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Veterinary Medicine > SA Surgery > Flashcards

SA Surgery Flashcards

1
Q

What occurs during stage 1 of wound healing?

A 
Inflammation:
Seal forms
Contaminants removed
Neuts & møs
Capillary sprouting
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2
Q

What occurs during stage 2 of wound healing?

A 
Proliferation:
Capillary growth
Collagen Production
Wound contraction
Granulation Tissue
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3
Q

What occurs during stage 3 of wound healing?

A

Remodelling/Maturation:
Strengthening of collagen
(Mechanical loading important)

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4
Q

Define Clean wound.

A

Sterile

NOT resp/GIT/UGT

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5
Q

Define Clean Contaminated wound.

A

Sterile

Inc resp/GIT/UGT

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6
Q

Define contaminated wound.

A

Contaminated during surgery.

Wounds <4h

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7
Q

Define dirty wound.

A

Evidence of infection/ purulence/perforation.

Wound >4h

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8
Q

Define 1st intention healing.

A

Surgically opposed w/aseptic technique

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9
Q

Define 2nd intention healing.

A

Allow wound to close by itself

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10
Q

Describe 3rd intention healing.

A

Delay primary closure to allow debridement and reduce contamination

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11
Q

When should a non-adherent dressing be used?

A

In repair phase - allow exudate to drain but keep moist

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12
Q

Name 3 non-adherent dressings.

A

Algisite M (calcium alginate) - 7d.
Melolin
Allevyn

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13
Q

What is the role of the 2e dressing layer?

A

Absorb excess fluid
Secure primary layer
Obliterate dead space
Protect Wound

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14
Q

What is the role of the 3e dressing layer?

A

Secure other layers

Keep dressing clean and dry.

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15
Q

What needle and syringe choice is appropriate for wound lavage?

A

19G (/20G)

20ml

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16
Q

What are halsteds principles of surgery?

A

HALSTED:

H andle tissue gently
A rrest all bleeding 
L eave blood supply intact
S trict Asepsis
T ension minimised

E dges together nicely
D ead space obliterated
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17
Q

In which 3 tissues should a round bodied needle be used?

A

Muscle
Fat
Viscera

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18
Q

Where should a cutting needle be used?

A

Tough tissue

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19
Q

Where should a reverse cutting needle be used?

A

Skin

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20
Q

When should skin staples NOT be used?

A

Wounds under tension

Wounds with irregular edges

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21
Q

What are the advantages of performing a median sternotomy?

A

Access both sides of thorax - good for exploratory surgery

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22
Q

What are the disadvantages of performing a median sternotomy?

A

Can’t reach dorsal lung field, thoracic duct and great vessels easily

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23
Q

What are the advantages of performing an intercostal thoracostomy?

A

Immediate access to adjacent structures

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24
Q

What are the disadvantages of performing an intercostal thoracostomy?

A

Poor access to other side of patient - use for unilateral procedure

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25
Q

What are the 4 indications for a lung lobectomy?

A

Lobe Torsion
Local Abscess
Severe lung trauma
Broncho-oesophageal fistula

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26
Q

After Stabilising and performing a clinical exam on a patient with thoracic trauma, what are your next steps?

A

Rx (Thorax AND Abdo)

Thoracocentesis if pleural air/fluid

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27
Q

What are the 3 indications for a tube thoracostomy?

A

post-op management
Continues pneumothorax
Severe pleural effusion

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28
Q

What Tx is adequate for Rib fractures?

A

Analgesia
Rest
Oxygen

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29
Q

What causes paradoxical movement of a segment of the chest wall?

A

1+ ribs fractured in 2 planes (flail chest)

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30
Q

How should “ flail chest” be treated?

A

Surgical Stabilisation

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31
Q

What may be caused by blunt abdominal trauma, leading to physical compression of the lungs and effusion?

A

Diaphragmatic rupture - abdominal organs enter pleural space

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32
Q

What method should be used for one-off drainage of the chest/to stabilise a patient with a pleural effusion?

