SA soft tissue surgery Flashcards
1
Q
what are halsteds principles of surgery?
A
gentle tissue handling meticulous haemostasis preservation of blood supply strict asepsis minimal tension accurate tissue apposition obliteration of dead space
2
Q
why is meticulous haemostasis important in surgery?
A
haemorrhage can obscure the surgical field and provide a medium for bacterial growth
can cause hypovolaemia, shock or death if not controlled
3
Q
why is it important to not leave dead space in a cavity after surgery?
A
blood or tissue fluid can accumulate and form a haematoma or serum which provides a medium for bacterial growth increasing the chance of infection
4
Q
what should always be used to attach a blade to a scalpel handle?
A
needed holders (avoid cutting yourself)
5
Q
what are the ways of holding a scalpel?
A
pencil grip
fingertip grip
palm grip
6
Q
what is the pencil grip on the scalpel used for?
A
short precise incisions due to small contact area
7
Q
what is the fingertip grip on the scalpel used for?
A
for inactions over 3cm long (maximised blade/tissue contact)
8
Q
when is the palm grip on a scalpel used?
A
rarely (allows substantial force but very imprecise)
9
Q
what types of cutting can be done with a scalpel?
A
press cutting
slide cutting
10
Q
how is press cutting done with a scalpel?
A
using the pencil grip and applying gradually increasing pressure in the direction of the motion of the blade (stab incision)
11
Q
how is slide cutting done with a scalpel?
A
using any grip apply pressure at a right angle to the direction of motion of the blade while the other hand tenses the tissue laterally
12
Q
why should slide cutting be done in a single motion?
A
creates less trauma and ensures smooth wound edges with less haemorrhage
13
Q
what types of tissues are scissors very useful for cutting?
A
flaccid tissue that can’t be cut efficiently with a scalpel
14
Q
what are metzenbaum scissors used for?
A
fine dissection
15
Q
what are mayo scissors used for?
A
dissecting connective tissue/fascia
16
Q
what are curved and straight scissors used for?
A
curved - dense tissue
straight - fine dissection
17
Q
what forces are responsible for cutting when using scissors?
A
closing force - pushing blades together
shearing force - sliding blades over eachother
torque force - rolling leading edge of blade in to touch the other
18
Q
what is the backhand thumb-third finger grip used for?
A
scissor cutting towards the dominant hand
19
Q
what is the backhand thumb-index finger grip used for?
A
cutting across the table toward your body
20
Q
what part of the scissors should be used for cutting?
A
tip (not the hinge)
21
Q
what are the three ways of cutting with scissors?
A
scissor cutting
push cutting
blunt dissection
22
Q
what is blunt dissection using scissors?
A
insert closed blades into tissue and open them then withdraw back
23
Q
what are electrosurgical instruments used for?
A
coagulating or incising tissue
24
Q
what are the types of electrosurgical instruments?
A
monopolar
unipolar
25
describe a monopolar electrosurgical instrument
electrode in the handpick and a ground plate
26
what can monopolar electrosurgical instruments be used for?
cutting
| coagulation
27
what are bipolar electrosurgical instruments used for?
coagulation
| haemostasis
28
why shouldn't electrosurgery be used in excess?
causes more trauma to the surrounding tissues than using a scalpel or scissors
29
what should be remembered when using electrosurgery?
anaesthetised patients only
don't use in presence of volatile gases/liquids
ground plate should be in complete contact with the animal
don't wrap lead around towel clips (may induce burns)
keep electrode clean for proper function
keep power as low as possible
30
what are toothed forceps used for?
gripping tissue with minimal pressure (less traumatic)
31
what are two types of toothed forceps?
adson
| debakey
32
describe the debakey forcep
fine atraumatic jaw pattern to the teeth
33
what should non-toothed forceps be used for?
handling inanimate objects (dressings...)
34
what are the types of tissue forceps?
allis
babcock
doyen
35
what are allis and babcock tissue forceps used for?
tissue that is going to be excised (they are traumatic)
36
what are doyen forceps used for?
holding and occluding the lumen of bowel (gap between the jaw avoids crushing tissue)
37
what are the types of retractors?
finger-held retractors
hand-held retractors
self-restraining retractors (balfour, gossett retractors, finochietto rib retractors, gulp retractors)
38
what are finger held retractors used for?
retraction of thin/delicate tissue
39
what are hand-held retractors used for?
retraction of thicker/robust tissue
40
what are balfour retractors used for?
abdominal wall retraction (used to lift the diploid process)
41
what are gossett retractors used for?
abdominal wall retraction
42
what are finochietto rib retractors used for?
separate ribs for intercostal thoracotomy
| divide halves if sternum for median sternotomy
43
why is wound irrigation/lavage important?
avoid drying and trauma to tissue
| role in asepsis
44
what are the types of suction tip?
frazier-ferguson
yankauer
poole
45
what is the frazier-ferguson suction tip good for?
removing haemorrhage during fine dissection
46
what is the yankauer suction tip good for?
removing large volumes of fluid fro body cavities
47
what is the advantage of the poole suction tip?
doesn't block easily (multiple suction holes)
48
what are some complications of improper tissue handling?
```
tissue ischaemia - delayed healing/necrosis
dead space formation
wound contamination
increased post-op pain
poorer cosmetic results
```
49
what is tensile strength of a suture material proportional to?
diameter of the suture
50
what should the tensile strength of a suture material be the same as?
strength of the tissue
51
what are the ideal properties of a suture material?
easy to handle
low tissue drag
resistant to contamination
good knot security
52
what are the two categories of suture material structure?
monofilament
| multifilament
53
what are the advantages of monofilament suture material?
little tissue drag
| withstand contamination well
54
what are the disadvantages of monofilament suture material?
prone to damage by instruments
| high degree of memory - harder to handle and poor knot security
55
what are the advantages of multifilament suture material?
less memory - easy to handle and high knot security
| higher surface friction - better knot security
56
what are the disadvantages of multifilament suture material?
can harbour bacteria (act as a wick)
| increased tissue drag (reduced by coating)
57
what two ways can suture material be divided by chemical composition?
absorbable vs non-absorbable
| synthetic vs natural
58
what are non-absorbable sutures mainly used for?
skin
| hernia, ligament and tendon repair
59
how are absorbable synthetic sutures broken down? what does this cause?
hydrolysis - minimal tissue reaction
60
how are absorbable natural sutures broken down? what does this cause?
enzymatic reactions - inflammation and tissue reaction
61
what suture material should be used in contaminated/infected wounds?
smallest amount possible of synthetic monofilament suture material
62
what tissues can absorbable sutures be used on?
visceral wounds (heal quicker)
63
name a natural absorbable suture material
catgut
64
is catgut monofilament or multifilament?
multifilament
65
name some synthetic absorbable suture material
```
dexon
vicryl
polysorb
monocryl
biosyn
PDS
```
66
which synthetic absorbable suture material is monofilament?
monocryl
biosyn
PDS
67
which synthetic absorbable suture materials multifilament?
dexon
vicryl
polysorb
68
name some synthetic non-absorbable suture material
nylon
supramid
prolene (surgilene)
69
what are the two methods suture material is attached to a needle?
swaged-on
| eyed needle
70
what are the advantages of swaged-on needles?
less traumatic to tissue as you get a new sharp needle each time
easier to use
71
what is the advantages of eyed needles?
they are cheap and reusable
72
what are the two shapes of needles?
straight
| curved
73
what are straight needles used for?
suturing near body surface or the skin
74
what are curved needles used for?
