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RUSVM Small Animal Surgery 2017 > Respiratory and Thoracic Surgery > Flashcards

Respiratory and Thoracic Surgery Flashcards

1
Q

When would you use a Nasal Planum Resection?

A

Unilateral Neoplasia

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2
Q

What will happen to dogs if you allow the Nasal Planum Resection to heal by second intention?

A

Nasal Stenosis

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3
Q

What are the complications of Nasal Planum Resection?

A

Dehiscence

Stenosis

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4
Q

When would you perform a Nasal Planectomy and Maxillectomy?

A

Oral Fibrosarcoma

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5
Q

What must you do to decrease the likely hood of nasal stenosis?

A

Fold the skin to appose skin and nasal mucosa

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6
Q

What do you gain access to with a Dorsal Rhinotomy?

A

Nasal cavity and sinuses

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7
Q

What do you gain access to with a Ventral Rhinotomy?

A

Access to ventral nasal cavity and choanae

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8
Q

What are the risks and complications of Nasal Surgery?

A 
Hemorrhage 
Flap necrosis
Oronasal fistula 
Dehiscence
Stenosis of airways
Incomplete resection/local recurrence
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9
Q

What are the Primary Components of Brachycephalic Airway Syndrome?

A

Elongated Soft Palate
Stenotic Nares
Shortened flattened nasal cavity
Hypoplastic trachea

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10
Q

What are the secondary/acquired components of Brachycephalic Airway Syndrome?

A 
Everted laryngeal saccules/Stage I laryngeal collapse
Pharyngeal/ laryngeal mucosal edema
Tonsillar eversion 
Macroglossia
Stage II/ III Laryngeal collapse
Tracheal collapse
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11
Q

What is the clinical sign of Elongated Soft palate?

A

Inspiratory dyspnea: Stertor

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12
Q

What does an Elongated Soft Palate cause?

A

Extension into Rima Glottidis: Severe obstruction or Loss of Protective Laryngeal function

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13
Q

What is the most common component of Brachycephalic Airway Syndrome?

A

Elongated Soft Palate

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14
Q

Stenotic Nares

A

Abnormal anatomy causes external and internal resistance - The inability to dilate nostrils

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15
Q

What are the 3 stages of Laryngeal collapse?

A

Stage 1: Everted Laryngeal saccules
Stage 2: Collapse of cuneiform cartilage
Stage 3: Collapse of corniculate cartilage

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16
Q

Chondromalacia

A

loss of cartilage rigidity

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17
Q

What are the characteristics of Hypoplastic trachea in English Bulldogs?

A

Irregular, thick/firm cartilage rings
Overlap of rings
Increased airflow resistance

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18
Q

What are the cardiovascular changes that lead to right heart failure in dogs with Brachycephalic Airway Syndrome?

A

Chronic decreased PO2 secondary to airway obstruction
Pulmonary vasconstriction
V/Q Mismatch
Subsequent vasoconstriction/hypertension

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19
Q

What are the clinical signs of Mild/Moderate Brachycephalic Airway Syndrome?

A

Exercise Intolerance
Increased noise: Snoring, Snuffing, reverse sneezing
+/- gastrointestinal signs

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20
Q

What are the clinical signs of Severe Brachycephalic Airway Syndrome?

A 
Acute respiratory distress
Upper airway swelling, hyperthermia, cyanosis
Heat stroke
Gatrointestinal signs
Lower airway disease
Non-cardiogenic pulmonary edema
Aspiration pneumonia
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21
Q

What drugs should you avoid in your Upper Airway Exam for Brachycephalic airway Syndrome?

A

Ketamine
Diazepam
pure mu agonists

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22
Q

What should you assess Thoracic Radiographs for with Brachycephalic syndrome?

A 
Right heart enlargement 
Hypoplastic trachea 
Non-cardiogenic pulmonary edema
Aspiration Pneumonia
Hiatal hernia
Megaesophagus
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23
Q

When is surgery necessary for Brachycephalic Airway Syndrome?

A

Presence of any component of BAS

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24
Q

How do you correct Stage 1 laryngeal collapse of Brachycephalic airway syndrome?

