Minor surgical conditions Flashcards
define abscess
localised collection of purulent material lined with granulation and fibrous tissue
what is the process of abscess formation?
pyogenic organisms cause cell death and inflammation
normally points and bursts for drainage
what are complications associated with abscesses?
toxaemia
pyaemia
sinus
skin necrosis
what are signs of an abscess?
pyrexia anorexia vomiting pain swelling discharge
how are abscesses treated?
drainage
antibiotics
analgesia
how is drainage provided to abscesses?
establishing drainage- lance with sterile scalpel and flush with saline, if deep or internal may need surgery for resection
maintaining drainage- keep open, regularly drain and flush
define cellulitis
non-localised distribution of pus through tissues
what causes cellulitis?
acute inflammation
what are signs of cellulitis?
pain
areas sensitive to touch
pyrexia
generalised swelling
how is cellulitis treated?
systemic antibiotics
anti-inflammatories
analgesia
define sinus
infected blind ending tract from a focus of infection to body surface or MM
describe the structure of a sinus
blind ended tract lined with granulation tissue
state examples of sinus
foreign body tract
anal furunculosis
list signs of a sinus
pyrexia
pain
sensitive to touch
disease specific signs
define a fistula
abnormal tract between 2 epithelial surfaces or connecting epithelial surface to skin
what are causes of fistulas?
injury or trauma
congenital
what are fistulas lined with?
epithelium
list signs of fistulas
chronic infection
visually abnormal
physically abnormal
how are fistulas treated?
surgical repair
define ulcer
loss of epithelial surface of a tissue
describe the structure of ulcers
shallow lesions
what are causes of ulcers?
trauma aggravated by poor blood supply or infection calici virus chemicals urine pressure
what are common affected areas of ulcers?
skin
GI tract
cornea
what are signs of ulcers?
pain
swelling
visual appearance
secondary problems including infection
how are ulcers treated?
remove cause
keep clean and dress if possible
surgery
often slow to heal
what are causes of corneal ulcers?
trauma
bacteria
eyelash or eyelid disorders
what are signs of corneal ulcers?
increased lacrimation
ocular pain
ocular discharge
blepharospasm
define decubitus ulcer
pressure sores
what are signs of decubitus ulcers?
pain open wound pyrexia from secondary infection sensitive around area restricted movement
define cysts
abnormal sac filled with fluid or semi solid matter lined with epithelium
list the types of cysts
sebaceous interdigital ovarian hydatid meibomian
define sebaceous cyst
swelling in skin arising in sebaceous gland, typically filled with yellowish sebum
define interdigital cyst
lesions growing between the toes
define ovarian cysts
fluid filled sacs in ovary or on surface
define hydatid cyst
larval cyst of a tapeworm occurring as a fluid filled sac containing daughter cysts in which scolices develop
define meibomian cyst
cyst in the eyelid usually due to blocked meibomian gland, typically in the middle of the eyelid
what are signs of cysts?
swelling visual appearance restricted movement secondary problems dependent on type
define haematoma
accumulation of blood in tissues due to bursting capillaries
list some causes of haematomas
trauma
surgery
clotting or blood vessel abnormality
what are signs of haematomas?
swelling
pain
discolouration of skin
state the 3 types of ruptures/hernias
reducible
irreducible/incarcerated
strangulated
what is meant by a reducible hernia?
contents can be repositioned to original anatomical location
how are reducible hernias treated?
gentle pressure corrects
may be surgically repaired
what is a irreducible/incarcerated hernia?
contents cant be repositioned to original anatomical location due to adhesions or other complications
how are irreducible or incarcerated hernias treated?
surgery
what is a strangulated hernia?
contents devitalised due to restriction of blood vessels leading to necrosis
is a life threatening emergency
define rupture
protrusion of organs or soft tissue through unnatural opening or tear
what is the main cause of ruptures?
trauma causing weakness to predispose tears
what are signs of diaphragmatic rupture?
dyspnoeic as abdominal contents fall into chest
how are diaphragmatic hernias treated?
surgery using IPPV once abdominal cavity opened as air fills thoracic cavity
what is a ventral or abdominal rupture?
tear anywhere on abdominal wall other than umbilical or inguinal region
define hernia
abnormal protrusion of organs or soft tissue through natural opening
what predisposes to umbilical hernias?
young animals
poor handling at birth may influence
how are umbilical hernias treated?
usually left alone unless large or already performing midline incision
what is the effect of umbilical hernias?
usually just a small amount of fat protrudes
if large can involve abdominal cavity
what are signs of inguinal hernia in females?
swelling by the groin extending to vulva
what happens in males with inguinal hernias?
fat or intestine herniates into scrotal sac
what can be complications of inguinal hernias?
strangulation or rupture
how is severity of inguinal hernias determined?