(most sutures)
| narrow wounds deep in body cavities
75
what are the two types of point profiles of needles?
round bodied
| cutting needles
76
what are round bodied needles used for suturing?
easily penetrated tissue such as fat, viscera or muscle
77
what are the three types of cutting needle?
conventional cutting needle
reverse cutting needle
taper-cut needles
78
describe conventional cutting needles
cutting edge on concave surface (can cause suture material to cut towards the edge of the incision)
79
describe reverse cutting needles
cutting edge on convex surface (less likely for suture to cut towards the incision)
80
what is the difference between mayo-hear and olsen-hegar needle holders?
Olsen-hegar have scissors built into them
81
what are the three effects sutures can have on tissue alignment?
appositional
inverting
everting
82
what does an appositional suture do?
brings wound edges into direct contact (most widely used)
83
what to inverting sutures do?
turn the suture edges inwards
84
what do everting sutures do?
turn the suture edges outwards
85
what are the types of interrupted suture pattern?
simple
cruciate mattress
vertical mattress
horizontal mattress
86
what are the advantages of simple interrupted suture patterns?
minimal interference with blood supply
allows tension to be easily adjusted across the wound
accurate apposition
87
what are the advantages of the cruciate mattress suture pattern?
tension relieving
| doesn't interfere with wound healing
88
what is the cruciate mattress pattern used for?
skin closure
89
what is the main advantage of the vertical mattress suture pattern?
doesn't interfere with blood supply around the wound edge
90
what are the disadvantages of the horizontal mattress pattern?
can cause skin eversion
poor stability to wound edges
interfere with blood supply
91
what are some continuous suture patterns?
simple continuous
continuous horizontal mattress
ford interlocking
92
what is the disadvantage of continuous suture patterns?
breakage will cause the whole suture to fail
93
what are the advantages of the simple continuous pattern?
good tissue apposition
| spreads tension evenly across the wound
94
what are the advantages of intradermal sutures?
no sutures to remove
no sutures passing through the skin surface to cause irritation or infection
minimal scar formation
95
what are subcutaneous sutures used for?
decrease tension across wound before placing skin sutures
| reduce dead space
96
what type of pattern is used for subcutaneous tissue sutures?
simple continuous
| continuous horizontal mattress
97
what suture patterns are used for the skin?
simple interrupted
cruciate mattress
continuous intradermal
98
what wounds are staples not suitable for?
wounds under tension
wound with irregular edges
less than 6mm depth of tissue separating them from bone/viscera
99
what is the name of tissue adhesives?
cyanoacrylate
100
what wounds are tissue adhesives used on?
small skin wounds under low tension
101
what wounds are tissue adhesives not suitable for?
```
mucous membranes (don't adhere well on moist surfaces)
larger wounds under tension
```
102
define -tomy
to incise into
103
define -ectomy
to remove
104
define -centesis
introduction of a needle into a cavity to aspirate fluid/gas
105
define -pexy
surgical fixation of an organ/structure
106
define -rraphy
act of suturing
107
define -stomy
surgically creating an opening
108
define -desis
secure fixation by surgical methods
109
define -plasty
surgical shaping/moulding of a structure
110
what are the phases of wound healing?
lag/inflammatory
repair
remodelling
111
how long does the lag phase of wound healing last?
1-5 days
112
what is the immediate response to injury that initiates the lag phase?
haemostasis
113
what happens during haemostasis?
cells/fluid exit blood vessels and platelets trigger the formation of fibrin clots to form the provisional extracellular matrix and stabilise the wounds edges
114
during the lag phase what are the first cells attracted to the wound?
neutrophils
115
what are neutrophils attracted to the wound by?
chemotaxis
116
what is the role of neutrophils in the lag phase of wound healing?
degrade necrotic tissue and control infection by destroying bacteria
117
what cells enter the wound after the neutrophils?
monocytes
118
what do monocytes differentiate into once they have entered the wound?
macrophages
119
what is the role of macrophages in the wound?
remove degenerate neutrophils, necrotic tissue and debris by phagocytosis
120
how long does the repair phase of wound healing last?
6-16 days
121
what are the three overlapping parts of the repair phase of wound healing?
connective tissue repair
wound contraction
epithelialisation
122
what do mesenchymal cells differentiate into during connective tissue repair?
fibroblasts
123
what do the fibroblasts create during connective tissue repair?
new collagenous extracellular matrix
124
what allows fibroblast migration into the wound?
angiogenesis (capillary ingrowth)
125
what happens towards the end of the connective tissue repair stage of wound healing?
fibroblasts and new capillaries undergo apoptosis resulting in granulation tissue becoming acellular (paler scarring)
126
in full thickness skin wounds, how long does it take for wound contraction to start?
5-9 days
127
what causes wound contraction?
specialised myofibroblasts proliferate in the wound, attach to the wound matrix and each other then begin to contract
128
when does epithelialisation begin in partial thickness skin wounds?
immediately
129
when does epithelialisation begin in full thickness skin wounds?
4-5 days post injury
130
what is required in full thickness skin wounds before epithelialisation can occur?
a granulation tissue bed
131
describe the process of epithelialisation of wounds
epithelial cells from wound edges migrate across the wound to form a monolayer, they then begin to proliferate to increase the epithelial thickness
they become firmly attached to the dermis and over time stratifies
132
what can be mistaken for infection during suture wound healing?
epithelial proliferation causing an inflammatory response a keratinising epithelial cells contact connective tissue
133
when does the remodelling stage of wound healing begin?
14-16 days post injury
134
what happens during the remodelling phase of wound healing?
cellular content of the granulation tissue reduces and collagen bundles reorganise by thickening, cross linking and reorientation along tension lines
135
what local factors can effect wound healing?