A

Needle thoracocentesis

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33
Q

What needle should be used for needle thoracocentesis?

A

16-20G 1-1.5”

Small dog/cat: butterfly cannula

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34
Q

Which ICS should be used for needle thoracocentesis?

A

7 or 8th

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35
Q

Which area of the ICS should be avoided for thoracocentesis?

A

Cranial ICS - nerves and vessels here

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36
Q

HOw far into the chest should a needle be for thoracocentesis?

A

Just past rib

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37
Q

What tubes should you use for effusion cytology?

A

EDTA

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38
Q

If placing a tube thoracostomy, how big should the tube be?

A

internal diameter = half ICS width

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39
Q

What are the 4 aims of skin reconstruction?

A

Square skin edges
Accurate Apposition
No Overlap
Slight eversion of edges

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40
Q

How may you close a wound that is too large for closure?

A

Undermining and advancing skin - blunt or sharp

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41
Q

Should undermining be done beneath or above the panniculus (where present)?

A

Below

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42
Q

Name 5 tension relieving suture patterns

A 
Vertical mattress
Horizontal mattress
Far-near-near-far
Far-Far-near-near
Simple interrupted (alternating width)
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43
Q

What are cutaneous pedicle grafts?

A

Portions of skin & S/C tissue moved from one area to another

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44
Q

Where are cutaneous pedicle grafts best used?

A

Head, Neck and Trunk

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45
Q

How large should a cutaneous pedicle graft be?

A

Larger than the wound you want to cover

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46
Q

When will the pedicle graft become revascularised?

A

7-10d

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47
Q

What are the 3 major reasons pedicle grafts fail?

A

Tension
Infection
Arterial/Venous Occlusion

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48
Q

What are 3 Tx you can use to save a dying pedicle graft?

A

Ointments
Debride and 2e closure
Hyperbaric Oxygen

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49
Q

When should surgical drains be removed?

A

Small vol serosanguineous fluid removed

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50
Q

What are the 4 surgical options for canine otitis interna which is completely refractory to medical Tx?

A

Lateral wall resection
Vertical canal ablation
TECA
Ventral Bulla Osteotomy

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51
Q

When are lateral wall resections indicated?

A

Small tumours of the lateral vertical wall

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52
Q

When is vertical canal ablation indicated?

A

VC neoplasia
VC ONLY stenosis
Trauma

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53
Q

What is another name for vertical canal ablation?

A

Tigari pull through

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54
Q

What is another name for lateral wall resection?

A

Zepps operation

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55
Q

Before surgery on the vertical canal, what should it be packed with?

A

Iodine Ointment

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56
Q

What should be done 1st in a lateral bulla osteotomy?

A

Curette bulla to remove all secretory epithelium

57
Q

What should the bulla be rinsed with in a lateral bulla osteotomy?

A

Lactated Ringers

58
Q

What should be given to a dog post ear surgery?

A

Opiates 24h
Meloxicam 7d

Remove sutures 14d

59
Q

What are the major complications of TICA?

A

FN paralysis
Horners
Haemorrhage
Infection

60
Q

Which procedure is performed in a cat with otitis interna that is completely refractory to medical Tx?

A

Ventral Bulla Osteotomy

61
Q

Which ear surgery has the best outcomes?

A

TECA/VBO

62
Q

What does the “pringle manouvre” do?

A

Temporary occlusion of hepatic blood flow for 15min

63
Q

Which bacteria resides in the liver as a resident population?

A

clostridia

64
Q

What should the abdomoen be lavaged with before closure?

A

1-3L warm STERILE saline

65
Q

What AB should be given for general surgical prophylaxis?

A

Amoxiclav

66
Q

Which AB should be given if you suspect anaerobic contamination during surgery?

A

Metronidazole

67
Q

Which AB should be given to work in bile/liver?

A

Amoxicillin

Cefazolin

68
Q

In which 2 parts of the GI tract is tension an issue for surgery?

