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SA surgical diseases > New Material for final > Flashcards

New Material for final Flashcards

1
Q

What do JPS, TPO and DPO have in common?

A

They are surgeries that modify the hip biomechanics and development in growing dogs
-to stop subluxation tendency
-to restore hip congruency and save the joint from OA development
-should be done before OA progression so there is a very narrow time window
-must be diagnosed early

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2
Q

Is hip dysplasia usually unilateral or bilateral?

A

Bilateral

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3
Q

What is the difference between subluxation, luxation, and dislocation?

A

Subluxation: there is articular to articular contact and surrounding joint capsule and musculature are intact
Luxation: there is no articular to articular contact, but joint muscle and surrounding musculature is intact
Dislocation: no articular to articular contact, joint and surrounding musculature not intact (usually due to trauma)

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4
Q

Define congruency

A

How well the joint fits together

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5
Q

Define hip dysplasia

A

Abnormal development of the hip joint leading to poor congruency

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6
Q

What is the biggest factor that influences skeletal maturity in dogs?

A

Age of spaying/neutering
-best time from orthopedic standpoint is 2 years of age

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7
Q

With joint laxity, what is the age in which OA will start to develop without intervention?

A

7 months

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8
Q

What causes laxity in young dogs?

A

Bone growing quicker than the surrounding musculature
-worsens with neutering

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9
Q

Describe the features of the juvenile pubic symphysiodesis (JPS) procedure.

A

-must be done at 3-5 months of age
-cauterization and subsequent fusion of the pubic symphysis causes acetabulum to grow medial and ventral, improving both coverage and congruency (more important)
-performed prophylactically (preventatively)

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10
Q

Why is JPS not very popular?

A

-done before clinical signs
-many owners aren’t knowledgeable enough to know about this
-best done between 12-17 weeks of age (very specific time period)

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11
Q

When should JPS be recommended?

A

As soon as early diagnosis is reliable:
- 3.5-4 months of age
-4.5-5 months of age for giant breeds

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12
Q

What used to be the most reliable view for hip radiographs to assess congruency in dogs?

A

OFA- must include cranial to ilial wings and distally must include stifle
- animals have to be a minimum of 2 years of age for these films to be considered

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13
Q

Describe the Penn Hip

A

Measure center of acetabulum and femoral head to find distance (distractive index)
- numbers are very reliable
-can be done at a young age(16 weeks)
-any practitioner can do this after taking online course
- if distractive index above a certain value, the probability of the dog having hip dysplasia is low

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14
Q

What is measuring ortalani?

A

measuring the angle of subluxation (degree of abduction where the femur comes out of acetabulum)

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15
Q

What are the criteria for JPS being indicated?

A

-penn hipp shows high probability of hip dysplasia
-3.5-4.5 months of age (breed variation)
-Ortolani sign (evidence of laxity)
-angle of reduction 15-40 degrees
-angle of subluxation 0-10 degrees
-dorsal acetabular rim angle up to 12 degrees with no DAR erosion
-DI between 0.4-0.7
-no clinical signs (but high probability due to the above)

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16
Q

Where do you cut for JPS?

A

Where spay incision ends, just cranial to pubis
- protect the abdominal organs with wooden spatula (especially the urethra)
-cauterize cranial part of pelvic symphysis

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17
Q

What are the ethical concerns associated with JPS?

A

-the dogs undergoing this procedure had a chance of not developing hip dysplasia
-might pass for breeding

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18
Q

What are the radiographic changes that occur after a JPS procedure?

A

-pubic symphysis fusion
-broader and short pubic rami
-widened obturator foramina
-irregular pubic profile
-detectable acetabular fossae (most prominent feature)

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19
Q

What are the potential complications associated with JPS?

A

-urethral damage (<5% of cases)
-skin burns due to electrocautery (dog needs to be grounded properly)
-lack of efficacy (wrong selection or wrong procedure)
-ethical consequences

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20
Q

T/F: JPS is ineffective in dogs with more severe clinical and radiographic changes

A

True

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21
Q

What is the purpose of the TPO and DPO procedures?

A

Corrective pelvic osteotomies in dogs with the purpose of arresting hip dysplasia in the early stages of the disease

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22
Q

What is cut during a TPO procedure?

A

-Body of ileum just caudal to the sacrum
-pubic ostectomy
-ischial osteotomy

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23
Q

What is cut during a DPO?

A

-pubic ostectomy
-osteotomy of ileal body just caudal to sacrum
-dont touch ischium- relying on immature bone of dog
-wont be able to rotate the pelvis as much as TPO

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24
Q

Why is TPO falling out of fashion?

