SA Surgery Flashcards
1
Q
What occurs during stage 1 of wound healing?
A
Inflammation: Seal forms Contaminants removed Neuts & møs Capillary sprouting
2
Q
What occurs during stage 2 of wound healing?
A
Proliferation: Capillary growth Collagen Production Wound contraction Granulation Tissue
3
Q
What occurs during stage 3 of wound healing?
A
Remodelling/Maturation:
Strengthening of collagen
(Mechanical loading important)
4
Q
Define Clean wound.
A
Sterile
NOT resp/GIT/UGT
5
Q
Define Clean Contaminated wound.
A
Sterile
Inc resp/GIT/UGT
6
Q
Define contaminated wound.
A
Contaminated during surgery.
Wounds <4h
7
Q
Define dirty wound.
A
Evidence of infection/ purulence/perforation.
Wound >4h
8
Q
Define 1st intention healing.
A
Surgically opposed w/aseptic technique
9
Q
Define 2nd intention healing.
A
Allow wound to close by itself
10
Q
Describe 3rd intention healing.
A
Delay primary closure to allow debridement and reduce contamination
11
Q
When should a non-adherent dressing be used?
A
In repair phase - allow exudate to drain but keep moist
12
Q
Name 3 non-adherent dressings.
A
Algisite M (calcium alginate) - 7d.
Melolin
Allevyn
13
Q
What is the role of the 2e dressing layer?
A
Absorb excess fluid
Secure primary layer
Obliterate dead space
Protect Wound
14
Q
What is the role of the 3e dressing layer?
A
Secure other layers
Keep dressing clean and dry.
15
Q
What needle and syringe choice is appropriate for wound lavage?
A
19G (/20G)
20ml
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
17
Q
In which 3 tissues should a round bodied needle be used?
A
Muscle
Fat
Viscera
18
Q
Where should a cutting needle be used?
A
Tough tissue
19
Q
Where should a reverse cutting needle be used?
A
Skin
20
Q
When should skin staples NOT be used?
A
Wounds under tension
Wounds with irregular edges
21
Q
What are the advantages of performing a median sternotomy?
A
Access both sides of thorax - good for exploratory surgery
22
Q
What are the disadvantages of performing a median sternotomy?
A
Can’t reach dorsal lung field, thoracic duct and great vessels easily
23
Q
What are the advantages of performing an intercostal thoracostomy?
A
Immediate access to adjacent structures
24
Q
What are the disadvantages of performing an intercostal thoracostomy?
A
Poor access to other side of patient - use for unilateral procedure
25
What are the 4 indications for a lung lobectomy?
Lobe Torsion
Local Abscess
Severe lung trauma
Broncho-oesophageal fistula
26
After Stabilising and performing a clinical exam on a patient with thoracic trauma, what are your next steps?
Rx (Thorax AND Abdo)
| Thoracocentesis if pleural air/fluid
27
What are the 3 indications for a tube thoracostomy?
post-op management
Continues pneumothorax
Severe pleural effusion
28
What Tx is adequate for Rib fractures?
Analgesia
Rest
Oxygen
29
What causes paradoxical movement of a segment of the chest wall?
1+ ribs fractured in 2 planes (flail chest)
30
How should " flail chest" be treated?
Surgical Stabilisation
31
What may be caused by blunt abdominal trauma, leading to physical compression of the lungs and effusion?
Diaphragmatic rupture - abdominal organs enter pleural space
32
What method should be used for one-off drainage of the chest/to stabilise a patient with a pleural effusion?
Needle thoracocentesis
33
What needle should be used for needle thoracocentesis?
16-20G 1-1.5"
Small dog/cat: butterfly cannula
34
Which ICS should be used for needle thoracocentesis?
7 or 8th
35
Which area of the ICS should be avoided for thoracocentesis?
Cranial ICS - nerves and vessels here
36
HOw far into the chest should a needle be for thoracocentesis?
Just past rib
37
What tubes should you use for effusion cytology?