```
wound perfusion
tissue viability
wound fluid accumulation
infection
mechanical factors
```
136
why is wound perfusion so important to healing?
dividing cells require a lot of oxygen to be able to divide
137
what is the rate limiting step of wound perfusion?
new capillary formation in the granulation tissue bed
138
what effect does tissue viability have on wound healing?
devitalised/necrotic tissue and debris will prolong the inflammatory phase and delay healing
139
how does fluid accumulation in wounds slow healing?
physically separates the tissue and puts pressure on surrounding tissue which reduces perfusion
140
what effect does bacterial infection have on wound healing?
prolongs inflammatory phase
reduces chemotaxis
increases tissue damage
reduces fibroblast activity and collagen synthesis (decreases wound strength)
141
what are some systemic factors that can effect wound healing?
immunosuppression
| neoplasia
142
why does neoplasia effect wound healing?
cancer cachexia due to increased cytokine level
| cytotoxic drugs/radiotherapy can kill rapidly dividing cells
143
what is the specific response of the intestine to a wound?
collagenase activity decreases the wound strength
144
what is crucial to successful intestinal wound healing?
avoiding infection
preservation of blood supply
avoiding tension
145
how does skeletal muscle heal from small wounds?
regeneration with minimal fibrous tissue formation (if held in close apposition)
146
what are the specific responses to a wound to a peripheral nerve?
severed ends retract
cell body swells
nucleus becomes eccentrically placed
axon undergoes Wallerian degeneration
147
what is significant about wound healing of the liver?
regenerate up to 80% of its volume in 6 weeks by proliferation and hypertrophy
148
what are the two ways in which wounds can be classified?
degree of contamination
| aetiology
149
what are the degrees of wound contamination?
clean
clean contaminated
contaminated
dirty
150
describe a clean wound
elective surgical wounds not entering respiratory, urogenital or GI tracts with no break in asepsis and primary closure
151
describe a clean contaminated wound
surgical wounds involving respiratory, urogenital or GI tract without significant contamination or minor breaks in asepsis
152
describe a contaminated wound
fresh traumatic would less than 6 hours old
surgical wounds involving respiratory, urogenital or GI tract with significant contamination
surgery in presence of inflammation
major breaks in asepsis
153
describe a dirty wound
traumatic wound greater than 6 hours old
traumatic wounds contaminated with foreign material/significantly devitalised tissue present
surgery in presence of abscessation
154
what are the categories of etiologically classifying a wound?
```
abrasion
avulsion
degloving
incision
laceration
puncture
burn
```
155
what is an abrasion?
partial thickness wound with loss of epidermis and part of dermis
156
what is an avulsion?
tearing of tissue from its attachments
157
what is a devolving injury?
low-velocity avulsion of skin due to rotational force
158
what is an incision wound?
sharp trauma resulting in smooth edged wound
159
what is a laceration?
sharp trauma resulting in irregular wound with tearing of tissue
160
what is a puncture wound?
penetration by a sharp object
161
why must care be taken with puncture wounds?
often minimal superficial damage but infection and damage to deeper structure (especially abdomen/thorax)
162
what is the first stage on preparing a wound for closure?
take a swab for bacteriology
163
how should a wound be prepared for treatment?
cover with sterile ointment (KY jelly) or sterile swabs then clip the edges working away from the wound
surgically scrub around d the wound (do not allow detergents to come into contact with the wound)
164
what are the ways a wound can be debrided?
hydrodynamic
hydromechanical
surgical
165
what is hydrodynamic debridement also known as?
lavage
166
what are the aims of lavage?
decrease bacteria in wound
remove debris
prevent further contamination
167
how should grossly contained wounds be lavaged?
tap water
168
what is used to lavage a wound?
large volume of isotonic solution
169
what can be added to the final lavage?
antiseptics
170
what antiseptic can be used at the end of lavage?
chlorhexidine
| povidone iodine
171
what is used for hydromechanical debridement?
amorphous hydrogel dressings
172
what functions do amorphous hydrogel dressings have?
```
promote hydration and autolysis of necrotic tissue
absorb sloughing tissue
moisten the wound
prevent eschar formation
allow cell migration/proliferation
bacteriostatic
```
173
what do amorphous hydrogel dressings contain to make them bacteriostatic?
propylene glycol
174
when should amorphous hydrogel dressings be removed?
when dressing is changed (by lavage)
175
what should hydrogel be covered with when in wounds containing necrotic tissue?
non-adherent semi-occlusive primary layer (fenestrated polyester film)
176
what should wounds with lots of exudate be covered with?
hydrocellular foam dressing - won't absorb gel but will wick away excess moisture
177
how should tissue viability be evaluated when deciding on surgical debridement?
tissue colour, pulse and bleeding
178
if in doubt about whether to surgically decried a wound, what should be done?
manage as an open wound until obvious demarcation of devitalised tissue occurs
179
what are the types of wound closure?
primary
delayed primary
secondary
secondary intention healing
180
what is primary closure of a wound?
immediate suture closure without tension
181
what is delayed primary closure of a wound?
closure of wound 1-5 days after injury before granulation bed forms
182
what is secondary closure of a wound?
closure of a wound 5 days after injury once the granulation bed has formed
183
what must be done just before closing a wound by secondary closure?
excise around wound edge or granulation tissue margin then close
184
what are the layers of dressing?
primary (contact)
secondary (intermediate)
tertiary (outer)
185
what are the two types of primary dressing layer?
adherent
| non-adherent
186
why do adherent dressing layers adhere to the wound?
fibrinous material, granulation tissue or exudate penetrates their structure and dries
187
why are adherent primary dressing layer not commonly used?
slow healing
painful to remove
can cause tissue maceration
188
what factors determine which type of non-adherent dressing to use?
what you want the dressing to do
how much exudate is being produced
if the wound is infected
189
what dressing should be used to deride necrotic tissue?
non-adherent with hydrogel
190
what dressing should be used used for a wound in the repair phase of healing?
non-adherent dressing for protection (to speed up granulation tissue formation)
191
what are the most absorbent/permeable non-adherent dressings?
calcium aginate
polyurethane foam dressings
fenestrated polyester film
192
what is the least absorbent/permeable non-adherent dressing type?
polyethylene film dressing
193
how often does the dressing of infected wounds need to be changed?
at least once a day
194
what are the type of non-adherent dressings?
