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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
Q

How do you correct Stage 2 laryngeal collapse of Brachycephalic airway syndrome?

A

Above + vocal fold excision, partial arytenoidectomy

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26
Q

How do you correct Stage 3 laryngeal collapse of Brachycephalic airway syndrome?

A

Permanent tracheotomy

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27
Q

How do you correct Soft Palate resection of Brachycephalic airway syndrome?

A

Palatectomy/Palatoplasty

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28
Q

What are some Preoperative Therapy Considerations for surgery for corrections of Brachycephalic airway syndrome?

A 
GI Protectants
Promotility agents
Anti-inflammatories
Anti-emetics
Pre-oxygenation
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29
Q

How should you position the patient for surgery for Brachycephalic airway syndrome?

A

Maxilla hanging from IV poles
+/- mouth gag
Endotracheal intubation - Ensure cuff is inflated
Gauze packing of larynx

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30
Q

What are the different tools for Palatoplasty-Paletectomy?

A

Sharp dissection
CO2 laser excision
Bipolar sealing device excision

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31
Q

What is the most traumatic technique for a Palatoplasty-Paletectomy?

A

Clamp (Crush) Technique

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32
Q

Describe the Freehand Technique for Palatoplasty-Paletectomy

A

Amputate soft palate to midline with scissors on one side then suture to midline
Amputate remaining palate and suture

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33
Q

What are the advantages to the Laser Freehand technique?

A 
Rapid 
Virtually no blood loss
excellent visualization 
Minimal post-operative inflammation 
Reduced post-operative discomfort
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34
Q

What are the Acute complications of Palatectomy?

A

Hemorrhage

Inflammation

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35
Q

What are the Chronic complications of Palatectomy?

A

Undershortening

Overshortening: Nasal Reflux or Aspiration

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36
Q

What are the complications with arytenoidectomy and ventriculochordectomy?

A

“webbing” or stricture

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37
Q

What are the different techniques for Stenotic Nares?

A

Wedge Resection: Horizontal, Vertical, or Dorsolateral
Amputation of the Alar wing +/- alar fold
Alaplexy

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38
Q

When would you perform a Unilateral Arytenoid lateralization?

A

Only in causes of laryngeal paralysis and if adequate cartilage rigidity is present

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39
Q

What analgesia do you use with post-operative care of Brachycephalic airway syndrome surgery?

A

Buprenorphine

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40
Q

What Medical Treatment is important for Brachycephalic airway syndrome surgery Post- operative care?

A

Weight Loss
Harness
Treat underlying GI disease

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41
Q

What are some major Post-operative complications of Brachycephalic airway syndrome surgery?

A

Pharyngeal swelling: Acute distress
Vomiting
Regurgitation
Aspiration Pneumonia

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42
Q

What are some minor post-operative complications of Brachycephalic airway syndrome surgery?

A 
Dehiscence of nares: recurrence of stenosis
Bleeding 
Persistent stertor/stridor
Rhinitis/Sinusitis
Voice change
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43
Q

What is the surgical treatment for Epiglottic Retroversion?

A

Surgical plexy of the ventral aspect of the epiglottis and the dorsal base of the tongue

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44
Q

What is the cause of Epiglottic Retroversion?

A

Laxity of hyoepiglotticus m. in face of extreme inspiratory effort

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45
Q

What are the clinical signs of Laryngeal Disease?

A 
Respiratory Stridor 
Exercise Intolerance
Gagging/Dysphagia 
Dysphonia
Coughing 
Dyspnea that does not improve with open mouth breathing
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46
Q

What muscles are responsible for laryngeal abduction?

A

crycoarytenoideus dorsalis

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47
Q

What nerves innervate the crycoarytenoideus dorsalis muscle?

A

Cranial and caudal laryngeal nerves

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48
Q

What nerve is the origin of the cranial laryngeal nerve?

A

vagus nerve

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49
Q

What nerve is the origin of the caudal laryngeal nerve?

A

vagus nerve through the recurrent laryngeal nerve

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50
Q

What are the 3 functions of the Larynx?

A

Swallowing
Abduction
Voice Production

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51
Q

In what breeds does Congenital Laryngeal Paralysis occur?