EDTA
38
If placing a tube thoracostomy, how big should the tube be?
internal diameter = half ICS width
39
What are the 4 aims of skin reconstruction?
Square skin edges
Accurate Apposition
No Overlap
Slight eversion of edges
40
How may you close a wound that is too large for closure?
Undermining and advancing skin - blunt or sharp
41
Should undermining be done beneath or above the panniculus (where present)?
Below
42
Name 5 tension relieving suture patterns
```
Vertical mattress
Horizontal mattress
Far-near-near-far
Far-Far-near-near
Simple interrupted (alternating width)
```
43
What are cutaneous pedicle grafts?
Portions of skin & S/C tissue moved from one area to another
44
Where are cutaneous pedicle grafts best used?
Head, Neck and Trunk
45
How large should a cutaneous pedicle graft be?
Larger than the wound you want to cover
46
When will the pedicle graft become revascularised?
7-10d
47
What are the 3 major reasons pedicle grafts fail?
Tension
Infection
Arterial/Venous Occlusion
48
What are 3 Tx you can use to save a dying pedicle graft?
Ointments
Debride and 2e closure
Hyperbaric Oxygen
49
When should surgical drains be removed?
Small vol serosanguineous fluid removed
50
What are the 4 surgical options for canine otitis interna which is completely refractory to medical Tx?
Lateral wall resection
Vertical canal ablation
TECA
Ventral Bulla Osteotomy
51
When are lateral wall resections indicated?
Small tumours of the lateral vertical wall
52
When is vertical canal ablation indicated?
VC neoplasia
VC ONLY stenosis
Trauma
53
What is another name for vertical canal ablation?
Tigari pull through
54
What is another name for lateral wall resection?
Zepps operation
55
Before surgery on the vertical canal, what should it be packed with?
Iodine Ointment
56
What should be done 1st in a lateral bulla osteotomy?
Curette bulla to remove all secretory epithelium
57
What should the bulla be rinsed with in a lateral bulla osteotomy?
Lactated Ringers
58
What should be given to a dog post ear surgery?
Opiates 24h
Meloxicam 7d
Remove sutures 14d
59
What are the major complications of TICA?
FN paralysis
Horners
Haemorrhage
Infection
60
Which procedure is performed in a cat with otitis interna that is completely refractory to medical Tx?
Ventral Bulla Osteotomy
61
Which ear surgery has the best outcomes?
TECA/VBO
62
What does the "pringle manouvre" do?
Temporary occlusion of hepatic blood flow for 15min
63
Which bacteria resides in the liver as a resident population?
clostridia
64
What should the abdomoen be lavaged with before closure?
1-3L warm STERILE saline
65
What AB should be given for general surgical prophylaxis?
Amoxiclav
66
Which AB should be given if you suspect anaerobic contamination during surgery?
Metronidazole
67
Which AB should be given to work in bile/liver?
Amoxicillin
| Cefazolin
68
In which 2 parts of the GI tract is tension an issue for surgery?
Oesophaggus
| Colon (subtotal colectomy)
69
Which grafts can be used to reinforce the oesophagus?
Omental
Pericardial
Diaphragmatic pedicle
Patch
70
What is the procedure of choice for oesophagectomy and enterectomy?
End-to-end anastomosis
71
How long does it take for the GIT to regain 75% of its normal sytrenth?
14d
72
Which suture material should be used in the GIT?
1.5-2m
Monofilament absorbable (PDS, monocryl)
73
What are the best patterns for GIT closure and what layer must be involved?
```
Submucosa
Simple (cont > interrupted)
```
74
What are the clinical signs of peritonitis?
```
Depression
Anorexia
C+
Abdo pain/ileus
Pyrexia and shock
```
75
How is peritonitis diagnosed?
Rx!
HB: neutrophilia (L), azotaemia, hypoglycaemia
Abdo paracentesis
76
What is seen on abdominal paracentesis during peritonitis?
Degen Neuts
Free/IC bacteria
Inc lactate/glucose cf serum
77
How is peritonitis treated?
