial)

resection xiphoid process

celiotomy extended to sternotomy

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9
Q

causes of diaphragm ernia

A

85% trauma

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10
Q

diaphragm muscle tears orientation cats dogs

A

DOG: 40% radial, 40% circumferential, 20% mixed

CAT: 59% circumferential, 18% radial

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11
Q

complications with diaphragm ernia

A

DISPNEA 38%

hepatic venous stasis
hepatic necrosis
biliary tract obstruction
jaundice

pleural effusion
ascites

hemotorax
urotorax
chylotorax

1 report cardia tamponade

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12
Q

radiographic signs of diaphragm hernia

A

LATERAL PROJECTION

loss line of diaphragm (66-97%)
viscera in torax
obscured cardiac shadow

DORSO VENTRAL

lung lobe collapse (20-31%)
pleural fluid (20-31%)
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12
Q

radiographic signs of diaphragm hernia

A

LATERAL PROJECTION

loss line of diaphragm (66-97%)
viscera in torax
obscured cardiac shadow

DORSO VENTRAL

lung lobe collapse (20-31%)
pleural fluid (20-31%)
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13
Q

ultrasonography accuracy for diaphragm hernia

A

93%

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14
Q

timing of surgery for repair of diaphragmatic hernia

A

as soon the patient is stable

67% within 24h
37% within 1 year

delay 1-3 weeks 93.7% (another study)

-> STABILIZE PATIENT BEFORE SURGERY

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15
Q

closure options for large diaphragm defects

A 
omentum
fascia
muscle
liver
Polypro mesh
silicon rubare sheating
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16
Q

muscle flaps for diaphragm closure

A

transversus abdominins
rectus abdominis
latissimus dorsi

have to be 10% bigger than defect to close

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17
Q

IAP: intraperitoneal pressure: values

A

increase pressure -> abdominal compartment syndrome

11-20 mmhg: medical treatments (analgesic therapy, evacuation intraperitoneal fluid-air or organ contents)
>20 mmhg: surgical correction; mesh to augment abdominal wall, splenectomy, advancement diaphragm

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18
Q

what muscle separate pleural and peritoneal cavities dorsally

A

psoas muscles, by only a thin layer of fused endothoracic and transversalis fascia

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19
Q

what is the “cullen sign”

A

ring of subcoutaneous hemorrage around the ombilicus (in same cases of hemoperitoneum or peritonitis)

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20
Q

what are the vascular structures that bound the epiploic foramen?

A

dorsally caudal vena cava

ventrally portal vein

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21
Q

what are the 3 portions of the omentum?

A

bursal portion, splenic portion (form gastroepipolic ligament), veil portion (left pancreas)

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22
Q

normal colloid-osmotic pressure of peritoneal fluid

A

28 mmHg, less than 300 cell/mm3

23
Q

normal intrabdominal pressure dog

A

2 - 7,5 cm H2O

24
Q

technique to prevent adhesion intraoperatively

A 
prevent tissue dessiccation
gentle handling
meticolous hemostasis
precise suture placement
removal blood clots-debris
thorough lavage
25
Q

what effect has peritonal fluid volume on peritonitis?

A

increase in bacterial proliferation
slowed bacterial clearance
increase mortality rates

26
Q

systemic manifestation of peritoneal inflammation

A

hypovolemia -> hypotension
hypoproteinemia

respiratory acidosis
hypoxiemia (diaph rigidity)

27
Q

common findings in animals with peritonitis

A

MODS
DIC
paralytic ileus
poorly defineable and localizable abdominal pain

28
Q

peritonitis classification

A

primary-secondary

acute-chronic

localized-generalized

septic-aseptic

29
Q

primary peritonitis, survival and aetiology (spontaneous inflammation)

A

CULP et al. 2009 survival 46.7 % dogs, 44,4% cats in one study

56% dogs monoculture, 100% cats monoculture

30
Q

most common form of peritonitis in dogs

A

secondary peritonitis most commonly from intestinal leakage-dehiscence

RALPHS et al., 2000 (85% death after int-leakage)

31
Q

what is intended for chemical peritonitis. is it primary or secondary?