A

-too many complications (implant loosening common)
-high morbidity due to cutting of ischium
-results in pelvic narrowing and excessive head coverage
-makes total hip more difficult

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25
Q

How should the iliac osteotomy be performed in a DPO?

A

-as close to the iliosacral joint as possible
-use oscillating saw or sharp osteotome (not as good)
-minimally invasive technique
-make cut perpendicular to long axis of pelvis, not long axis of ileal body (results in better bone to bone contact)

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26
Q

What arteries need to be avoided when performing a DPO procedure?

A

Iliacus artery and cranial gluteal artery
-also need to avoid lumbosacral trunk on medial side

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27
Q

What are the benefits of locking screws with a DPO surgery?

A

Stronger fixation of the plate and screws

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28
Q

What was the main problem that occurred with the TPO?

A

Tendency was to overcorrect
-too much rotation lead to excessive femoral head coverage
-causes dog to walk like a duck
-also causes severe narrowing of the pelvic canal

29
Q

What is the morbidity associated with DPO?

A

-dogs often up and walking 2-8 hours after surgery
-with bilateral DPO there is a risk of obstructing the urethra

30
Q

T/F: It is still beneficial to perform a DPO after 7 months

A

False- you can improve coverage but not congruency which is the most important part

31
Q

Why are DPOs uncommonly done?

A

Not enough surgeons
-no one wants to do them because of the potential complications

The only reason this is done is if your out of the window for JPS

32
Q

Describe some clinical features of patellar luxation

A

-many different causes, therefore each case needs individual evaluation
-PL is the clinical manifestation of an underlying disease, not a disease itself
-pathophysiology of PL is due to limb deformity that results in a misaligned quadriceps mechanism (deformity of the hip in most cases)
-any treatment plan must address the underlying problem

33
Q

T/F: the rectus femoris is the only muscle of the quadriceps that does not originate from the proximal femur

A

True

34
Q

What are the different grades of patellar luxation?

A

Normal: alignment of the quadriceps mechanism is normal and patella cannot be luxated from groove
Grade 1: patella can be luxated medially when joint is in full extension. Clinical signs are typically absent
Grade 2: spontaneous luxation occurs with non-painful “skipping” lameness, mild skeletal deformities are present
Grade 3: patella is luxated permanently but can be reduced, more severe bony deformities present
Grade 4: permanent non-reducible luxation of the patella

35
Q

What is patella laxity?

A

When patella can be moved, but stays within the trochlear ridge
-NOT a luxation

36
Q

What side is the patella usually luxated to?

A

Medially in both small and large breed dogs
-if it is a lateral, more likely to be seen in large dogs

37
Q

What are the treatment options for the bony tissue in a patellar luxation?

A

Trochleoplasty- deep or modify trochlear groove
Patelloplasty -remove osteophyte and reshape
Patellar lowering or raising (if alta or baja)
Distal femoral osteotomy for valgus and varus cases and torsion
Tibial tuberosity transposition (TTT): should be done in every case
Proximal tibial osteotomy: if grade 3,4 with valgus/varus
Femoral trochlear prosthesis
Total knee prosthesis/arthrodesis

38
Q

What has to be done to the soft tissues in patellar luxation cases?

A

Capsulorrhaphy (modifying the joint capsule)
Ispilateral retinacular and joint capsule desmotomy
Release f the medial crural fascia for MPL
Transposition or release of the rectus femoris origin for MPL

39
Q

Describe the block resection trochleoplasty

A

Deepening of the trochlear groove proximally
-helps patella track more naturally

Complications: will lead to OA, can fracture the trochlear ridge or the block, can make it too thin

40
Q

Describe the patelloplasty

A

-adapts the patellar shape to the trochlear groove
-performed with bone rasp or osteotome
-important to expose the articular surface of the patella and check for osteophytes, erosions or widening
-ultimate goal is to remove pain in order to encourage animal to use and build up the quadriceps
-only a temporary fix

41
Q

Describe the tibial tuberosity transposition

A

-move in opposite direction of the luxation
-controversial in skeletally immature patients due to arresting of the physis

42
Q

What do you do during the capsulorrhaphy/desmotomy?

A

-release the medial patellar ligament and imbricate the lateral for a medial luxation
-use horizontal mattress to pull the patellar laterally

43
Q

What is the best you can hope for with surgery to correct patellar luxation?

A

Improvement by one lameness grade and one luxation grade
-why early diagnosis and treatment is so important before they get worse

44
Q

What disease often occurs concurrently with patellar luxation?

A

CCL disease

45
Q

What abnormalities are usually present with medial vs lateral patellar luxation?