A

Oesophaggus

Colon (subtotal colectomy)

69
Q

Which grafts can be used to reinforce the oesophagus?

A

Omental
Pericardial
Diaphragmatic pedicle
Patch

70
Q

What is the procedure of choice for oesophagectomy and enterectomy?

A

End-to-end anastomosis

71
Q

How long does it take for the GIT to regain 75% of its normal sytrenth?

A

14d

72
Q

Which suture material should be used in the GIT?

A

1.5-2m

Monofilament absorbable (PDS, monocryl)

73
Q

What are the best patterns for GIT closure and what layer must be involved?

A 
Submucosa
Simple (cont > interrupted)
74
Q

What are the clinical signs of peritonitis?

A 
Depression
Anorexia
C+
Abdo pain/ileus
Pyrexia and shock
75
Q

How is peritonitis diagnosed?

A

Rx!

HB: neutrophilia (L), azotaemia, hypoglycaemia

Abdo paracentesis

76
Q

What is seen on abdominal paracentesis during peritonitis?

A

Degen Neuts
Free/IC bacteria
Inc lactate/glucose cf serum

77
Q

How is peritonitis treated?

A

IVFT
Copious lavage
BSABs
Identify cause and treat

78
Q

What can be given to a dog with ileus to improve its condition?

A

IVFT

Metaclopramide

79
Q

What is your surgical approach to the oesophagus?

A

Ventral Cervical midline to level of 2nd rib

OR
R intercostal thoracotomy at level of lesion

80
Q

How should the linea alba be closed?

A

Simple continuous in external sheath of Rectus muscle

81
Q

how should incisions be made through the abdominal muscles?

A

Parallel to its fibres

82
Q

What is a primary cleft palate?

A

Failure to fuse of lips and premaxilla

83
Q

What is a secondary cleft palate?

A

Failure to fuse of hard and soft palates

84
Q

How are benign oral tumours treated in the dog?

A

Wide local excision

85
Q

How are benign oral tumours treated in the cat?

A

Wide local excision

RT

86
Q

what is the most common Dz of the canine salivary glands?

A

Salivary mucocele - sublingual esp affected

87
Q

What are the clinical signs of a salivary mucocele?

A

Painless fluctuating swelling
Dysphagia/ptyalism
Inspiratory stridor
Cough/resp distress

88
Q

How long should a patient receive NIL-by-mouth post oesophageal Surgery?

A

24-48h

5-7d soft food/water only

89
Q

Where are the 3 places oesophageal FBs tend to lodge in small animals?

A

Thoracic Inlet
Heart Base
In front of cardia

90
Q

What is the most common canine vascular ring abnormality?

A

Persistent Right Aortic Arch

91
Q

What are the 3 indications for partial gastrectomy?

A

Necrosis
Neoplasia
Ulceration

92
Q

What degree of rotation is most commonly seen in a GDV?

A

180

93
Q

Where does the pylorus come to lie in a clockwise GDV?

A

L ventral abdomen

94
Q

What are the 1 immediate priorities with a GDV case?

A

IVFT

Decompression

95
Q

What must be done surgically to ALL GDV cases to prevent recurrence?

A

Gastropexy

96
Q

How can you decompress the stomach of a conscious dog?

A

Stomach tube w/lubrication and gag

Needle paracentesis

Temporary gastrotomy (with local)

97
Q

How is needle paracentesis performed in a GDV?

A

14-16G 1.5-2” needle

98
Q

What is a gastropexy?

A

Fix pylorus to R abdominal wall - 5 potential techniques

99
Q

When is splenectomy indicated in a GDV?

A

Thrombi or torsion

100
Q

What is common on an ECG 24h post GDV op?

A

VPCs

101
Q

When should a GDV begin receiving food again?

A

24-48h post-op SMALL amount

102
Q

Which 2 gastric mucosal protectants can be given following GDV Surgery?

A

Sucralfate

Antacids

103
Q

What should be given to patient vomiting after GDV surgery?

A

Metaclopramide

104
Q

Which procedure can aid a gastric outflow obstruction?