ultrasound
radiography
when do perineal hernias mainly occur?
older dogs with chronic constipation excessively straining causing gradual breakdown of muscle layers around anal sphincter
define pre-op
before surgery
define peri-op
start of GA to patient waking up from anaesthesia
define post-op
return to normal after GA or surgery, including long and short term monitoring
what is the period of recovery?
from post-op period, ending when full consciousness is present and physiological values are normal
what is involved in pre-op period?
preparation
pre med
induction of GA
what is the importance of post op period?
high percent of deaths in this time, mainly due to lack of monitoring
define dysphoria
state of generalised unhappiness, restlessness or frustration
what is needed for immediate post op management?
close monitoring until staying in sternal unaided
in clean comfy and dry kennel
safe area in case aggressive, thrashing or dysphoric
when are ETT removed in dogs?
when swallow or move tongue
when do ETT get removed in cats?
blink reflex
what should you do to patients who have just been extubated?
extend neck and head and pull tongue forward to keep patent airway
why is it important to monitor temperature post op?
heat is lost during anaesthesia and surgery
cold patients recover slower
list the parameters that need monitoring during post op period
TPR BP pain eating and drinking wounds excretion hydration
when should you give IVFT post op?
if given peri operatively
animals at risk of AKI, CKD
sick animals
low BP
when should you give water post op?
as soon as can hold in sternal themselves
when should you give food to recovering patients?
soft bland food when fully conscious
rabbits as soon as possible
what is the importance of monitoring rabbit droppings post-op?
observe for signs of gut stasis
when is it especially important to monitor excretions post op?
surgery involving urogenital tract
how should you care for rabbits post op?
keep low stress- reduce risk of gut stasis, keep away from predators
monitor defecation
pro-kinetics
eye lube
what are signs of pain post op?
pain scales facial expression changed behaviour inappetence reluctance to move
how is pain post op managed?
analgesia
what are signs of haemorrhage post op?
slow CRT pale MM low BP tachycardia lethargy dull behaviour
how is post op haemorrhage managed?
surgery
exploration
state risk factors for aspiration pneumonia post op
dental surgery
vomiting and regurgitation
brachycephalic
long surgery
what are signs of aspiration pneumonia?
fluid from nose
crackles on lung auscultation
dyspnoea
how is aspiration pneumonia managed post op?
close monitoring
oxygen
antibiotics and diuretics as needed
how is long recovery times managed post op?
manage temperature
antagonise drugs
what predisposes to gut stasis post op?
abdominal surgery
rabbits
what are signs of gut stasis post op?
lack of faeces produced
inappetence
how is gut stasis managed post op?
manage complicating factors such as pain
promotility agents
IVFT
careful monitoring
what are signs of dehiscence post op?
strike through of dressing
disrupted sutures
how is dehiscence managed?
surgery
how is aggression and dysphoria managed post op?
anticipate before waking, place muzzle and buster collar
what are signs of crashing post op?
bradycardia
apnoea
non-responsive
how is crashing post op managed?
CPR
advanced life support
when are opioids used post op?
routine surgery
providing strong analgesia
what are examples of opioids used post op?
methadone
buprenorphine
fentanyl
what are side effects of opioids?
respiratory depression bradycardia panting salivation vocalisation urination defecation
how long does methadone last?
4 hours
what are the routes of admin of methadone?
IV
IM
SC
what is the benefit of methadone?
large dose range so can tailor to individuals
what are the routes of admin of buprenorphine?
IM
IV
SC
sublingual in cats
how long does buprenorphine last?
6-12 hours
how is fentanyl administered?
IV
dural patch
what NSAIDs are used post op?
metacam
carprofen
what are side effects of NSAIDs?
vomiting diarrhoea lethargy renal failure gastric ulcers
when are antiemetics used post op?
nauseous patients
what antiemetics can be used?
maropitant
ranitidine
metoclopramide
when is maropitant used and how is it administered?
GI pain relief
SC, IV, PO
when is ranitidine used and how is it administered?
pro motility so used in rabbits
SC, IV, PO, every 8 hours
when is metoclopramide used and how is it adminisered?
pro motility so used in rabbits
SC, IV, IM, PO
what are side effects of anti emetics?
maropitant- pain on SC injection
ranitidine- hypotension, weakness, cardiac arrhythmia
metoclopramide- rare, behavioural changes, sedation
when are antibiotics used post op?
orthopaedic patients
sick patients
surgery over 2 hours
already infected wounds
when are probiotics used post op?
diarrhoea in post op period
rabbits to prevent gut stasis
what antibiotics are used post op and how are they administered?
amoxicillin-clavulanic acid- IV, SC
cephalosporin and metronidazole- IV
what are side effects of antibiotics?
vomiting neuro effects nausea diarrhoea skin rash