A

secondary

endogenous contaminant (gastric-intestinal, bile, pancreatic enzymes, urine)

32
Q

types of aseptic peritonitis

A

mechanical-foreign body (sterile)

starch granulomatous (glove powder)

chemical peritonitis

sclerosing encapsulating peritonitis (abdominal organ encapsulated in thick layer of connective tissue

parasitic-protozoal (toxocara, toxoplasma, mesocestoides, angiostrongylus costaricensis

32
Q

types of aseptic peritonitis

A

mechanical-foreign body (sterile)

starch granulomatous (glove powder)

chemical peritonitis

sclerosing encapsulating peritonitis (abdominal organ encapsulated in thick layer of connective tissue

parasitic-protozoal (toxocara, toxoplasma, mesocestoides, angiostrongylus costaricensis

33
Q

risk factors for developing septic peritonitis after celiotomy

A

preoperative septic peritonitis
hypoprotinemia
hypoalbuminemia
intraoperative hypotension

foreign body protective against development!!

34
Q

can peritonitis being associated with uroabdomen?

A

rarely, unless urine already infected before trauma-rupture

35
Q

bile peritonitis, survival rates

A

LUDWIG ET AL 1997 survival 100% nonseptic. 27% septic

MEHLER ET AL 2004 survival 55% septic, 13% nonseptic

CREWS ET AL 2009 survival 82% gallb infection and rupture

36
Q

most common bacterium in bowel perforation septic peritonitis

A

e. coli

bacterioides fragilis

37
Q

what toxin is believed to facilitate patogenicity of e.coli in peritoneum?

A

alpha-hemolysin (common exotoxin of e.coli)

decrease intraperitoneal ph
lyses intrap. erytrocites
reduces recoverable viable lymphocites

38
Q

SIRS criteria

A

T: >39.7 (39.2) or < 37.8 (38.1) DOG (CAT)
FC: >225 (120) <140 DOG (CAT)
FR: >40 (20) DOG (CAT)
WBC: >19500 (18000) <5000 (5000) DOG (CAT)

BAND NEUTROPHILS >5% DOG

39
Q

wuat volume of free peritoneal fluid can be detected with ballottement exam?

A

> 10 ml/kg

40
Q

can you use absolute or differential cell count to distinguish beetween normal “postsurgical” response or post-op infection?

A

NO

41
Q

diagnostic accuracy of different ABDOMINOCENTESIS techniques

A

43% needle paracentesis

  1. 9% catheter paracentesis
  2. 6% peritoneal lavage (20-22 ml7kg warmed sterile isotonic saline)
42
Q

blood glucose VS abdominal fluid glucose

A

first study reported >20 mg/dl difference high specificity and sensibility.

KOENIG 2015 reported better result with cutoff >38 mg/dl difference

  • > dog anemia: false high blood glucose
  • > dog hemoconcentration: false low blood glucose
43
Q

accuracy of citology exam for peritoneal fluid

A

LEVIN 2004 87% or less

44
Q

fluid lactate sensitivity and specificity

A

DOG >2.5 mmol/L 100% sensitive 91% specific

CAT 67% sensitive 67% specific

45
Q

is triple drug therapy better than monotherapy for septic peritonitis?

A

MOSDELL 1991 no big difference in mono-bi-triple therapy

46
Q

fluid volume for peritoneal cavbity lavage

A

200-300 ml/kg

47
Q

is i useful to add antibiotics to fluid lavage?

A

no, can be toxic

48
Q

is laparoscopic treatement for septic peritonitis a good choice?

A

no, it increase mortality. appears to be related to peritoneal damage due to insufflation

49
Q

most common post-op complication with closed peritoneal drainage

A

anemia and hypoproteinemia

50
Q

Open peritoneal drainage versus primary closure for the treatment of septic peritonitis in dogs and cats

A

STAATZ 2002: no big differences, overall survival 71%

LANZ 2001: 54% survival with primary celiotomy closure

use primary closure when

there is not an ICU
plasma and colloids not available
monobacterial infection
localized inflammation, that has beem removed 
no foreign material 
no gastrointestinal spillage
51
Q

most common bacteria in dog and cat bite

A

pasteurella multocida

52
Q

most common bacteria isolated cat dog gunshot wounds

A

staphylococcus spp. clostridium spp.

53
Q

diagnosis of uroperitoneum

A

abdominal fluid creatinine and potassium higher than plasmatic

urea is not useful: urea concentrations quickly equilibrates with serum ones

54
Q

most common anaerobic bacteria in intraabdominal abscess formation

A

bacterioides fragilis

TOBIAS VETERINARY SURGERY (25 decks)

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