A 
Bouvier de Flandres 
Huskies
Bull Terriers
Dalmations
Rottweilers
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52
Q

What are the characteristics of Congenital Laryngeal Paralysis in Bouvier de Flandres, Huskies, Bull Terriers, and Dalmations?

A

Progressive degeneration of neurons with onset before 1 year

May have cranial tibial muscle paralysis

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53
Q

What are the characteristics of Congenital Laryngeal Paralysis in Rottweilers?

A

Progressive generalized degenerative disease
Onset of signs between 11 and 13 weeks
Ataxia, paresis, head tremors, and neurogenic muscle atrophy

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54
Q

What is the most common cause of Acquired Laryngeal Paralysis?

A

Idiopathic

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55
Q

What do you see on radiographs for Laryngeal Paralysis?

A

Aspiration pneumonia
Megaesophagus
Cranial mediastinal masses: Thymoma
Non-cardiogenic pulmonary edema

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56
Q

What is the surgical treatment of Laryngeal Paralysis?

A

Unilateral arytenoid lateralization

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57
Q

Describe the Unilateral Arytenoid Lateralization technique?

A

Secure the muscular process of the crycoid to the arytenoid

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58
Q

Poiseuille’s Law

A

In laminar flow resistance to flow is inversely proportional to the radius to the fourth power

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59
Q

What does Excessive torsion increase the risk of?

A

aspiration pneumonia due to poor epiglottic coverage of rima glottidis

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60
Q

What should you avoid with Post-op care after Unilateral Arytenoid Lateralization?

A

heavy sedation or medications that may incite nausea/vomiting

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61
Q

What are the complications of Unilateral Arytenoid Lateralization?

A 
Aspiration Pneumonia
Seroma
Intramural hematoma
coughing 
gagging 
dysphagia
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62
Q

What structures would you be approaching with a Cervical Ventral Midline Approach?

A 
Sternohyoideus and sternothyroideus mm. 
Recurrent Laryngeal n. 
Vagosympathetic trunks
R and L common carotid arteries
Thyroid glands
Esophagus
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63
Q

What structures would you be approaching with a Median Sternotomy?

A

Caudal and cervical thoracic trachea

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64
Q

What structures would you be approaching with a Right 3rd Intercostal Space Thoracotomy?

A

Cranial Thoracic trachea

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65
Q

What structures would you be approaching with a Right 4th Intercostal Space Thoracotomy?

A

Tracheal Bifurcation

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66
Q

What is the Pathophysiology of Tracheal Collapse?

A

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

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67
Q

What are the secondary factors leading to Tracheal Collapse?

A

Obesity
Environmental allergens
Respiratory Irritants
Kennel Cough

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68
Q

What is the signalment for Tracheal Collapse?

A

Small and toy breed dogs

Middle aged dogs

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69
Q

Clinical signs of Tracheal Collapse

A 
"Goose Honk" Progressive Cough 
Waxing and waning dyspnea
Exercise intolerance
Cyanosis
Syncope
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70
Q

Where does the collapse in the trachea occur during inhalation?

A

cervical

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71
Q

Where does the collapse in the trachea occur during exhalation?

A

Thoracic

72
Q

What should you perform to diagnose Tracheal Collapse?

A

Fluoroscopy

Tracheoscopy

73
Q

What is the gold standard for diagnosis of Tracheal Collapse?

A

Tracheoscopy

74
Q

Grade 1 Tracheal Collapse

A

25% lumen reduction

75
Q

Grade 2 Tracheal Collapse

A

50% lumen reduction

76
Q

Grade 3 Tracheal Collapse

A

75% lumen reduction

77
Q

Grade 4 Tracheal Collapse

A

Almost no lumen

78
Q

When do you consider surgical treatment for tracheal collapse?

A

When Medical Management fails

79
Q

How do you treat cervical tracheal collapse?

A

External Prosthetic Tracheal Rings

80
Q

What are the complications associated with External Prosthetic Tracheal Rings?

A

Laryngeal Paralysis
Tracheal necrosis
Pneumothorax

81
Q

What are the surgical options for treating Tracheal Collapse?

