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TOBIAS VETERINARY SURGERY > RESPIRATORY SYSTEM: 99, 100, 101, 102, 103 > Flashcards

RESPIRATORY SYSTEM: 99, 100, 101, 102, 103 Flashcards

1
Q

what are the 3 pairs of nasal cartilages?

A

dorsolateral
ventral lateral
accessory

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2
Q

Laryngeal paralysis: diagnostics

A 
BLOOD WORK
CHEST RX (PNEUMONIA, MEGAESOFAGUS, LUNG TRACHEA NEOPLASIA)
CERVICAL RX (MASS LARYNX, TRACHEA, FOREIGN OBJ

EMERGENCY: O2, SEDATION, COOLING, STEROIDS

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3
Q

Laryngeal paralisys: premed

A

NO PREMED. JUST LIGHT SEDATION 8TIOPENTAL IV, PROPOFOL, ALFAXAN
DOXAPRAM RESPIRATORY STIMULANT.
IN DOG WITH LARYNGEAL PARALISIS DOXAPRAM WILL NOT WORK!

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4
Q

Laringeal paralisys differentials

A 
1 congenital denervation
2 traumatic
3 iatrogenic
4 idiopathic
5 neoplastic
6 associated with diffuse neuromuscular disease

CITINA

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5
Q

Braund 1989: Laringeal paralisys

A

sign of a polineuropaty desease

up to 90-95% of dogs diagnosed wuith LP develop at 12 month neurological deficits.

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6
Q

sedation for Laryngeal paralisys

A

use of agonist-antagonist as buthorfanol reduce risk of aspiration pneumonia compared to pure agonist (morphine-metadone)

acepromromazine

ace and but maintain laryngeal function

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7
Q

laryingeal paralisys medical treatement

A

sedation, cooling, acute resp distress control, antinflammatory, WEIGHT LOSS in long time

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8
Q

milovancev 2016 metoclopramide laryngeal paralisys

A

metoclopramide, at the doses used in this study, did not affect the incidence of aspiration pneumonia in the short term postoperative period

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9
Q

laryngeal paralisys surgical management

A

1 laryngeal tie back monolateral (bilateral up to 70% aspiration pneumonia)
2 vocal cordectomy +- castellated laryngeal fissure
3 aritenoidectomy
4 stent

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10
Q

what are the main muscles acting in the nasal planum?

A

levator naso-labialis: dorsal midline muzzle to frontal and maxillary bones

orbicularis oris (primarily lips but also nares

levator labii maxillaries+ labial part (caninus muscle): deep to levator naso-labialis

INNERVATED BY FACIAL NERVE

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11
Q

name the 3 paranasal sinuses

A

maxillary recess

sphenoidal sinus

frontal sinus

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12
Q

major differential disgnoses for nasopharingeal desease

A 
neoplasia (AC dog, lymphoma cat)
inflammatory polyp (cat)
fungal infection (cryptosporidium cat, aspergillosis Large breed dog)
viral + bacterial infection
foreing body
dental desease
idiophatic rhinosinusitis
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13
Q

does inflammatory polips in cat always invade the bulla?

A

in a study all cats with inflammatory polyps had invasion of at least one bulla

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14
Q

does inflammatory rinitis in cats extend to he bulla?

A

up to 28% cats with rinitis can have involvement of the bulla without symptoms of ot otitis externa

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15
Q

significance of septal and cribriform lysis in prediction of neoplastic desease

A

associated with neoplasia in dogs, not so clearly in cats

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16
Q

how to diagnose cryptococcus spp. in cats efficiently

A

antigen serology has a hig specificity and sensibility

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17
Q

nasal malformations regarding brachicephalic breeds

A

axial displacement of the dorsolarteral nasal cartilage
intranasal senosis
abnormal conchal development

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18
Q

preferred treatement for intranasal neoplasia

A

cytoreductive surgery may not improve outcome.

radiation therapy is the recommended treatement

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19
Q

most typical radiographic appearance of conchal of nasal fungal infection

A

conchal lysis and punctate bone lucency with soft tissue opacity contents or mass in the nose and sinuses

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20
Q

how is cats bulla divided?