A

Excision of everted laryngeal saccules

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25
How do you correct Stage 2 laryngeal collapse of Brachycephalic airway syndrome?
Above + vocal fold excision, partial arytenoidectomy
26
How do you correct Stage 3 laryngeal collapse of Brachycephalic airway syndrome?
Permanent tracheotomy
27
How do you correct Soft Palate resection of Brachycephalic airway syndrome?
Palatectomy/Palatoplasty
28
What are some Preoperative Therapy Considerations for surgery for corrections of Brachycephalic airway syndrome?
``` GI Protectants Promotility agents Anti-inflammatories Anti-emetics Pre-oxygenation ```
29
How should you position the patient for surgery for Brachycephalic airway syndrome?
Maxilla hanging from IV poles +/- mouth gag Endotracheal intubation - Ensure cuff is inflated Gauze packing of larynx
30
What are the different tools for Palatoplasty-Paletectomy?
Sharp dissection CO2 laser excision Bipolar sealing device excision
31
What is the most traumatic technique for a Palatoplasty-Paletectomy?
Clamp (Crush) Technique
32
Describe the Freehand Technique for Palatoplasty-Paletectomy
Amputate soft palate to midline with scissors on one side then suture to midline Amputate remaining palate and suture
33
What are the advantages to the Laser Freehand technique?
``` Rapid Virtually no blood loss excellent visualization Minimal post-operative inflammation Reduced post-operative discomfort ```
34
What are the Acute complications of Palatectomy?
Hemorrhage | Inflammation
35
What are the Chronic complications of Palatectomy?
Undershortening | Overshortening: Nasal Reflux or Aspiration
36
What are the complications with arytenoidectomy and ventriculochordectomy?
"webbing" or stricture
37
What are the different techniques for Stenotic Nares?
Wedge Resection: Horizontal, Vertical, or Dorsolateral Amputation of the Alar wing +/- alar fold Alaplexy
38
When would you perform a Unilateral Arytenoid lateralization?
Only in causes of laryngeal paralysis and if adequate cartilage rigidity is present
39
What analgesia do you use with post-operative care of Brachycephalic airway syndrome surgery?
Buprenorphine
40
What Medical Treatment is important for Brachycephalic airway syndrome surgery Post- operative care?
Weight Loss Harness Treat underlying GI disease
41
What are some major Post-operative complications of Brachycephalic airway syndrome surgery?
Pharyngeal swelling: Acute distress Vomiting Regurgitation Aspiration Pneumonia
42
What are some minor post-operative complications of Brachycephalic airway syndrome surgery?
``` Dehiscence of nares: recurrence of stenosis Bleeding Persistent stertor/stridor Rhinitis/Sinusitis Voice change ```
43
What is the surgical treatment for Epiglottic Retroversion?
Surgical plexy of the ventral aspect of the epiglottis and the dorsal base of the tongue
44
What is the cause of Epiglottic Retroversion?
Laxity of hyoepiglotticus m. in face of extreme inspiratory effort
45
What are the clinical signs of Laryngeal Disease?
``` Respiratory Stridor Exercise Intolerance Gagging/Dysphagia Dysphonia Coughing Dyspnea that does not improve with open mouth breathing ```
46
What muscles are responsible for laryngeal abduction?
crycoarytenoideus dorsalis
47
What nerves innervate the crycoarytenoideus dorsalis muscle?
Cranial and caudal laryngeal nerves
48
What nerve is the origin of the cranial laryngeal nerve?
vagus nerve
49
What nerve is the origin of the caudal laryngeal nerve?
vagus nerve through the recurrent laryngeal nerve
50
What are the 3 functions of the Larynx?
Swallowing Abduction Voice Production
51
In what breeds does Congenital Laryngeal Paralysis occur?
``` Bouvier de Flandres Huskies Bull Terriers Dalmations Rottweilers ```
52
What are the characteristics of Congenital Laryngeal Paralysis in Bouvier de Flandres, Huskies, Bull Terriers, and Dalmations?
Progressive degeneration of neurons with onset before 1 year | May have cranial tibial muscle paralysis
53
What are the characteristics of Congenital Laryngeal Paralysis in Rottweilers?
Progressive generalized degenerative disease Onset of signs between 11 and 13 weeks Ataxia, paresis, head tremors, and neurogenic muscle atrophy
54
What is the most common cause of Acquired Laryngeal Paralysis?
Idiopathic
55
What do you see on radiographs for Laryngeal Paralysis?
Aspiration pneumonia Megaesophagus Cranial mediastinal masses: Thymoma Non-cardiogenic pulmonary edema
56
What is the surgical treatment of Laryngeal Paralysis?
Unilateral arytenoid lateralization
57
Describe the Unilateral Arytenoid Lateralization technique?