A

External Prothetic Tracheal Rings

Intraluminal Stent

82
Q

Intraluminal Stent

A

Self-expanding nitinol stent placed fluoroscopically or endoscopically

83
Q

What are the advantages of the Intraluminal Stent?

A

Minimally invasive
Shortened anesthesia time
Can be used in the cervical or thoracic trachea
Immediate improvement in clinical signs

84
Q

What are the disadvantages of the Intraluminal Stent?

A

Requires fluoroscopy or endoscopy
$$$$$
Shorter life-span than tracheal rings
Moderate to high complication rate

85
Q

What are the complications of stenting?

A 
Stent fracture
Stent migration 
Tracheitis
Collapse beyong stented region 
Tracheal obstruction secondary to granulation tissue formation 
Tracheal rupture
86
Q

What are the clinical signs of Tracheal Trauma?

A 
Subcutaneous emphysema
Anorexia
Lethargy
Stridor coughing
Dyspnea
Mediastinal emphysema
Pneumothorax
87
Q

When is surgical intervention of Tracheal Trauma indicated?

A

Dyspnea persists or worsens with medical management
If pneumothorax persists for more than 2-3 days
Severe tracheal damage is visible

88
Q

What are the options for surgical intervention of Tracheal Trauma?

A

Primary closure of tear

Tracheal resection and anastomosis

89
Q

What kind of suture is used in Tracheal Trauma?

A

Fine absorbable suture

90
Q

What are the complications of surgical repair of Tracheal Trauma?

A

SQ emphysemaa
Pneumomediastinum and pneumothorax
Infection
Stricture

91
Q

When would you perform a Permanent Tracheostomy?

A

Salvage procedure for treatment of untreatable upper airway obstruction

92
Q

Permanent Tracheostomy

A

Creates permanent opening at level of proximal cervical trachea

93
Q

What are the complications of Permanent Tracheostomy?

A 
Infection 
Bleeding 
stenosis
foreign bodies
increased risk of pneumonia 
drowning
94
Q

Why is prognosis for for cats with permanent tracheostomy?

A

Mucus plugs are very common and lead to acute death

95
Q

What is the most common surgical approach to the thorax?

A

Lateral Thoracotomy

96
Q

Combined Abdominal and Median Sternotomy

A

Lesions where access to both sides of the diaphragm facilitate surgery

97
Q

Transdiaphragmatic Surgical Approach

A

Allows access to thoracic cavity during celiotomy

98
Q

When would you perform a Transdiaphragmatic Surgical Approach

A 
thoracic duct ligation 
Portoazygous EHPS ligation 
epicardial cardiac pacemaker lead implantation 
surgery of the caudal esophagus 
intra-operative CPR/cardiac massage
99
Q

When would you perform a Rib Resection/Pivot lateral Thoracotomy?

A

remove or pivot rib to increase exposure or remove masses too large to exteriorize through standard level thoractomy

100
Q

When would you perform a Median Sternotomy?

A

Bilateral thoracic exploration
Cranial mediastinal masses
Cranial thoracic trachea

101
Q

What would you close with in a Median Sternotomy?

A

Polypropylene sutures

Orthopedic wire

102
Q

What are the special considerations for Thoracic surgery?

A

Positive Pressure Ventilation required

Chest tube commonly required post-operatively

103
Q

Pneumonectomy

A

Removal of all lobes of one lung

104
Q

When is a Pneumonectomy indicated?

A

where disease is diffuse through multiple lung lobes

105
Q

What approach do you use for a Pneumonectomy?

A

lateral intercostal approach

106
Q

When would you use Guilllotine suture in a partial lobectomy?

A

biopsies and very small peripheral masses

107
Q

What is the suture technique for complete lobectomy?

A

Triple ligation of vessels
Pre-place horizontal mattress sutures and tie prior to transection
Oversew transected end of bronchus

108
Q

What is the advantage to Stapling technique for a Partial/Complete Lobectomy?

A

Decreased anesthesia and surgery time

109
Q

What is the disadvantage to the Stapling Technique for a Partial/Complete Lobectomy?

A

Standard devices too large for very small patients

110
Q

What should you check for with Pulmonary Surgery?