A

2 portions: dorso lateral and ventro medial

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21
Q

recurrence of inflammatory polyps with avulsion vs bulla osteotomy

A

nasopahringeal only traction -> only 1-12 recurred

aural only traction -> 6-7 recurred

with VBO recurrence down to 5%

one study reported 0 reccurrence after glucocorticoids treatement

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22
Q

3 surgical options for nasopharingeal stenosis

A

open surgical resection of the stenotic menbrane

endoscopoic guided balloon dilation

stents

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23
Q

during excision of the nasal planum what arteries will be responsible for hemorrage?

A

paired dorsal and lateral nasal arteries (originate from the infraorbitary artery)

major palatine arteries (from maxillary artery)

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24
Q

what should be avoided in cats during intrabuccal surgery or hemorrage prevention?

A

1) do not close carotid artery to prevent hemorrage from rhinotomy (no internal carotid ad less robust cerebral blood supply so risk for ischemic damage)
2) do not keep too long with buccal openers to prevent compression to the maxillary artery and consequent cerebral and retinal ischemia

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25
Q

describe the 4 possible approach to the nasal cavity

A

1) DORSAL: mosto commonly used
2) VENTRAL
3) LATERAL
4) ROSTRAL

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26
Q

name the bones that forms the hard palate cranial to caudal

A

incisive, maxillary, palatine

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27
Q

Major palatine foramen: vasculature and innervation

A

VASCULATURE: major palatine artery

INNERVATION:

           major palatine branch of the maxillary division of trigeminal nerve 
           (sensory innervation oral side hard palate) 

           minor palatine branch of the maxillary division of trigeminal nerve (sensory 
           innervation soft palate)
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28
Q

nerves supply to the pterygopharyngeal and palatopharyngeal muscles

A

glossopharyngeal and vagus nerves

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29
Q

name the 3 soft palate muscles

A

1) palatinus : from palatine processo (palatine bone) to caudal border SP
2) tensor veli palatini: stretches SP beetween pterygoid bones
3) levator veli palatini: elevate the caudal SP (protect naxopharynx during vomiting and swallowing)

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30
Q

correct timing to perform a palatal surgery

A

3-4 months

before: is more difficult and tissues are more friable and delicate
after: wider cleft and compounded management problems

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31
Q

name the 2 main surgical technique for hard palate cleft repair

A

overlapping flap technique

medially positioned flap technique

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32
Q

technique to close large caudal hard palate defects

A

split palatal U-flap can be used

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33
Q

name the 4 arythenoid processes from cranial to caudal

A

cuneiform, corniculate, muscolar, vocal

34
Q

name the main extrinsic muscle of the larynx

A

1) tyropharingeus

2) cricopharyngeus

35
Q

name the main intrinsic larynx muscles

A

1) cricoarytenoideus dorsalis (abduction arytenoids)
2) cricoarytenoideus lateralis (pivot aryt inward, closing glottis)

3) tyroarytenoideus: give rise to ventricularis + vocalis muscle
4) arytenoideus transversus (vocal folds adduction and glottis constriction)
5) hyoepiglotticus (draws the epiglottis down)

36
Q

innervation of the larynx

A

1) cranial larinngeal nerve (from vagus): innervation to cricotyroideus muscle
2) caudal laringeal nerve (from vagus): terminal segment of the recurrent laryngeal nerve

        -left recurrent arches around aorta, gives off pararecurrent laryngeal nerve 
         and terminate as left caudal laryngeal nerve 
        -right recurrent arches around right subclavian and ends as right caudal 
         laryngeal nerve
37
Q

difference beetween dog and cats arytenoids

A

cats arytenoids lacks of the cuneiform and corniculate process. also true aryepiglottic folds are absent.

