Respiratory Surgery Flashcards
Laryngeal collapse: Cx
Stertor (expiratory); Stridor (Inspiratory); Exercise intolerance; Coughing; Regurg and vomiting
Tracheal obstruction: Cx
Cough; Dyspnea; Cyanosis; Collapse
Tracheal obstruction: Tx
Resection and anastomosis; Tracheostomy
What is the main surgical treatment for lung lobe consolidation, bronchiectasis; lung lobe torsion or pulmonary neoplasia?
Partial or complete lung lobectomies
What are the four main components of BOAS?
Stenotic nares; Elongated, thickened soft palate; Everted laryngeal saccules; Hypoplastic trachea; (also can have abherent turbinates; lorg tongue; tracheal collapse)
List at least 3 clinical signs of BOAS
Stertor; Obstructive sleep apnea; Heat intolerance; Cyanosis and collapse; GI Signs (difficult swallowing, regurg, reflux, hiatal hernia)
How do we diagnose BOAS?
Typical way is to evaluate the dog’s breathing at rest and exercise (walk), and do a sedated oral and laryngeal exam, based on these parameters we can assign a severity score; CT?radiology can be nice for issues like tracheal/bronchial hypoplasia, collapse, hiatal hernias, aspiration pneumonia
Medical management of BOAS
Weight management; Avoid overheating
List 5 surgical procedures we can do to manage BOAS
Rhinoplasty; Endoscope-guided turbinectomy; Shorten soft palate (e.g. Staphylectomy); Partial tonsillectomy; Laryngeal sacculectomy
Prognosis of BOAS
The more severe, the worse the prognosis
What does post-operative management look like for dogs with BOAS?
Susceptible to post-operative airway inflammation or pneumonia so address w/ supplemental oxygen, anti-inflammatories and possible a tracheostomy
Pathomechanism of Laryngeal Paralysis (LarPar)
Idiopathic disorder typically in older large breed dogs (e.g. Labs and Goldens) where there is damage to the recurrent laryngeal nerve/caudal laryngeal nerve leading to failure of the cricoarytenoideus dorsalis muscle to abduct the arytenoids. Typically bilateral
GOLPP
Geriatric Onset Laryngeal Paralysis and Polyneuropathy
Three components of GOLPP
Laryngeal paralysis; Radial nerve dysfunction; Tibial nerve dysfunction
Clinical signs of Laryngeal Paralysis
Change in phonation; Gagging; Exercise intolerance; Laryngeal stridor (during inspiration the arytenoids and vocal folds get pulled into the larynx closing the airway); Cyanosis; Dyspnea
How is laryngeal paralysis diagnosed?
Radiographs to rule out other causes and look for supportive pathology such as aspiration pneumonia, non-cardiogenic pulmonary edema and megaesophagus); Laryngoscopy under light anaesthesia
How would you address an emergency case of LarPar?
Cooling, oxygen therapy and anxiolytics +/- emergency intubation or tracheostomy
For mild cases of LarPar, medical management solely tends to be appropriate. Describe medical management of this condition
Weight management, stress reduction, exercise restriction and avoiding heat. Warn owners that it will progress and can cause an emergency
For moderate to severe cases of LarPar, how can we surgically manage the condition? What is a drawback?
Unilateral cricoarytenoid lateralization (“tie-back”); risk of aspiration (no swimmy :( )
Prognosis of LarPar
Fair to poor (worsens as disease progresses)
For tracheal collapse, which type of stenting is preferred, intraluminal or extraluminal?
Intraluminal (easier, and less severe complications especially in dogs where sx approach could be difficult)
Does stenting a tracheal collapse stop the dog from coughing?
Naur
Provide at least three causes of a spontaneous pneumothorax
Pulmonary emphysema; Pulmonary neoplasia; Chronic pneumonia; Migrating plant material; Asthma; Lungworm; Heartworm
Clinical signs of spontaneous pneumothorax
In moderate to severe cases, we get restrictive breathing, hypoventilation, diminished lung sounds and respiratory distress
Diagnosis of pneumothorax
US and PE to confirm presence of pneumothorax
Four treatments for spontaneous pneumothorax
Thoracocentesis; Thoracotomy + continuous suction; Autologous blood patch (basically using animal’s own blood, injecting it into the pleural space, and incuding the formation of a fibrin clot); Surgery
Pathomechanism of pyothorax
Accumulation of septic purulent fluid in the pleural space
Clinical signs of pyothorax
(May not be evident): tachypnea; dyspnea; cough; lethargy; weight loss; anorexia; restrictive breathing pattern
Treatment of pyothorax
Typically, thoracocentesis or chest tube to drain +/- lavage + antibiotics (Fluoroquinolone and penicillin or clindamycin)
Diagnosis of a pyothorax
Thoracocentesis; Cytology and culture
When would surgical management of a pyothorax be indicated? What does this involve?
If you have failure of medical management (3-7d) or complications with the thoracostomy tube; remove inciting cause of pyothorax
Prognosis of pyothorax
Guarded to good; Dogs tend to do better than cats with surgery
Pathomechanism of a diaphragmatic hernia
Trauma leads to deatchment/rupture of part of the diaphragm from the body wall, allowing abdominal organs (liver most often) to enter the thoracic cavity
Clinical signs of a Diaphragmatic hernia
Respiratory distress; Exercise intoelrance; Muffled heart and lung sounds: +/- borborygmi
Diagnosis of a diaphragmatic hernia
radiographs; Ultrasound
How are patients with diaphragmatic hernias treated?
Taken into surgery ASAP once stabilized; hernia is reduced via an abdominal approach while patient is on ventilatory support
Briefly describe diaphragmatic hernia reduction surgery
Gently reduce the abdominal contents back into the abdomen, breaking adhesions where possible; Close opening dorsal to ventral using a continuous pattern +/- surgical mesh if chronic; Place thoracostomy tubes
Prognosis of diaphragmatic hernia patients that receive surgeru
80-90% survival to discharge
True or false. Death w/in 24 h of DH reduction is typically due to issues related to the GI tract.
False. Death w/in 24 h of DH reduction tends to be due to either pulmonary or cardiac dysfunction. Following 24hj, death typically due to GI damage or an unrelated issue
True or false. Diaphragmatic hernias and peritoneopericardial diaphragmatic hernia are acquired.
False. PPDH are congenital while DH are acquired
PPDH
Opening in the ventral diaphragm which allows the pericardial sac and peritoneal cavity to interact
Clinical signs of PPDH
Muffled heart sounds, Boroborygmi in the thoracic cavity; Dyspnea; Cardiac dysnfunction
Diagnosis of PPDH
radiographs; Ultrasound
Surgery used to correct PPDH
Midline celliotomy (may have to enter pleural space and pericardium)