```
calcium aginate
fenestrated polyester film
hydrocellular foam
hydrocolloid
polyethylene
petrolatum-impregnated gauze
hyperosmolar agents
maggots
silver dressing
```
195
what is calcium aginate dressing indicated for?
full/partial thickness wounds at any stage of healing with moderate/heavy exudation
196
what are fenestrated polyester film dressings mainly used for?
protecting wounds with an intact epithelial surface
197
what type of lesions are hydrocellular foam dressing good for?
ulcers
198
what does silver dressing do?
release bacteriocidal silver ions into the wound
199
what do maggots do?
debridement (difficult to keep them in the right place) - useful as antibacterial resistance increases
200
what is an example of a hyperosmolar agent that can be used in dressings?
honey
201
what are the actions of honey when used as a hyperosmolar dressing?
dehydrate bacteria to impair growth
| low pH reduces bacterial growth
202
what is the function of the secondary layer of a dressing?
```
draws away and absorbs excess fluid
keep primary layer in contact with wound
obliterate dead space
protect wound (padding)
support and immobilisation
```
203
what are some types of secondary layers of dressings?
cast paddings
disposable nappies
cotton wool
204
what is the function of the tertiary layer of dressing?
support
| keep other layers clean
205
what are the haemostat techniques?
```
pressure
haemostatic forceps
electrosurgery
ligatures
vascular clips
topical haemostat agents
```
206
what types of haemorrhage should pressure be used to control?
low-pressure haemorrhage
| temporarily to high-pressure haemorrhage to allow time to select a better technique
207
how should pressure be applied to haemorrhage?
for 5 minutes with a saline moistened swab (take care when removing not to remove clot)
208
what vessels should haemostatic forceps be used on?
ones that are going to be sacrificed rather than repaired
209
what are the methods of clamping using haemostatic forceps?
tip clamping
| jaw clamping
210
what is tip clamping? and what is it used for?
apply tip of smaller haemostat to tissue to occlude small vessels
211
describe the features of monopolar cautery
current flows from single hand electrode to a ground plate under the patient
212
what are the types of electrosurgery?
radiofrequency instruments
| vessel sealing devices
213
what are the two radio frequency devices used for haemostasis?
monpolar cautery
| bipolar cautery
214
what are the advantages of bipolar cautery?
more precise
requires less current
works better in a wet field
215
what are the two types of vessel sealing devices?
elecrtrothermal bipolar vessel sealers
| harmonic scalpels
216
how do harmonic scalpels work?
ultrasonic vibrations of the instruments tip cause heating and coagulation of tissue
217
what are the two types of ligatures used for haemostasis?
simple/circumferential
| transfixing
218
describe a circumferential ligature
simple loop placed a few mm from the end of the cut vessel
219
how should large vessels (arteries) be ligated?
circumferential and a distal transfixing ligature
220
what is a transfixing ligature?
penetrates the vessel and then encircles it in a figure of eight pattern
221
what are the advantages of vascular clips?
rapid and convenient (but more expensive than ligatures)
222
what are examples of topical haemostatic agents?
granules, powder or sheets of collagen or fibrin
223
how do topical haemostatic agents work?
act as a scaffold for fibrin clot formation
224
what are used for?
persistent capillary haemorrhage
225
what are risk factors for increased wound infection?
```
type/number of bacteria
clipping surgical site
anaesthesia/surgical time
propofol use
endocrinopathies
number of people in operating room
sex of patient
local wound environment
```
226
how does the clipping of a surgical site effect the risk of wound infection?
causes microtrauma to the skin the can increase bacterial growth
227
when should skin be clipped relative to surgery?
immediately before to avoid bacterial growth due to microtrauma
228
why does increased anaesthetic time and surgical time increase the risk of wound infection?
immunosuppression
increased tissue handling
longer exposure of bacteria
229
why can propofol use increase the risk of wound infection?
it is suspended in lipid that can support bacterial growth (if contaminated and injected it can cause infection)
230
why do endocrinopathies increase the risk of wound infection?
many of them can cause immunosuppression
231
what sex are more at risk of wound infection?
males
232
why are male patients more at risk of wound infection?
due to the immunomodulatory effects of androgens
233
what can impair tissue response to an infection?
```
trauma
foreign material
ischaemia
poor nutrition
chemotherapy
systemic disease
```
234
what ways can surgical infections be prevented?
```
patient selection/prep
surgical team prep
sterilisation of equipment
operating theatre prep
wound lavage
post-op care
antibacterial
```
235
what patients should elective surgery be postponed in?
those with pre-existing disease/infections
236
what should be used on a regular basis in autoclave machines to ensure the sterilisation is efficient?
biological indicators
237
should prophylactic antibacterials be used for clean surgeries?
only if they last longer than 90 minutes or if the animal is at risk due to other factors
238
should prophylactic antibacterials be used for clean contaminated surgeries?
yes
239
should prophylactic antibacterials be used for dirty surgeries?
no the wound is already infected, use therapeutic antibacterials
240
define antisepsis
use of germicidal substances on living tissue
241
define disinfection
use of germicidal substances on inanimate objects
242
define nosocomial infections
hospita; enquired infections often caused by highly antibacterial resistant strains of bacteria
243
define sterilisation
process of destroying all micro-organisms
244
define a surgical infection
infection developing at the site of a surgery within 30 days of the surgery (1 year if its an implant)
245
what are the main clinical signs of nasal disease?
```
sneezing
increased respiratory noise
nasal discharge
epistaxis
facial pain
```
246
what are the common causes of acute nasal disease?
nasal foreign body
viral URT infection
allergic/irritant rhinitis
tooth root abscess
247
what are the two usual clinical signs of acute nasal disease?
snoring
| serous nasal discharge
248
what are the common causes of chronic nasal disease?
progression of acute disease
feline rhinotracheitis
fungal rhinitis (aspergillosis)
lymphocytic/plasmacytic rhinitis
249
what would be examined on a clinical exam of a patient with suspected nasal disease?
symmetry of the head
nasal discharge, crusting, ulceration, depigmentation
pain and swellings
retropulse both globes
assess airflow (place hair by nares)
oral cavity - dental disease, fistulae, palate defects
palpate submandibular lymph node
250
what are some possible diagnostic tests that can be carried out to diagnose nasal disease?