38
Q

describe the 3 stages of laryngeal collapse

A

Stage 1: laryngeal saccules eversion

Stage 2: cuneiform process loses rigidity and became medially displaced

Stage 3: corniculate process collapse, resulting in loss of the dorsal arch of rima glottis and subsequent airway obstruction

39
Q

at what possible anatomic location can i have a damage that esitate in laryngeal paralisys?

A

CENTRAL to PERIFERIC

1) nucleus ambiguus
2) vagus nerve or branches
3) crycoaritenoideus dorsalis muscle

40
Q

in laryngeal paralisys are more affecte male or female dogs?

A

male dogs 2-3 times more

41
Q

congenital laryngeal paralysis: signalment

A

bouviers has an autosomal dominant trait

young rottweilers (neuronal vacuolation and axonal degeneration)

huskies, huskies crosses and bouviers start with progressive degeneration of neurons within the nucleus ambiguus abd subsequent wallerian degeneration of laryngeal nerve

42
Q

signalment and anamnesis in acquired laryngeal paralysis:

A
  • labrador and golden retrievers, saint bernards, irish setters
  • median age 9 years
  • chronic endocrine, infectious, immune mediate polineuropaty
43
Q

most common radiographic changes in cats with laryngeal paralysis

A

-hyperinflation, caudal displacement of the larynx, air in the pharynx, larynx, esophagus and stomach

less common megaesophagus, ab ingestis polmonitis

44
Q

what anestetic drug can be used to stimulate the respiratory centre, if there is a doubt of an anaestetic plan too deep for laryngeal evaluation?

A

doxapram hydrocloride: increases RR and also tidal volume

45
Q

describe the surgical access to perform unilateral cricoarytenoid lateralization

A

1) incision over the larynx ventral to jugular groove, caudal to vertical mandible ramus
2) dissect subcoutaneous tissues and muscles
3) identify dorsal edge of the tyroid cartilage. identify tyropharingeus muscle and transect it along dorsocaudal edge of the tyroid
4) elevate off the edge of the tyroid cartilage the mucosa lining of the laryngopharynx.
5) expose cricoarytenoidesu dorsalis and muscolar process.

46
Q

vascular supply to the trachea

A

cranial and caudal thyroid arteries. anastomose in the middle, from those is formed a rich subepithelial mucosal plexus

47
Q

what nerve control the smooth muscle contraction of the trachea?

A

vagus nerve

in the dogs the right vagal efferents are presumed to be dominant

48
Q

trachea to Thoracic inlet RATIO

A
  1. 2 +- 0.03 Non BR
  2. 16 +- 0.03 BR
  3. 13 +- 0.38 english bulldogs
49
Q

recommended diameter for tracheostomy tube

A

not exceeding 75% of trachea lumen diameter to allow flow in case the tube plugs

50
Q

possible cardiovascular effect consequent to tracheostomy tube insertion

A

vagal stimulation with consequent bradicardia

ECG monitoring!!

51
Q

surgical access to perform a tracheostomy

A

ventral midline incision

sternohyoideus muscle are separated. vertical or horizontal cut on the trachea

52
Q

most common reported complication after permanent tracheostomy in dogs

A

aspiration pneumonia

53
Q

continue VS interrupted suture in trachea anastomosis

A

in a rabbit model with continue suturing, reduction in local microcirculation

54
Q

Hedlund 2 techniques for end to end trachea anastomosis

A

1) split cartilage technique

2) annular ligament cartilage technique

55
Q

surgical approac to thoracic trachea

A

3 to 5 intercostal toracotomy

56
Q

common clinical findings in cat with tracheal rupture

A

100% manifest subcutaneous emphysema

38% had an history of endotracheal intubation

57
Q

where is commonly reported the tracheal tears?

A

at the junction of the tracheal rings and trachealis muscle

58
Q

esophagotracheal and esophagobronchial fistulas.

congenital or acquired?
most common cause?

