Lecture 22 11/8/24 Flashcards
What are the general characteristics of thoracic surgery?
-animals must be intubated and ventilated
-analgesia should be started before the animal is recovered
-analgesia continued for days to weeks
-animals should be recovered on oxygen after respiratory surgery
What are the characteristics of traumatic diaphragmatic hernia?
-diaphragm muscle tears or avulses
-organs enter the pleural space
-multiple injuries may be present
What are the clinical signs/findings with traumatic diaphragmatic hernia?
-dyspnea
-exercise intolerance
-cough
-vague GI signs
-muffled heart sounds
-possible gut sounds when ausculting chest
-abdomen feels empty on palpation
What are the diagnostic steps for traumatic diaphragmatic hernia?
-survey films
-contrast films
-ultrasound
-CT
What is the pre-surgical treatment for animals with traumatic diaphragmatic hernia?
-pre-oxygenate
-induce and intubate rapidly
-can prep the animal in lateral recumbency if animal is struggling to ventilate/oxygenate
-inflate lungs based on SpO2 prior to operation
-tilt table to take pressure off lungs
What are the key points of traumatic diaphragmatic hernia surgery?
-midline abdominal approach; animal should be shaved to mid-thorax
-once abdomen is open, animal must be ventilated
-hernia can be enlarged in order to reduce the contents
-lungs should NOT be fully reinflated and chest should NOT be fully emptied via chest tube once the diaphragm is closed; can cause re-expansion pulmonary edema
What are the steps of diaphragmatic hernia repair?
-remove abdominal contents gently from the thorax
-close hernia with simple continuous pattern using absorbable suture
-exit chest tube out the thoracic wall or out the diaphragm and abdomen
What should be done after diaphragmatic hernia repair?
-keep animal on oxygen until it fully recovers from anesthesia
-empty chest of air if animal is having trouble breathing and/or SpO2 falls below 95%
What are the characteristics of peritoneopericardial diaphragmatic hernia?
-congenital diaphragmatic hernia
-abdominal contents in pericardial sac
-signs are usually resp. or GI in nature
-asymptomatic animals may not need surgery
What are the steps of peritoneopericardial diaphragmatic hernia repair?
-reduce the contents
-resect any liver that adheres to the pericardium
-close the hernia
-empty air from the pericardial sac
How does the surgical approach differ for lung lobectomy when disease is unilateral vs bilateral/spontaneous pneumothorax?
-unilateral disease: surgery through a lateral thoracotomy
-bilateral disease/spontaneous pneumothorax: surgery through a median sternotomy
What are the steps of a lateral thoracotomy?
-chest is entered between the ribs
-closure is performed in layers
-sutures are passed around the ribs to pull them together
-muscle, subcutis, and skin are then closed
-chest tubes are exited out the main incision if not being left in, or through a separate incision if being left in
What are the characteristics of primary lung lobe tumors?
-often removed through a lateral thoracotomy
-overall median survival of about 1 year
-survival times are better with small, well differentiated masses and no clinical signs, lymph node involvement, or effusion
What are the characteristics of spontaneous pneumothorax?
-recurrence and mortality rates are lowest with surgical management
-prognosis is poor for generalized emphysema
What are the characteristics of lung lobe torsion?
-often presents with pleural effusion and lung consolidation
-survival rates around 50-60% in all dogs