```
blood tests
virology
radiography/imaging
rhinos copy
nasal biopsy
forced flush
FNA
swabs
```
251
what blood tests can be carried out for suspected nasal disease?
haematology/biochemistry
clotting profile
serology
252
why may clotting profiles be carried out for suspected nasal disease?
if epistaxis is the only clinical sign
253
what species is virology used for in suspected nasal disease?
cats
254
what are the most useful radiographs for detecting nasal disease?
lateral of the skull
dorsoventral intramural of nasal cavity
rostrocaudal of frontal sinuses
255
if nasal neoplasia is suspected, what diagnostic test should be carried out?
thoracic radiography to look for metastasis
256
what should be done if haemorrhage after a nasal biopsy doesn't stop after a few minutes?
flush nasal cavity with ice cold saline and place ice pack on the maxilla to cause vasoconstriction
257
where in the nasal cavity should not be biopsied blind?
caudal to medial canthus of the eye
258
why should you not blind biopsy caudal to medial canthus of the eye?
because you may damage he cribriform plate
259
how is a forced nasal flush carried out?
cuffed endotracheal tube is placed and abdominal swabs packed into the common pharynx
the nasal cavities are then flushed under pressure to dislodge any foreign bodies or tissue fragments which will then be collected in the pharyngeal swabs
260
what can you do an FNA of to help diagnose nasal disease?
mandibular or retropharyngeal lymph nodes (if enlarged or firm)
261
what is fungal rhinosinusitis usually due to in dogs?
Aspergillus fumigatus
262
what is fungal rhinosinusitis usually due to in cats?
Cryptococcus neoformans (rare)
263
what dogs most commonly get fungal rhinosinusitis?
young/middle aged medium/large breed dogs
264
what can fungal rhinitis cause extensive damage to?
turbinates
265
what are the clinical signs of fungal rhinitis?
```
nasal discharge
epistaxis
facial pain
ulceration/depigemented nares
dullness/depression
```
266
what type of nasal discharge is associated with final rhinitis?
mucopurulent
267
how can be used to diagnose fungal rhinitis?
```
history/clinical signs
serology
radiography
rhinoscopy
histopathology
```
268
what is seen on radiographs of animals with fungal rhinitis?
turbinate bone destruction
| increased fluid density in the cavity
269
what will rhinoscopy of dogs with fungal rhinitis reveal?
fungal plaques
| turbinate destruction
270
what is the gold standard of diagnosing fungal rhinitis?
histopathology
271
what can be used to treat fungal rhinitis?
topical antifungals
272
how are topical fungals used to treat fungal rhinitis?
trephination of frontal sinus and flush with sterile saline followed by packing of the sinus and nasal cavity with clotrimazole cream
soaking of nasal cavity with cltrimazole solutions using foley catheters
273
are tumours of the nasal cavity usually benign or malignant?
malignant
274
what neoplasias can effect the nasal cavity?
```
adenocarcinoma
osteosarcoma
chondrosarcoma
squamous cell carcinoma
fibrosarcoma
lymphoma
```
275
what are the clinical signs of nasal neoplasia?
```
reduced airflow
nasal discharge (with epistaxis)
facial swelling/distortion
palate swelling/distortion
exophthalmos
neurological signs
```
276
when may neurological signs be a clinical sign of nasal neoplasia?
if it extends through the cribriform plate
277
when may exophthalmos be a clinical sign of nasal neoplasia?
if there is invasion of the retrobulbar space
278
what can be used to diagnose nasal neoplasia?
history/clinical signs
diagnostic imaging
rhinoscopy (biopsy)
279
when taking a biopsy of a nasal mass, what must you be careful of?
not taking too smaller sample - will only contain normal nasal mucosa overlying neoplasia
280
what can be done to treat nasal lymphomas?
chemotherapy
281
what is the most effective treatment of nasal neoplasms?
radiation therapy (not usually curative)
282
what palliative treatments can be used for nasal neoplasias?
antibacterials
analgesics
anti-inflammatories
283
what is non-infectious inflammatory rhinitis also known as?
lymphocytic/plasmacytic rhinitis
284
what are the clinical signs of non-infectious inflammatory rhinitis?
bilateral serous/mucopurulent nasal discharge
sneezing
snorting
285
what can be used to diagnose non-infectious inflammatory rhinitis?
history/clinical signs
diagnostic imaging
rhinoscopy and biopsy
286
what will be the findings on diagnostic imaging of animals with non-infectious inflammatory rhinitis?
mild loss of turbinate detail
| increased soft tissue density (due to discharge)
287
how can biopsy help to diagnose non-infectious inflammatory rhinitis?
histopathology to view lymphocytic/plasmocytic infiltration of the mucosa with possible secondary bacterial infection and neutrophilic inflammation
288
how effective is treatment of non-infectious inflammatory rhinitis?
rarely curative and will often require longterm treatment
289
what are the options for treating non-infectious inflammatory rhinitis?
```
environmental modification
saline in nares to liquefy/clear discharge
nasal flushes
NSAIDs
antibacterials
mucolytics
test/eliminate allergens
```
290
what effect does doxycycline have on the nares?
anti-inflammatory on nasal mucosa
| antibacterial
291
how can the environment be modified to treat non-infectious inflammatory rhinitis?
minimise exposure to irritants/allergens through ventilation, cleaning and humidification
292
what are the clinical signs of nasal foreign bodies?
sudden onset
sneezing
distress/face pawing
purulent nasal discharge (unilateral)
293
what can be used to diagnose nasal foreign bodies?
history/clinical signs
rhinoscopy
diagnostic imaging
exploratory rhinotomy (last resort)
294
how are nasal foreign bodies treated?
nasal flushing
endoscopic removal
rostral retraction of the soft palate and retrieval
rhinotomy (last resort)
295
what are some less common causes of nasal discharge?
```
dental disease
bacterial rhinitis
cleft palate
ciliary dyskinesis
parasites (rare)
dysphagia causing nasopharyngeal reflux
```
296
what is a major risk of rhinotomy?
haemorrhage - apply tourniquet around common carotid artery (whole blood should be available for transfusion)
297
what has caused brachycephalic obstructive syndrome (BOS)?
selective breeding leading to shortening of the skull but without the same reduction of volume of connective tissue
298
what are the primary components of BOS?
overlong soft palate
stenotic nares
tracheal /laryngeal hypoplasia
299
what secondary change can occur as BOS progresses?
tonsillar enlargement and protrusion
laryngeal collapse
tracheal collapse
300
describe the laryngeal collapse associated with BOS
eversion of the laryngeal saccules and progressive medial deviation of the corniculate and cuneiform processes of the arytenoid cartilage
301
what are the clinical signs of brachycephalic obstructive syndrome?