A

Bleeding/Hemorrhage
Air Leakage
Chest Tube placed via separate intercostal incision

111
Q

What type of wound is a Lung Biopsy?

A

Clean-contaminated

112
Q

Bleb

A

localized collection of air between internal and external layer of visceral pleura

113
Q

Bullae

A

non-epithelized cavities produced by disruption of intraalveolar sepsis

114
Q

Cysts

A

Closed sacs lined by epithelium filled with fluid or air

115
Q

Pleurodesis

A

Lung is fused to the body wall

116
Q

What is conservative treatment for Cysts, Bullae, and Blebs?

A

Thoracostomy tubes for 48-72 hours

117
Q

What are the possible causes of Lung Lobe Torsion?

A

Pleural effusion

Partial collapse of lung lobe

118
Q

What dogs are affected by Lung Lobe Torsion?

A

Large deep chested dogs and pugs

119
Q

Which lung lobes are affected by Lung lobe torsion in large dogs?

A

Right middle or left cranial lung lobe

120
Q

What lung lobe is affected by Lung Lobe torsion in Pugs?

A

Left Cranial lung lobe

121
Q

Clinical signs of Lung lobe Torsion?

A 
Acute onset of Dyspnea
Tachycardia
Cough 
Exercise Intolerance 
Hemoptysis
Pyrexia
pale MM
Decreased lung sounds ventrally
122
Q

What do you see on Thoracocentesis of Lung Lobe Torsion?

A

Serosanguinous or chylous effusion

123
Q

What should you not do with Lung Lobe Torsion?

A

Do not untorse the lung

Avoid release of cytokines and endotoxins- Reperfusion injury

124
Q

What are the most common types of Primary Pulmonary Neoplasia?

A

Bronchiolar or alveolar carcinoma

125
Q

When would you perform a Lung Lobectomy for Primary Pulmonary Neoplasia?

A

Peripheral tumors not involving the hilus

126
Q

Where do you get Squamous cell carcinoma in the lung?

A

Cranially

127
Q

Where do you get Adenocarcinoma in the lung?

A

Caudally

128
Q

What is important to remember with Penetrating Chest Wounds?

A

DO NOT REMOVE OBJECTS PENETRATING CHEST WALL

129
Q

How do you treat penetrating chest wounds?

A

Debride any severely damage muscle
Repair intercostal lacerations
Place a thoracostomy tube

130
Q

What causes Flail Chest?

A

Multiple segmental rib fractures

131
Q

Flail Chest

A

Flail segment moves paradoxically with chest wall during respirations due to rib fractures

132
Q

How would you treat Flail Chest?

A

Interfragmentary wire
Cross Pinning of the rib fractures
Splint

133
Q

What is the most common cause of Chylothorax?

A

Idiopathic

134
Q

What is the treatment for Idiopathic Chylothorax?

A

Thoracic duct ligation
Cystena chyli ablation
Subtotal pericardiectomy

135
Q

What will improve the visualization of mesenteric lymph nodes?

A

Lymphangiography

Injection of methylene blue into the mesenteric LN

136
Q

Why would a pericardectomy be performed with chylothorax?

A

Chylothorax causes fibrosis of the pericardium

137
Q

What is performed with thoracic duct ligation to maximized success of the surgery?

A

Subtotal pericardectomy

138
Q

What are the complications of CIsterna Chyli Ablation?

A

Persistent chylous or non-chylous effusion
Lung Lobe torsion
Pneumothorax

139
Q

Diaphragmatic Hernia

A

Loss of continuity of diaphragm resulting in movement of abdominal organs into thoracic cavity

140
Q

What is the most common diaphragmatic hernia cause?

A

Trauma

141
Q

What is the pathophysiology of Diaphragmatic Hernia?

A

Rapid deflation of lungs with open glottis produces large pleuroperitoneal pressure gradient

142
Q

What are the acute clinical signs of Diaphragmatic Hernia?

A 
Respiratory Distress (tachypnea, dyspnea, cyanosis)
Shock
143
Q

What are the chronic clinical signs of Diaphragmatic Hernia?

A 
Respiratory and Gastrointestinal signs 
Dyspnea 
Lethargy
Exercise intolerance
Vomiting
Regurgitation
inappetance
Pleural/peritoneal effusion
144
Q

What is the first thing you should do for treatment for Diaphragmatic Hernia?