A

Femur:
- Medial: distal varus, external torsion
- Lateral: distal valgus, internal torsion
Tibia:
- Medial or lateral : internal or external torsion
Patella:
- Medial: alta
- Lateral: Baja

46
Q

When should you perform a Patellar Groove Replacement (PGR)?

A

When existing treatment modalities are at their limit when confronted with severe patellofemoral DJD
-or when there is agenesis of the trochlear ridge and patient is skeletally mature

47
Q

T/F: Heat drives degenerative changes

A

True

48
Q

T/F: PGR corrects for patellar luxation

A

False
- it is to reduce pain, but you need the other alignment procedures to correct for the luxation
-recommended in older painful animals with severe DJD

49
Q

Describe the contraindications for trochleoplasty

A

-chronic and severe patellar luxation
-severe osteophytosis
-severe loss of joint cartilage
-revisions of failed previous surgery
-severe malformation of the trochlea
-presence of trochlear ridge fracture (challenging to repair)
-convex trochlear groove with congenital patellar luxation

These also make an animal a candidate for trochlear groove replacement

50
Q

What is the procedure that corrects for malalignment?

A

TTT
- with grade 3 and grade 4 also add in distal femoral osteotomy to address valgus/varus

51
Q

What are the 4 layers of the esophagus?

A

Adventitia, Muscularis, Submucosa, Mucosa
*note- no serosa

52
Q

Where would you cut to approach the different areas of the esophagus?

A

Cervical: ventral midline
Thoracic: Thoracotomy
Abdominal: ventral midline celiotomy

53
Q

What are the main surgical principles that need to be considered when working with the esophagus?

A

Gentle tissue handling, minimize contamination, appropriate use of suture materials, judicious use of electrocautery, accurate apposition of tissues
-generally the esophagus is associated with a higher instance of complications, especially dehiscence

54
Q

Why is the esophagus more prone to dehiscence?

A

Lack of serosa, segmental blood supply, lack of omentum, and constant motion

55
Q

What suture do you want to use when operating on the esophagus?

A

Monofilament, minimally reactive, slowly absorbable suture(aka PDS)

-two layer closure is ideal (submucosal first, then all layers)

56
Q

What is the difference between an esophagotomy, esophagectomy, and esophagostomy?

A

Esophagotomy: creating an opening into the esophagus that is later closed
Esophagectomy: removal of a portion of the esophagus
Esophagostomy: creating an opening- can be temporary or permanent

57
Q

Describe a vascular ring anomaly.

A

Congenital anomaly where aortic branches persist and cause constriction around the esophagus

58
Q

How would you approach a vascular ring anomaly surgically?

A

4th rib space thoracotomy in dogs, 5th in cats
- identify the anomaly and transect it
-ligate as there may be vessels that live within it

59
Q

What is a GI condition that often goes along with brachycephalic syndrome?

A

Hiatal Hernias

60
Q

What are the 4 types of hiatal hernias?

A

Type 1: gastroesophageal junction moving orally into the chest
Type 2: a part of the fundus herniates between abdominal esophagus and through hiatus
Type 3: combo of type 1 and 2
Type 4: Another organ moves up through the hiatus into the chest

61
Q

What are the surgical treatment options for hiatal hernias? What potential complications exist with these procedures?

A

Phrenoplasty (reduction of hiatus)
Esophagopexy (to diaphragm)
Left gastropexy (to body wall) of the fundus

Complications: may narrow esophagus leading to obstruction
-persistent regurgitation due to esophagitis, re-herniation or hiatus over-reduction

62
Q

What can you do to remove a foreign body in the esophagus?

A

Endoscopy or gastrotomy (for caudal cases), orogastric tube placement to push foreign body into the stomach to hopefully pass it (preferred over surgery)
-surgery would be indicated if the airway is compromised or the viability of the intestine is questionable

63
Q

What arteries provide the main blood supply to the stomach?

A

Right and left gastric artery on lesser curvature
Gastroepiploics on greater curvature that give off the short gastrics

64
Q

What are the surgeries that are commonly performed on the stomach?

A

Gastrotomy, partial gastrectomy, gastropexy, gastrostomy tube placement

65
Q

What is the difference between the cushings and connell suture patterns?

A

Connell is full thickness (l for entering lumen), cushings is partial thickness

66
Q

What is the radiographic view to diagnose GVD?

A

RIGHT LATERAL

67
Q

Is one reading of high lactate a poor prognostic indicator?

A

No- need serial lactates

68
Q

What is the first thing you will see upon ventral midline celiotomy in a GDV case?

A

Omental drape

69
Q
A

SA surgical diseases (11 decks)

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