A

more often acquired secondary to esophageal foreign body

59
Q

tracheal collapse patogenesis and signalment

A

initially laxity of the trachealis muscle
secondly weakness of the whole cartilaginous ring

toy-small breed dogs. up to 25% manifest symptoms by 6 months of age

60
Q

grading in tracheal collapse

A

4 grades:

1) 25% stenosis
2) 50% stenosis
3) 75% stenosis
4) 100% stenosis

Tangner and Hobson

61
Q

surgical technique to correct tracheal collapse

A

1) extraluminal prosthetic tracheal rings
2) extraluminal spiral prosthesis
3) intraluminal stents

62
Q

recommended length of intratracheal stent

A

1 cm caudal to the cricoid cartilage (cricoid at C3-C4)

1 cm cranial to the carina (carina 4th rib)

63
Q

measurement of tracheal diameter to decide stent dimension

A

positive pressure ventilation at 20 cm H2O

stent have to exceed maximum trachea diameter by 10 to 20%

64
Q

what is the most commonly affected lobe with congenutal lobar emphisema?

A

right middle lung lobe is the most commonly afflicted one

65
Q

what is the kartagener syndrome?

A

1) situs inversus
2) chronic rhinosinusitis
3) bronchiectasis

(discinesia ciliare primaria)

66
Q

muscles that covers the thoracic wall outside to inside

A

1) cutaneous trunci
2) pectoralis
3) latissimus dorsi
4) external oblique
5) scalenus
6) serratus ventralis and dorsalis
7) external + internal intercostal muscle

67
Q

where do intercostal arteries arise?

A

FIRST ICA: costocervical trunk

OTHERS ICA: aorta. then anastomoses with internal thoracic artery

68
Q

bronchi subdivision

A
  • lobar bronchi
  • segmental bronchi
  • subsegmental bronchi
  • treminal bronchioles
  • respiratory bronchioles
  • alveolar ducts
  • alveolar sacs
  • pulmonary alveoli
69
Q

is it greater the coefficient of diffusion of CO2 or O2?

A

CO2 20 times > than O2.

this means that if the area for gas excange decrease, there will be ah hypoxemia well before an hypercapnia

70
Q

in the graphic of oxygen hemogobin dissociation cirve, what do we find on the X axis and wath on the Y axis?

A

X axis: oxigen partial pressure (mmHg) = PaO2

Y axis: Oxigen saturation (%)

71
Q

in what cases the oxygen dissociation curve can be shifted towards the right side?

A

1) acidosis
2) increase temperature
3) 2,3 diphosphoglycerate in RBC
4) CO2

72
Q

what is the correct ratio beetween blood flow (Q) and centilation to the alveoli (V) ?

A

should always be 1

73
Q

how much access can you gain with an intercostal toracotomy?

A

general rule= 1/3 of the ipsilateral thorax

74
Q

where are usually located the intercostal toracotomies to access the hilus?

A

CRANIAL LL: 4-5 th ICS
CAUDAL LL: 5-6 th ICS
RIGHT MIDDLE: right 5 th ICS

75
Q

is there a consistent difference in pain beetween IC toratoromy or median sternotomy?

A

no!

in humans > pain with an intercostal toracotomy

76
Q

difference beetween bullae, blebs and cysts

A

bullae: > 1-2 cm
blebs: < 1-2 cm
cysts: have an epithelial lining!

77
Q

lung lobe torsion signalment

A

large deep chest dogs: right middle or left cranial

pugs (tought to be spontaneous), yorkshire terriers: left cranial

78
Q

lung lobe torsion signalment

A

large deep chest dogs: right middle or left cranial

pugs (tought to be spontaneous), yorkshire terriers: left cranial

79
Q

radiographic appearance of lung primary histiocitic sarcoma

A

usually affects the periphery or entire right middle or left cranial lobes

have an internal air bronchogram

80
Q

overall approximate survival for primary lung tumors

A

50% one year

81
Q

suggested staples length for lung lobectomy

A

3.5 mm staples

82
Q

survival associated with pneumonectomy

A

retriction of more than 60% or pulmonary artery blood flow can be fatal.

so if you remove right lung (bigger than left) can be fatal. removal of 50% or less can be tolerated.

TOBIAS VETERINARY SURGERY (25 decks)

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