Secure the muscular process of the crycoid to the arytenoid
58
Poiseuille's Law
In laminar flow resistance to flow is inversely proportional to the radius to the fourth power
59
What does Excessive torsion increase the risk of?
aspiration pneumonia due to poor epiglottic coverage of rima glottidis
60
What should you avoid with Post-op care after Unilateral Arytenoid Lateralization?
heavy sedation or medications that may incite nausea/vomiting
61
What are the complications of Unilateral Arytenoid Lateralization?
``` Aspiration Pneumonia Seroma Intramural hematoma coughing gagging dysphagia ```
62
What structures would you be approaching with a Cervical Ventral Midline Approach?
``` Sternohyoideus and sternothyroideus mm. Recurrent Laryngeal n. Vagosympathetic trunks R and L common carotid arteries Thyroid glands Esophagus ```
63
What structures would you be approaching with a Median Sternotomy?
Caudal and cervical thoracic trachea
64
What structures would you be approaching with a Right 3rd Intercostal Space Thoracotomy?
Cranial Thoracic trachea
65
What structures would you be approaching with a Right 4th Intercostal Space Thoracotomy?
Tracheal Bifurcation
66
What is the Pathophysiology of Tracheal Collapse?
Progressive irreversible degeneration of lower airway Laxity of trachealis muscle Hypocellular Tracheal cartilage Increased weakness/pliability Decreased water retention secondary to loss of glycoprotein and GAG Progressive cough
67
What are the secondary factors leading to Tracheal Collapse?
Obesity Environmental allergens Respiratory Irritants Kennel Cough
68
What is the signalment for Tracheal Collapse?
Small and toy breed dogs | Middle aged dogs
69
Clinical signs of Tracheal Collapse
``` "Goose Honk" Progressive Cough Waxing and waning dyspnea Exercise intolerance Cyanosis Syncope ```
70
Where does the collapse in the trachea occur during inhalation?
cervical
71
Where does the collapse in the trachea occur during exhalation?
Thoracic
72
What should you perform to diagnose Tracheal Collapse?
Fluoroscopy | Tracheoscopy
73
What is the gold standard for diagnosis of Tracheal Collapse?
Tracheoscopy
74
Grade 1 Tracheal Collapse
25% lumen reduction
75
Grade 2 Tracheal Collapse
50% lumen reduction
76
Grade 3 Tracheal Collapse
75% lumen reduction
77
Grade 4 Tracheal Collapse
Almost no lumen
78
When do you consider surgical treatment for tracheal collapse?
When Medical Management fails
79
How do you treat cervical tracheal collapse?
External Prosthetic Tracheal Rings
80
What are the complications associated with External Prosthetic Tracheal Rings?
Laryngeal Paralysis Tracheal necrosis Pneumothorax
81
What are the surgical options for treating Tracheal Collapse?
External Prothetic Tracheal Rings | Intraluminal Stent
82
Intraluminal Stent
Self-expanding nitinol stent placed fluoroscopically or endoscopically
83
What are the advantages of the Intraluminal Stent?
Minimally invasive Shortened anesthesia time Can be used in the cervical or thoracic trachea Immediate improvement in clinical signs
84
What are the disadvantages of the Intraluminal Stent?
Requires fluoroscopy or endoscopy $$$$$ Shorter life-span than tracheal rings Moderate to high complication rate
85
What are the complications of stenting?
``` Stent fracture Stent migration Tracheitis Collapse beyong stented region Tracheal obstruction secondary to granulation tissue formation Tracheal rupture ```
86
What are the clinical signs of Tracheal Trauma?
``` Subcutaneous emphysema Anorexia Lethargy Stridor coughing Dyspnea Mediastinal emphysema Pneumothorax ```
87
When is surgical intervention of Tracheal Trauma indicated?
Dyspnea persists or worsens with medical management If pneumothorax persists for more than 2-3 days Severe tracheal damage is visible
88
What are the options for surgical intervention of Tracheal Trauma?
Primary closure of tear | Tracheal resection and anastomosis
89
What kind of suture is used in Tracheal Trauma?
Fine absorbable suture
90
What are the complications of surgical repair of Tracheal Trauma?
SQ emphysemaa Pneumomediastinum and pneumothorax Infection Stricture
91
When would you perform a Permanent Tracheostomy?
Salvage procedure for treatment of untreatable upper airway obstruction
92
Permanent Tracheostomy
Creates permanent opening at level of proximal cervical trachea
93
What are the complications of Permanent Tracheostomy?
``` Infection Bleeding stenosis foreign bodies increased risk of pneumonia drowning ```
94
Why is prognosis for for cats with permanent tracheostomy?
Mucus plugs are very common and lead to acute death
95
What is the most common surgical approach to the thorax?
Lateral Thoracotomy