```
marked inspiratory noise
dyspnoea
snoring
sleep apnoea
exercise intolerance
cyanosis
fainting/collapse
gagging
dysphagia
regurgitation
coughing
```
302
is starter or stridor associated with brachycephalic obstructive syndrome?
stertor
303
what can exacerbate the clinical signs of BOS?
heat, excitement, exercise
304
what can be used to diagnose BOS?
breed, history, clinical signs
examination of upper airway
radiography
305
what is assessed in BOS cases by examination of the airway under light anaesthesia?
tonsillar size/protrusion from the crypts
soft palate - should just overlap the epiglottis
larynx - look for collapse
306
why does care need to be taken when assessing the soft palate length of BOS patients?
don't pull the tongue forward as this will displace the larynx/epiglottis and cause an overestimation of palate length
307
what is assessed on radiographs of suspected BOS patients?
pharyngeal airway
tracheal diameter
signs of aspiration pneumonia
other causes of upper airway obstruction (masses...)
308
what are the options for treatment of brachycephalic obstructive syndrome?
rhinoplasty
palatoplasty
laryngeal sacculectomy
tonsillectomy
309
when should you intervene surgically with BOS cases?
if indicated by severity of clinical signs and impact on quality of life
as soon as possible before there is extensive secondary changes
wait until animal is skeletally mature so the tissue is less delicate and there is more room
310
what should be done to stabilise severe BOS cases?
```
cool, quiet environment
supplementary oxygen
sedation
IV corticosteroids
intubate to bypass obstruction
```
311
describe the rhinoplasty performed on BOS cases
lateral, vertical or horizontal wedge resection of the dorso-lateral nasal cartilages
312
how is haemorrhage controlled when performing rhinoplasty in BOS cases?
2 absorbable sutures placed in the defects
313
what is given to patients undergoing palatoplasty? and why?
IV corticosteroid to reduce post-op airway swelling
314
describe the procedure of a palatoplasty for BOS patients
resect the excess soft palate to it just overlaps the epiglottis
315
what is the limit for resection of the soft palate?
caudal border of tonsillar crypts
316
why should you not resect further than the caudal border of the tonsillar crypts?
will allow nasopharyngeal reflux of food/fluid leading to a chronic rhinitis
317
describe the process of laryngeal sacculectomy for BOS patients
grasp the everted laryngeal saccule mucosa and amputate level with the laryngeal mucosa
318
what usually causes laryngeal collapse?
secondary to chronic upper airway obstruction leading to increase resistance and hence increase negative pressure and turbulence
319
what are the stages of laryngeal collapse?
1 - eversion of laryngeal saccules
2 - eversion of laryngeal saccules and medial deviation of the cuneiform process of the arytenoids
3 - eversion of laryngeal saccules and medial deviation of the cuneiform and corniculate processes of the arytenoid cartilages
320
how is stage 1 laryngeal collapse treated?
laryngeal sacculectomy
321
how are stage 2/3 laryngeal collapse treated?
laryngeal sacculectomy with/without arytenoid caudolateralisation
322
what is an alternative treatment for laryngeal collapse if laryngeal sacculectomy fails?
permanent tracheostomy
323
describe the procedure of arytenoid caudolateralisation for patients with laryngeal collapse
arytenoid cartilage is pulled further caudal than normal so it is medially supported by the cricoid cartilage preventing the medial deviation
324
what can cause laryngeal paralysis?
congenital dysfunction of the recurrent laryngeal nerve
idiopathic degeneration of the recurrent laryngeal nerve
neuropathy due to metabolic disease
myopathies
trauma/neoplasia effecting the recurrent laryngeal nerve
325
what can paralysis of the dorsal cricoarytenoid result in?
reduced size of the glottis and increased airway resistance during inspiration
326
what breeds are predisposed to acquired laryngeal paralysis?
golden retrievers
labradors
irish setters
327
what breeds are predisposed to congenital laryngeal paralysis?
Bouvier des Flandres
| white German shepherds
328
what are the clinical signs of laryngeal paralysis?
```
inspiratory stridor
exercise intolerance
fainting/collapse
altered phonation
coughing/gagging during swallowing
dysphagia
```
329
what can be used to diagnose laryngeal paralysis?
```
history/clinical signs
laryngoscopy
thoracic/cervical radiographs
haematology/biochemistry
electromyography
```
330
what is being observed during a laryngoscopy off patients with suspected laryngeal collapse?
arytenoid cartilages should abduct during inspiration and adduct during expiration - take care with paradoxical movements caused by turbulence
331
what is cervical/thoracic radiography used for when examining for suspected laryngeal disease?
mass lesions and concurrent aspiration pneumonia
332
what is haematology/biochemistry used for in cases of suspected laryngeal paralysis?
to rule out metabolic disease
333
what is the most common treatment of laryngeal paralysis?
arytenoid lateralisation (laryngeal tieback)
334
describe the procedure of arytenoid lateralisation (tie back)
sutures permanently placed to permanently abduct the arytenoid cartilage and open the glottis
usually unilaterally on the left
335
why is arytenoid lateralisation done unilaterally on the left side?
surgery on the left is easier for right handed surgeon
| unilateral provided adequate airway for most cases but also minimises postoperative aspiration pneumonia
336
what are some possible complications associated with arytenoid lateralisation (tie back)?
aspiration pneumonia
suture/cartilage breakage
serum development
337
what techniques can be used to investigate tracheal disease?
```
clinical exam
diagnostic imagery
tracheobronchoscopy
biopsy
tracheal wash
```
338
how can tracheal disease be investigated on a clinical examination?
auscultation of larynx, cervical trachea and thorax to localise respiratory noise
palpation of cervical trachea - changes in shape (collapse, neoplasia..)
339
why are many tracheal abnormalities visible on radiographs?
high contrast between air filled lumen and surrounding soft tissues
340
what diagnostic imagining can be used to visualise dynamic tracheal abnormalities?
fluoroscopy
341
what are tracheal washes and bronchioaveolar lavage useful for?
bacterial culture
| cytology
342
what can cause tracheal tears?
sharp penetrating objects
blunt trauma
overinflation of cuffed ET tube in cats
343
what can large tears of the trachea cause?
subcutaneous emphysema
| pneumothorax
344
what can be done to treat tracheal tears?
cage rest if not dyspneic
| tracheoscopy - expose, decried and suture
345
where does tracheal avulsion usually occur?
in the intrathoracic trachea caudal to the bifurcation
346
how can tracheal avulsion be diagnosed?
history of trauma and progressive dyspnoea
tracheoscopy
toracic radiography
347
what will tracheoscopy reveal in patients with tracheal avulsion?
circumferential tracheal ring disruption or tracheal stenosis
348
what will thoracic radiography reveal in patients with tracheal avulsion?
intrathoracic pseudo trachea (area of gas density in line with the trachea)
349
how is tracheal avulsion treated?
