RESPIRATORY SYSTEM: 99, 100, 101, 102, 103 Flashcards
what are the 3 pairs of nasal cartilages?
dorsolateral
ventral lateral
accessory
Laryngeal paralysis: diagnostics
BLOOD WORK CHEST RX (PNEUMONIA, MEGAESOFAGUS, LUNG TRACHEA NEOPLASIA) CERVICAL RX (MASS LARYNX, TRACHEA, FOREIGN OBJ
EMERGENCY: O2, SEDATION, COOLING, STEROIDS
Laryngeal paralisys: premed
NO PREMED. JUST LIGHT SEDATION 8TIOPENTAL IV, PROPOFOL, ALFAXAN
DOXAPRAM RESPIRATORY STIMULANT.
IN DOG WITH LARYNGEAL PARALISIS DOXAPRAM WILL NOT WORK!
Laringeal paralisys differentials
1 congenital denervation 2 traumatic 3 iatrogenic 4 idiopathic 5 neoplastic 6 associated with diffuse neuromuscular disease
CITINA
Braund 1989: Laringeal paralisys
sign of a polineuropaty desease
up to 90-95% of dogs diagnosed wuith LP develop at 12 month neurological deficits.
sedation for Laryngeal paralisys
use of agonist-antagonist as buthorfanol reduce risk of aspiration pneumonia compared to pure agonist (morphine-metadone)
acepromromazine
ace and but maintain laryngeal function
laryingeal paralisys medical treatement
sedation, cooling, acute resp distress control, antinflammatory, WEIGHT LOSS in long time
milovancev 2016 metoclopramide laryngeal paralisys
metoclopramide, at the doses used in this study, did not affect the incidence of aspiration pneumonia in the short term postoperative period
laryngeal paralisys surgical management
1 laryngeal tie back monolateral (bilateral up to 70% aspiration pneumonia)
2 vocal cordectomy +- castellated laryngeal fissure
3 aritenoidectomy
4 stent
what are the main muscles acting in the nasal planum?
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
name the 3 paranasal sinuses
maxillary recess
sphenoidal sinus
frontal sinus
major differential disgnoses for nasopharingeal desease
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
does inflammatory polips in cat always invade the bulla?
in a study all cats with inflammatory polyps had invasion of at least one bulla
does inflammatory rinitis in cats extend to he bulla?
up to 28% cats with rinitis can have involvement of the bulla without symptoms of ot otitis externa
significance of septal and cribriform lysis in prediction of neoplastic desease
associated with neoplasia in dogs, not so clearly in cats
how to diagnose cryptococcus spp. in cats efficiently
antigen serology has a hig specificity and sensibility
nasal malformations regarding brachicephalic breeds
axial displacement of the dorsolarteral nasal cartilage
intranasal senosis
abnormal conchal development
preferred treatement for intranasal neoplasia
cytoreductive surgery may not improve outcome.
radiation therapy is the recommended treatement
most typical radiographic appearance of conchal of nasal fungal infection
conchal lysis and punctate bone lucency with soft tissue opacity contents or mass in the nose and sinuses
how is cats bulla divided?
2 portions: dorso lateral and ventro medial
recurrence of inflammatory polyps with avulsion vs bulla osteotomy
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
3 surgical options for nasopharingeal stenosis
open surgical resection of the stenotic menbrane
endoscopoic guided balloon dilation
stents
during excision of the nasal planum what arteries will be responsible for hemorrage?
paired dorsal and lateral nasal arteries (originate from the infraorbitary artery)
major palatine arteries (from maxillary artery)
what should be avoided in cats during intrabuccal surgery or hemorrage prevention?
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
describe the 4 possible approach to the nasal cavity
1) DORSAL: mosto commonly used
2) VENTRAL
3) LATERAL
4) ROSTRAL
name the bones that forms the hard palate cranial to caudal
incisive, maxillary, palatine
Major palatine foramen: vasculature and innervation
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)
nerves supply to the pterygopharyngeal and palatopharyngeal muscles
glossopharyngeal and vagus nerves
name the 3 soft palate muscles
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)
correct timing to perform a palatal surgery
3-4 months
before: is more difficult and tissues are more friable and delicate
after: wider cleft and compounded management problems
name the 2 main surgical technique for hard palate cleft repair
overlapping flap technique
medially positioned flap technique
technique to close large caudal hard palate defects
split palatal U-flap can be used
name the 4 arythenoid processes from cranial to caudal
cuneiform, corniculate, muscolar, vocal
name the main extrinsic muscle of the larynx
1) tyropharingeus
2) cricopharyngeus
name the main intrinsic larynx muscles
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)
innervation of the larynx
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
difference beetween dog and cats arytenoids
cats arytenoids lacks of the cuneiform and corniculate process. also true aryepiglottic folds are absent.
describe the 3 stages of laryngeal collapse
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
at what possible anatomic location can i have a damage that esitate in laryngeal paralisys?