96
Combined Abdominal and Median Sternotomy
Lesions where access to both sides of the diaphragm facilitate surgery
97
Transdiaphragmatic Surgical Approach
Allows access to thoracic cavity during celiotomy
98
When would you perform a Transdiaphragmatic Surgical Approach
``` thoracic duct ligation Portoazygous EHPS ligation epicardial cardiac pacemaker lead implantation surgery of the caudal esophagus intra-operative CPR/cardiac massage ```
99
When would you perform a Rib Resection/Pivot lateral Thoracotomy?
remove or pivot rib to increase exposure or remove masses too large to exteriorize through standard level thoractomy
100
When would you perform a Median Sternotomy?
Bilateral thoracic exploration Cranial mediastinal masses Cranial thoracic trachea
101
What would you close with in a Median Sternotomy?
Polypropylene sutures | Orthopedic wire
102
What are the special considerations for Thoracic surgery?
Positive Pressure Ventilation required | Chest tube commonly required post-operatively
103
Pneumonectomy
Removal of all lobes of one lung
104
When is a Pneumonectomy indicated?
where disease is diffuse through multiple lung lobes
105
What approach do you use for a Pneumonectomy?
lateral intercostal approach
106
When would you use Guilllotine suture in a partial lobectomy?
biopsies and very small peripheral masses
107
What is the suture technique for complete lobectomy?
Triple ligation of vessels Pre-place horizontal mattress sutures and tie prior to transection Oversew transected end of bronchus
108
What is the advantage to Stapling technique for a Partial/Complete Lobectomy?
Decreased anesthesia and surgery time
109
What is the disadvantage to the Stapling Technique for a Partial/Complete Lobectomy?
Standard devices too large for very small patients
110
What should you check for with Pulmonary Surgery?
Bleeding/Hemorrhage Air Leakage Chest Tube placed via separate intercostal incision
111
What type of wound is a Lung Biopsy?
Clean-contaminated
112
Bleb
localized collection of air between internal and external layer of visceral pleura
113
Bullae
non-epithelized cavities produced by disruption of intraalveolar sepsis
114
Cysts
Closed sacs lined by epithelium filled with fluid or air
115
Pleurodesis
Lung is fused to the body wall
116
What is conservative treatment for Cysts, Bullae, and Blebs?
Thoracostomy tubes for 48-72 hours
117
What are the possible causes of Lung Lobe Torsion?
Pleural effusion | Partial collapse of lung lobe
118
What dogs are affected by Lung Lobe Torsion?
Large deep chested dogs and pugs
119
Which lung lobes are affected by Lung lobe torsion in large dogs?
Right middle or left cranial lung lobe
120
What lung lobe is affected by Lung Lobe torsion in Pugs?
Left Cranial lung lobe
121
Clinical signs of Lung lobe Torsion?
``` Acute onset of Dyspnea Tachycardia Cough Exercise Intolerance Hemoptysis Pyrexia pale MM Decreased lung sounds ventrally ```
122
What do you see on Thoracocentesis of Lung Lobe Torsion?
Serosanguinous or chylous effusion
123
What should you not do with Lung Lobe Torsion?
Do not untorse the lung | Avoid release of cytokines and endotoxins- Reperfusion injury
124
What are the most common types of Primary Pulmonary Neoplasia?
Bronchiolar or alveolar carcinoma
125
When would you perform a Lung Lobectomy for Primary Pulmonary Neoplasia?
Peripheral tumors not involving the hilus
126
Where do you get Squamous cell carcinoma in the lung?
Cranially
127
Where do you get Adenocarcinoma in the lung?
Caudally
128
What is important to remember with Penetrating Chest Wounds?
DO NOT REMOVE OBJECTS PENETRATING CHEST WALL
129
How do you treat penetrating chest wounds?
Debride any severely damage muscle Repair intercostal lacerations Place a thoracostomy tube
130
What causes Flail Chest?
Multiple segmental rib fractures
131
Flail Chest
Flail segment moves paradoxically with chest wall during respirations due to rib fractures
132
How would you treat Flail Chest?
Interfragmentary wire Cross Pinning of the rib fractures Splint
133
What is the most common cause of Chylothorax?
Idiopathic
134
What is the treatment for Idiopathic Chylothorax?
Thoracic duct ligation Cystena chyli ablation Subtotal pericardiectomy
135
What will improve the visualization of mesenteric lymph nodes?
Lymphangiography | Injection of methylene blue into the mesenteric LN
136
Why would a pericardectomy be performed with chylothorax?
Chylothorax causes fibrosis of the pericardium
137
What is performed with thoracic duct ligation to maximized success of the surgery?
Subtotal pericardectomy
138
What are the complications of CIsterna Chyli Ablation?