decried and anastomose avulsed ends
350
what causes tracheal collapse?
laxity of the tracheal muscle
| chondromalacia of the tracheal rings
351
how is the severity of tracheal collapse catagorised?
grade I-IV
352
describe a grade I tracheal collapse
laxity of the dorsal tracheal membrane resulting in 25% collapse of the lumen
353
describe a grade II tracheal collapse
loss of cartilage rigidity and further laxity of the membrane resulting in 50% collapse of the lumen
354
describe a grade III tracheal collapse
flattening of the tracheal cartilage resulting in 75% collapse of the lumen
355
describe a grade IV tracheal collapse
collapse of the rings resulting in 100% loss of luminal integrity
356
tracheal collapse is a dynamic process, describe this
cervical trachea collapses on inspiration and the intrathoracic trachea collapses on expiration
357
what animals is tracheal collapse usually seen in?
small/toy dog breeds
358
what are the clinical signs of tracheal collapse?
cough (goose honk) - elicited by tracheal pressure
waxing/waning dyspnoea
exercise intolerance
cyanosis
flattening of cervical trachea on palpation
359
what can be used to diagnose tracheal collapse?
signalment, clinical signs, history
endoscopy
fluoroscopy
radiography
360
what can fluoroscopy be used for when diagnosing tracheal collapse?
can reveal changes in the lumen diameter during inspiration/expiration
361
how is tracheoscopy used when diagnosing tracheal collapse?
determine the location and grade of the collapse
362
what can be done in most cases to treat tracheal collapse?
medical management - most dogs respond for more than 12 months
363
what medical management techniques can be used in the treatment of tracheal collapse?
```
weight loss (if required)
avoid stress, heat, excitement...
use harness instead of collar
address any other airway disease
corticosteroids
antitussives
bronchodilators
antibacterials for concurrent infections
```
364
what are possible surgical treatments of tracheal collapse?
intraluminal stent
| extraluminal stent
365
what are some complications of intraluminal stenting to treat tracheal collapse?
stent migration
stent fracture
failure to integrate into mucosa
366
what will failure of an intraluminal stent to integrate into the tracheal mucosa result in?
reduced mucociliary clearance
granulation tissue formation
tracheal stenosis
collapse of unstented trachea/bronchi
367
what is used for extraluminal stenting of the trachea?
prosthetic rings
368
what are some complications of extraluminal stenting for treating tracheal collapse?
iatrogenic damage to laryngeal nerves
tracheal necrosis (disrupted blood flow)
persistent cough
further collapse
369
what is done to reduce the complication of laryngeal collapse due to damaged nerves caused by extraluminal stenting?
concurrent arytenoid lateralisation
370
what animals is tracheal hypoplasia most commonly seen in?
tracheal hypoplasia
371
how is tracheal hypoplasia diagnosed?
lateral cervical/thoracic radiographs
372
how is tracheal hypoplasia treated?
management of other airway abnormalities (stenotic nares, long soft palate...)
symptomatic treatment to improve mucociliary clearance
373
what is tracheal necrosis?
abnormal narrowing due to trauma and excessive granulation tissue formation
374
what are the clinical signs of tracheal stenosis?
progressive cough
exercise intolerance
dyspnoea
375
what can be used to diagnose tracheal stenosis?
history/clinical signs
diagnostic imaging
tracheoscopy and biopsy
376
what can be done to treat tracheal stenosis?
tracheal resection and anastomosis
377
what can be done to treat tracheal neoplasia?
excision and anastomosis for small minimally invasive neoplasms
chemotherapy
radiotherapy for lymphoma
378
how is the cervical trachea accessed for surgery?
ventral midline incision, separating the sternohyoideus muscles along the midline to reveal the trachea
379
how is the thoracic trachea accessed for surgery?
3rd to 5th intercostal space thoracotomy on the level of the lesion
380
what type of blood supply does the trachea have?
segmental
381
why does care need to be taken with tracheal surgery?
close to many important structures - recurrent laryngeal, carotid arteries, thyroid gland
382
what should be used to close tracheal injuries?
monofilament absorbable suture material with knots placed extraluminally
383
what is temporary tracheostomy used for?
release potentially life threatening URT obstruction
assist ventilation
removal of secretion or aspirated materials
inhalation anaesthetic agents
384
describe the technique for placing a temporary tracheostomy tube
incise skin and separate right/left sternothyroid and sternohyoid
make a transverse incision between the 4th/5th tracheal rings
place a suture loop cranial and caudal to the incision
place a non-cuffed tracheostomy tube into the lumen
suture skin around the tube leaving an open wound for replacing the tube
place a light bandage
385
how does a tracheostomy tube have to be maintained?
change at least twice a week
clean/disinfect
suction airway when required
moisten airway every 1-4 hours
386
what are some common complications associated with tracheostomy tubes?
```
tube obstruction/removal
gagging/coughing
SC emphysema
pneumothorax
infection
tracheal stenosis
```
387
what should be done before removing a tracheostomy tube?
occlude the tube for 15-20 minutes to ensure no respiratory distress
388
how is the stoma of tracheostomy tube placement allowed to heal?
secondary intention
389
how are permanent tracheostomy tubes managed?
```
cleaning opening
keep hair short
maintain good BCS
cover when outside
restrict patient from swimming
```
390
what is tracheal resection indicated for?
congenital or acquired tracheal strictures
localised tracheal neoplasia
tracheal granuloma
391
what is the maximum number of tracheal rings you can remove?
5-6
392
what are some developmental abnormalities of the kidneys?
renal agenesis
renal dysplasia
renal ectopia
polycystic kidney disease
393
what species are predisposed to polycystic kidney disease?
Persians
| Bull terriers
394
what is renal agenesis?
when the kidney and ureter aren't present
395
what is renal dysplasia?
disorganisation of the parenchyma
396
what are the indications for a renal biopsy?
```
renal mass (most common)
haematuria of UUT origin
renal cortical disease
renal failure of unknown cause
evaluate severity of renal disease
```
397
what tests should be carried out before a renal biopsy?
```
haematology
serum biochemistry
urinalysis
diagnostic imaging
coagulation profile
```
398
what are the contraindications for a renal biopsy?
```
anaemia
coagulopathy
oliguria/anuria/severe azotaemia
hypertension
urinary obstruction
hydronephrosis
renal abscess
solitary functioning kidney
```
399
what are some potential complications of renal biopsies?
```
haemarrhage
haematuria
hydronephrosis
renal infarction
damage to renal vasculature
infection
fibrosis
```
400
what are the methods of taking a renal biopsy?