CENTRAL to PERIFERIC
1) nucleus ambiguus
2) vagus nerve or branches
3) crycoaritenoideus dorsalis muscle
in laryngeal paralisys are more affecte male or female dogs?
male dogs 2-3 times more
congenital laryngeal paralysis: signalment
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
signalment and anamnesis in acquired laryngeal paralysis:
- labrador and golden retrievers, saint bernards, irish setters
- median age 9 years
- chronic endocrine, infectious, immune mediate polineuropaty
most common radiographic changes in cats with laryngeal paralysis
-hyperinflation, caudal displacement of the larynx, air in the pharynx, larynx, esophagus and stomach
less common megaesophagus, ab ingestis polmonitis
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?
doxapram hydrocloride: increases RR and also tidal volume
describe the surgical access to perform unilateral cricoarytenoid lateralization
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.
vascular supply to the trachea
cranial and caudal thyroid arteries. anastomose in the middle, from those is formed a rich subepithelial mucosal plexus
what nerve control the smooth muscle contraction of the trachea?
vagus nerve
in the dogs the right vagal efferents are presumed to be dominant
trachea to Thoracic inlet RATIO
- 2 +- 0.03 Non BR
- 16 +- 0.03 BR
- 13 +- 0.38 english bulldogs
recommended diameter for tracheostomy tube
not exceeding 75% of trachea lumen diameter to allow flow in case the tube plugs
possible cardiovascular effect consequent to tracheostomy tube insertion
vagal stimulation with consequent bradicardia
ECG monitoring!!
surgical access to perform a tracheostomy
ventral midline incision
sternohyoideus muscle are separated. vertical or horizontal cut on the trachea
most common reported complication after permanent tracheostomy in dogs
aspiration pneumonia
continue VS interrupted suture in trachea anastomosis
in a rabbit model with continue suturing, reduction in local microcirculation
Hedlund 2 techniques for end to end trachea anastomosis
1) split cartilage technique
2) annular ligament cartilage technique
surgical approac to thoracic trachea
3 to 5 intercostal toracotomy
common clinical findings in cat with tracheal rupture
100% manifest subcutaneous emphysema
38% had an history of endotracheal intubation
where is commonly reported the tracheal tears?
at the junction of the tracheal rings and trachealis muscle
esophagotracheal and esophagobronchial fistulas.
congenital or acquired?
most common cause?
more often acquired secondary to esophageal foreign body
tracheal collapse patogenesis and signalment
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
grading in tracheal collapse
4 grades:
1) 25% stenosis
2) 50% stenosis
3) 75% stenosis
4) 100% stenosis
Tangner and Hobson
surgical technique to correct tracheal collapse
1) extraluminal prosthetic tracheal rings
2) extraluminal spiral prosthesis
3) intraluminal stents
recommended length of intratracheal stent
1 cm caudal to the cricoid cartilage (cricoid at C3-C4)
1 cm cranial to the carina (carina 4th rib)
measurement of tracheal diameter to decide stent dimension
positive pressure ventilation at 20 cm H2O
stent have to exceed maximum trachea diameter by 10 to 20%
what is the most commonly affected lobe with congenutal lobar emphisema?
right middle lung lobe is the most commonly afflicted one
what is the kartagener syndrome?
1) situs inversus
2) chronic rhinosinusitis
3) bronchiectasis
(discinesia ciliare primaria)
muscles that covers the thoracic wall outside to inside
1) cutaneous trunci
2) pectoralis
3) latissimus dorsi
4) external oblique
5) scalenus
6) serratus ventralis and dorsalis
7) external + internal intercostal muscle
where do intercostal arteries arise?
FIRST ICA: costocervical trunk
OTHERS ICA: aorta. then anastomoses with internal thoracic artery
bronchi subdivision
- lobar bronchi
- segmental bronchi
- subsegmental bronchi
- treminal bronchioles
- respiratory bronchioles
- alveolar ducts
- alveolar sacs
- pulmonary alveoli
is it greater the coefficient of diffusion of CO2 or O2?
CO2 20 times > than O2.
this means that if the area for gas excange decrease, there will be ah hypoxemia well before an hypercapnia
in the graphic of oxygen hemogobin dissociation cirve, what do we find on the X axis and wath on the Y axis?
X axis: oxigen partial pressure (mmHg) = PaO2
Y axis: Oxigen saturation (%)
in what cases the oxygen dissociation curve can be shifted towards the right side?
1) acidosis
2) increase temperature
3) 2,3 diphosphoglycerate in RBC
4) CO2
what is the correct ratio beetween blood flow (Q) and centilation to the alveoli (V) ?
should always be 1
how much access can you gain with an intercostal toracotomy?
general rule= 1/3 of the ipsilateral thorax
where are usually located the intercostal toracotomies to access the hilus?
CRANIAL LL: 4-5 th ICS
CAUDAL LL: 5-6 th ICS
RIGHT MIDDLE: right 5 th ICS
is there a consistent difference in pain beetween IC toratoromy or median sternotomy?
no!
in humans > pain with an intercostal toracotomy
difference beetween bullae, blebs and cysts
bullae: > 1-2 cm
blebs: < 1-2 cm
cysts: have an epithelial lining!
lung lobe torsion signalment
large deep chest dogs: right middle or left cranial
pugs (tought to be spontaneous), yorkshire terriers: left cranial
lung lobe torsion signalment
large deep chest dogs: right middle or left cranial
pugs (tought to be spontaneous), yorkshire terriers: left cranial
radiographic appearance of lung primary histiocitic sarcoma
usually affects the periphery or entire right middle or left cranial lobes
have an internal air bronchogram
overall approximate survival for primary lung tumors
50% one year
suggested staples length for lung lobectomy
3.5 mm staples
survival associated with pneumonectomy
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.