A

Pyloroplasty

105
Q

What are Billroth I and II procedures used to treat?

A

Resection of large amount of distal stomach and pylorus

106
Q

IF you find a linear FB under the tongue, what should you do?

A

Cut it (if no peritonitis)

If peritonitis - surgery

107
Q

How is a rectal prolapse treated?

A

Reduce

Surgery: purse string 1-5d, colopexy or resection.

108
Q

What should be given as part of post-op care for a rectal prolapse?

A

Stool softeners
Low bulk diet
Sedation

109
Q

What are the clinical signs of perianal fistulas?

A

Tenesmus
Pruritis
Fistulae

110
Q

What is the best Tx for perianal fistulas?

A

MEDICAL - ciclosporine

111
Q

What is the % functional reserve of the liver?

A

70-80%

112
Q

How should peripheral liver lesions be biopsied?

A

Guillotine method

113
Q

How should central liver lesions be biopsied?

A

Trucut or punch biopsy

114
Q

What are the 3 indications for a partial liver lobectomy?

A

Neoplasia
Abscess
Trauma

115
Q

How is a PSS diagnosed?

A

Clinical signs +

Rx: small liver
US: direct visualisation
Scintigraphy

116
Q

What are 2 methods to gradually close a PSS?

A

Ameroid constrictor placement

Cellophane banding

117
Q

What are the signs of portal hypertension?

A

Ascites and pain
bloody D+
Endotoxic shock
Death

118
Q

Which are the 2 procedures that can be performed to divert bile flow?

A

Cholecystoduodenostomy (if can be apposed without tension

Cholecystojejunostomy

119
Q

What are the 3 types of panceratic biopsy?

A

Trucut
FNA
shaving affected tissue w/scalpel

120
Q

How is a partial pancreatectomy formed on single peripheral lesions?

A

Simple Encircling ligature

121
Q

How is a partial pancreatectomy formed on central or peripheral lesions?

A

Blunt dissect between lobules

Individually ligate ducts and vessels for tissue being excised

122
Q

what are 2 causes of umbilical hernias?

A

Excessive traction on umbilical cord

Severing cord too short

123
Q

When should an umbilical hernia be diagnosed?

A

1st vaccine

124
Q

Which hernias are hard to diagnose, and therefore need Rx to define?

A

Inguinal Hernias

125
Q

Where should the surgical incision be made for a simple inguinal hernia repair?

A

Lateral aspect of swelling - blunt dissect to expose hernial sac

126
Q

Where should the surgical incision be made for a complicated inguinal hernia repair?

A

Caudal midline coeliotomy

127
Q

What are the 3 most common complications post hernia repair?

A

Pain
Haematoma
Seroma

128
Q

Via which anatomical “ring” does a scrotal hernia pass?

A

Vaginal Ring

129
Q

Which sutures can be used to reduce the size of a hernial sac?

A

Mattress

130
Q

Which animals are most at risk for a perineal hernia?

A

Old Male Entire Dogs

131
Q

Where are perineal hernias found, relative to the anus?

A

Ventrolaterally

132
Q

What is normally contained in a perineal hernia?

A

Prostate
Bladder
Omentum
SI

133
Q

How can patients with perineal hernias be stabilised before surgery?

A

Decompress bladder

Correct electrolytes - IVFT, Catheter

134
Q

Which 2 faecal softeners are given as part of long term post-op care following perianal hernia repair?

A

Isogel

Lactulose

135
Q

What are the major signs of a traumatic abdominal hernia?

A

Asymmetry of abdomen
Bulging mass under skin
Pain and bruising

136
Q

How should acute and chronic diaphragmatic hernias be treated?

A

Acute: stabilise then surgery

Chronic: Surgery

137
Q

What are the signs of acute incisional hernia?

A

Oedema/swelling
Serosanguineous disch
Evisceration

138
Q

When should debridement of the abdominal wall take place in an incisional hernia?

A

ONLY if edges are devitalised

Veterinary Medicine (68 decks)

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