FNA
tru-cut needle
surgical
401
what does tru-cut or FNA take a renal sample of??
```
the cortex
(don't go in medulla - causes problems)
```
402
why are FNA and tru-cut renal biopsies taken under ultrasound guidance?
to make sure you don't put the needle in the medulla
403
what are the ways of approaching the kidney for a biopsy?
ultrasound guided
keyhole (flank)
laparoscopic
ventral midline coeliotomy
404
how do you expose the right kidney when doing a midline coeliotomy?
retract descending duodenum to the midline
405
how do you expose the left kidney when doing a midline coeliotomy?
retract the colon to the midline
406
which kidney has multiple arteries?
left
407
what is a nephrotomy?
an incision into the kidney
408
what are the indications for a nephrotomy?
wedge biopsy
| removal of nephroliths
409
how should haemostasis be carried out during a nephrotomy?
using assistants fingers or vascular clamps for no longer than 20 minutes
410
what is bisectional removal of calculi from the kidney?
incisioin made from pole to pole of the kidney
411
after removing the nephroliths from the kidney, what must you do?
check for patency of the ureter
412
what must be done at the end of a nephrotomy?
fix the kidney back onto the body wall
413
what are the two types of neophrotomy to remove calculi?
bisectional
| intersegmental
414
what are the clinical signs of nephroliths?
lumbar/abdominal pain
haematuria
recurrent UTI
azotaemia
415
how can nephroliths be treated?
medical management - specific diets
| surgery
416
what type of nephroliths don't respond to medical management?
calcium oxalate
417
what is ureteronephrectomy?
removal of the kidney and associated ureter
418
what are the indications for ureteronephrectomy?
trauma
hydronephrosis
renal masses
harvest for transplant
419
what is a key aspect that must be taken into account before carrying out a ureteronephrectomy?
animals must have two functioning kidneys
420
what is the only indication for partial nephrectomy?
if patient has lost other kidney and need to do surgery on the other kidney
421
what is the most common renal neoplasm in cats?
lymphoma
422
what is the most common neoplasm in dogs?
renal cell carcinoma
423
are primary or metastatic renal neoplasms more common?
metastatic
424
what are the clinical signs of renal neoplasia?
```
(slow onset)
haematuria
weight loss
depression/lethargy
inappetance
pyrexia
lameness
abdominal distension
```
425
how are renal neoplasms investigated?
```
abdominal palpation
haematology/biochemistry
radiography
computed tomography
ultrasound
biopsy
(check for metastasis)
```
426
is renal lymphoma in cats usually bilateral or unilateral?
bilateral
427
how can renal neoplasms be treated?
lymphoma - chemotherapy
| ureteronephrectomy
428
why is surgery to remove renal neoplasms often challenging?
can be metastasis and extensive neovascularisation (high risk of haemorrhage)
429
what are some possible congenital abnormalities of the bladder?
patent urachus
| vesicourachal diverticulum
430
what does the urachus connect?
bladder and allantoic sac
431
what s vesicourachal diverticulum?
when the external opening of the rachis closes but the blind ending diverticulum remains open
432
where on the bladder should be avoided during surgery?
trigone
433
what is cystotomy?
opening of the bladder
434
what are the indications for cystotomy?
```
removal of calculi
repair bladder trauma
biopsy/resection of bladder mass
biopsy of bladder wall
repair ectopic ureters
```
435
what is the surgical approach for cystotomy?
ventral midline coeliotomy from umbilicus to the pubis
isolate the bladder and place stay sutures
make incision and suction urine
436
why is gentle tissue manipulation of the bladder very important?
the urothelium quickly becomes congested and oedematous
437
what suture material is used to close the bladder?
monofilament - monocryl
438
what two patterns of suture can be used to close the bladder?
single layer of simple interrupted/continuous
| double layer using inverting continuous pattern
439
how fast does the bladder heal?
rapidly - 100% strength in 2-3 weeks
440
what is the postoperative management after cystotomy?
hospitalisation to monitor urination
| don't palpate abdomen
441
what are possible complications associated with cystotomy?
haematuria
dysuria
uroabdomen (uncommon)
442
what are the main types of bladder calculi?
struvite
| calcium oxalate
443
what are the clinical signs of bladder calculi?
haematuria
pollakuria
stranguria
dysuria
444
how are baldder calculi diagnosed?
```
radiography
pneumocystography
double contrast cystography
ultrasound
CT
```
445
what are the possible causes of bladder rupture?
trauma
neoplasia
urethral obstruction
iatrogenic
446
what are the clinical signs of bladder rupture?
haematuria, dysuria
abdominal bruising
abdominal distention
depression, vomiting, shock
447
how can bladder rupture be diagnosed?
```
history/clinical exam
abscence of urine on catheterisation
urethral obstruction
azotaemia, dehydration, metabolic acidosis
abdominocentesis
ultrasound
positive contrast study
```
448
what differences will be seen in the fluid from abdominocentesis of patients with bladder rupture?
increased creatinine and potassium (higher than serum)
449
how is bladder rupture treated?
fluid therapy and urine drainage
| closure of rupture (same as cystotomy) after exploratory laparotomy to identify the defect
450
what does cystostomy tubes allow?
urinary diversion and avoid bladder distention
451
what are the indications for a cystostomy tube?
bladder or urethral surgery
obstructed bladder neck or urethral neoplasia
neurogenic bladder atony
452
what is the most common bladder neoplasia of dogs/cats?
transitional cell carcinoma
453
how can bladder neoplasias be treated?
```
chemotherapy
NSAIDs
cystostomy tubes
urethral stenting
partial cystectomy
```
454
what is the difference between male and female urethras?
female - shorter and wider
| males - divided into pelvic, membranous and penile urethra
455
what are the possible clinical signs of patients with urinary tract disease?
```
haematuria
polyuria/polydipsia
dysuria
pollakiuria
stranguria
oliguria
anuria
nocturia
incontinence
lethargy
collapse
pyrexia
weight loss
vomiting/diarrhoea
abdominal/lumbar pain
```
456
what is dysuria?
pain on urination
457
what is polydipsia defined by?
water intake exceeding 100ml/kg/day
458
what is polyuria define by?
urine output higher than 50ml/kg/day
459
what is oliguria?
lower than normal urine output
460
what is pollackiuria?
frequent small amounts of urination
461
what vital parameters are assessed in patients with urinary tract disease?
HR, RR, hydration, MM colour, mentation, temperature
462
what is assessed on abdominal palpation in patients with urinary tract disease?
pain
| changes in kidney size