Persistent chylous or non-chylous effusion Lung Lobe torsion Pneumothorax
139
Diaphragmatic Hernia
Loss of continuity of diaphragm resulting in movement of abdominal organs into thoracic cavity
140
What is the most common diaphragmatic hernia cause?
Trauma
141
What is the pathophysiology of Diaphragmatic Hernia?
Rapid deflation of lungs with open glottis produces large pleuroperitoneal pressure gradient
142
What are the acute clinical signs of Diaphragmatic Hernia?
``` Respiratory Distress (tachypnea, dyspnea, cyanosis) Shock ```
143
What are the chronic clinical signs of Diaphragmatic Hernia?
``` Respiratory and Gastrointestinal signs Dyspnea Lethargy Exercise intolerance Vomiting Regurgitation inappetance Pleural/peritoneal effusion ```
144
What is the first thing you should do for treatment for Diaphragmatic Hernia?
Stabilize the Patient
145
When is surgery emergent with Diaphragmatic Hernia?
When the stomach is herniated
146
What is the most commonly herniated organ in Diaphragmatic Hernia?
Liver
147
What suture is used to repair Diaphragmatic Hernia?
PDS | Prolene
148
What suture pattern is used for Diaphragmatic Hernia repair?
Simple Continuous pattern
149
What are the complications associated with repair of Diaphragmatic Hernia?
``` Re-expansion pulmonary edema Persistent Pneumothorax hemorrhage Failure of repair and re-herniation Loss of domain: contracture of the abdominal muscles ```
150
Peritoneopericardial Diaphragmatic Hernia
Congenital communication between pericardium and peritoneal cavity
151
Pentology of defects associated with Congenital Cranial Abdominal Wall and Diaphragmatic Defects
``` Cranial Abdominal wall defect Caudal sternal fusion defect Pericardial defect Diaphragmatic defect Intracardiac defects ```
152
Radiographic signs of Peritoneopericardial Diaphragmatic Hernia
Enlarged cardiac silhouette Dorsal elevation of trachea Overlap of heart and diaphragmatic borders Gas filled structures in pericardial sac Sternal defects Dorsal peritoneopericardial mesothelial remnant
153
How soon should you perform surgery on Peritoneopericardial Diaphragmatic Hernia?
Between 8-16 weeks
154
Why would you give antibiotics for Peritoneopericardial Diaphragmatic Hernia?
Hepatic compromise may result in release of toxins
155
What approach would you use for surgical treatment of Peritoneopericardial Diaphragmatic Hernia?
Ventral Midline Abdominal approach
156
What suture pattern would you use to repair a Peritoneopericardial Diaphragmatic Hernia?
Simple continuous pattern
157
What is the most common congenital cardiac defect in dogs?
Patent Ductus Arteriosus
158
What is the pathophysiology of PDA?
PDA shunts blood from left to right side of heart leading to severe volume overload of left heart and left sided failure
159
What are the clinical signs of PDA?
Continuous murmur | Hyperkinetic "waterhammer" pulses
160
What is the treatment for PDA?
Coil embolization Amplatzer ductal occluder Surgical ligation
161
What are the complications associated with PDA?
Severe hemorrhage Bradycardia Residual ductal flow
162
What is the most common cardiac neoplasia in dogs?
Hemangiosarcoma of right auricale
163
How do you diagnose Hemangiosarcoma of right auricle?
echocardiography
164
What is the treatment of Hemangiosarcoma of right auricle?
Excision of right auricular mass, pericaardectomy followed by chemotherapy
165
What are the functions of the pericardium?
Prevents over-distention Provides gliding surface for heart Protects heart from spread of infection from thoracic cavity
166
What do you find on physical exam with Pericardial disease?
Muffled heart sounds | Weak femoral pulses +/- pulsus paridoxicus
167
What do you see on Electrocardiogram with Pericardial disease?
Electrical alterans
168
What do you do to diagnose Pericardial disease?
Pericardiocentesis
169
What is a palliative treatment for cardiac tamponade?
Pericardiectomy
170
What is the most common persistent right aortic arch?
PRAA with left ligamentum arteriosum
171
What results from PRAA?
Esophageal constriction/occlusion
172
What breed is the most commonly affected by PRAA?
German Shepards
173
What are the clinical signs of PRAA?
Regurgitation Unthrifty Respiratory signs secondary to aspiration pneumonia
174
How would you approach a PRAA?
Left intercostal thoracotomy
175
How do you surgically treat PRAA?
Isolattion of ligamentum arteriosum Double ligate and transect Pass foley catheter and ensure inflated balloon can pass through site of obstruction
176
What is a long term complication of PRAA?
Aspiration pneumonia

RUSVM Small Animal Surgery 2017 (17 decks)

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