A

Stabilize the Patient

145
Q

When is surgery emergent with Diaphragmatic Hernia?

A

When the stomach is herniated

146
Q

What is the most commonly herniated organ in Diaphragmatic Hernia?

A

Liver

147
Q

What suture is used to repair Diaphragmatic Hernia?

A

PDS

Prolene

148
Q

What suture pattern is used for Diaphragmatic Hernia repair?

A

Simple Continuous pattern

149
Q

What are the complications associated with repair of Diaphragmatic Hernia?

A 
Re-expansion pulmonary edema
Persistent Pneumothorax
hemorrhage
Failure of repair and re-herniation 
Loss of domain: contracture of the abdominal muscles
150
Q

Peritoneopericardial Diaphragmatic Hernia

A

Congenital communication between pericardium and peritoneal cavity

151
Q

Pentology of defects associated with Congenital Cranial Abdominal Wall and Diaphragmatic Defects

A 
Cranial Abdominal wall defect
Caudal sternal fusion defect 
Pericardial defect 
Diaphragmatic  defect 
Intracardiac defects
152
Q

Radiographic signs of Peritoneopericardial Diaphragmatic Hernia

A

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
Q

How soon should you perform surgery on Peritoneopericardial Diaphragmatic Hernia?

A

Between 8-16 weeks

154
Q

Why would you give antibiotics for Peritoneopericardial Diaphragmatic Hernia?

A

Hepatic compromise may result in release of toxins

155
Q

What approach would you use for surgical treatment of Peritoneopericardial Diaphragmatic Hernia?

A

Ventral Midline Abdominal approach

156
Q

What suture pattern would you use to repair a Peritoneopericardial Diaphragmatic Hernia?

A

Simple continuous pattern

157
Q

What is the most common congenital cardiac defect in dogs?

A

Patent Ductus Arteriosus

158
Q

What is the pathophysiology of PDA?

A

PDA shunts blood from left to right side of heart leading to severe volume overload of left heart and left sided failure

159
Q

What are the clinical signs of PDA?

A

Continuous murmur

Hyperkinetic “waterhammer” pulses

160
Q

What is the treatment for PDA?

A

Coil embolization
Amplatzer ductal occluder
Surgical ligation

161
Q

What are the complications associated with PDA?

A

Severe hemorrhage
Bradycardia
Residual ductal flow

162
Q

What is the most common cardiac neoplasia in dogs?

A

Hemangiosarcoma of right auricale

163
Q

How do you diagnose Hemangiosarcoma of right auricle?

A

echocardiography

164
Q

What is the treatment of Hemangiosarcoma of right auricle?

A

Excision of right auricular mass, pericaardectomy followed by chemotherapy

165
Q

What are the functions of the pericardium?

A

Prevents over-distention
Provides gliding surface for heart
Protects heart from spread of infection from thoracic cavity

166
Q

What do you find on physical exam with Pericardial disease?

A

Muffled heart sounds

Weak femoral pulses +/- pulsus paridoxicus

167
Q

What do you see on Electrocardiogram with Pericardial disease?

A

Electrical alterans

168
Q

What do you do to diagnose Pericardial disease?

A

Pericardiocentesis

169
Q

What is a palliative treatment for cardiac tamponade?

A

Pericardiectomy

170
Q

What is the most common persistent right aortic arch?

A

PRAA with left ligamentum arteriosum

171
Q

What results from PRAA?

A

Esophageal constriction/occlusion

172
Q

What breed is the most commonly affected by PRAA?

A

German Shepards

173
Q

What are the clinical signs of PRAA?

A

Regurgitation
Unthrifty
Respiratory signs secondary to aspiration pneumonia

174
Q

How would you approach a PRAA?

A

Left intercostal thoracotomy

175
Q

How do you surgically treat PRAA?

A

Isolattion of ligamentum arteriosum
Double ligate and transect
Pass foley catheter and ensure inflated balloon can pass through site of obstruction

176
Q

What is a long term complication of PRAA?

A

Aspiration pneumonia

RUSVM Small Animal Surgery 2017 (17 decks)

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