IVFT
Copious lavage
BSABs
Identify cause and treat
78
What can be given to a dog with ileus to improve its condition?
IVFT
| Metaclopramide
79
What is your surgical approach to the oesophagus?
Ventral Cervical midline to level of 2nd rib
OR
R intercostal thoracotomy at level of lesion
80
How should the linea alba be closed?
Simple continuous in external sheath of Rectus muscle
81
how should incisions be made through the abdominal muscles?
Parallel to its fibres
82
What is a primary cleft palate?
Failure to fuse of lips and premaxilla
83
What is a secondary cleft palate?
Failure to fuse of hard and soft palates
84
How are benign oral tumours treated in the dog?
Wide local excision
85
How are benign oral tumours treated in the cat?
Wide local excision
| RT
86
what is the most common Dz of the canine salivary glands?
Salivary mucocele - sublingual esp affected
87
What are the clinical signs of a salivary mucocele?
Painless fluctuating swelling
Dysphagia/ptyalism
Inspiratory stridor
Cough/resp distress
88
How long should a patient receive NIL-by-mouth post oesophageal Surgery?
24-48h
5-7d soft food/water only
89
Where are the 3 places oesophageal FBs tend to lodge in small animals?
Thoracic Inlet
Heart Base
In front of cardia
90
What is the most common canine vascular ring abnormality?
Persistent Right Aortic Arch
91
What are the 3 indications for partial gastrectomy?
Necrosis
Neoplasia
Ulceration
92
What degree of rotation is most commonly seen in a GDV?
180
93
Where does the pylorus come to lie in a clockwise GDV?
L ventral abdomen
94
What are the 1 immediate priorities with a GDV case?
IVFT
| Decompression
95
What must be done surgically to ALL GDV cases to prevent recurrence?
Gastropexy
96
How can you decompress the stomach of a conscious dog?
Stomach tube w/lubrication and gag
Needle paracentesis
Temporary gastrotomy (with local)
97
How is needle paracentesis performed in a GDV?
14-16G 1.5-2" needle
98
What is a gastropexy?
Fix pylorus to R abdominal wall - 5 potential techniques
99
When is splenectomy indicated in a GDV?
Thrombi or torsion
100
What is common on an ECG 24h post GDV op?
VPCs
101
When should a GDV begin receiving food again?
24-48h post-op SMALL amount
102
Which 2 gastric mucosal protectants can be given following GDV Surgery?
Sucralfate
| Antacids
103
What should be given to patient vomiting after GDV surgery?
Metaclopramide
104
Which procedure can aid a gastric outflow obstruction?
Pyloroplasty
105
What are Billroth I and II procedures used to treat?
Resection of large amount of distal stomach and pylorus
106
IF you find a linear FB under the tongue, what should you do?
Cut it (if no peritonitis)
If peritonitis - surgery
107
How is a rectal prolapse treated?
Reduce
| Surgery: purse string 1-5d, colopexy or resection.
108
What should be given as part of post-op care for a rectal prolapse?
Stool softeners
Low bulk diet
Sedation
109
What are the clinical signs of perianal fistulas?
Tenesmus
Pruritis
Fistulae
110
What is the best Tx for perianal fistulas?
MEDICAL - ciclosporine
111
What is the % functional reserve of the liver?
70-80%
112
How should peripheral liver lesions be biopsied?
Guillotine method
113
How should central liver lesions be biopsied?
Trucut or punch biopsy
114
What are the 3 indications for a partial liver lobectomy?
Neoplasia
Abscess
Trauma
115
How is a PSS diagnosed?
Clinical signs +
Rx: small liver
US: direct visualisation
Scintigraphy
116
What are 2 methods to gradually close a PSS?
Ameroid constrictor placement
Cellophane banding
117
What are the signs of portal hypertension?
Ascites and pain
bloody D+
Endotoxic shock
Death
118
Which are the 2 procedures that can be performed to divert bile flow?
Cholecystoduodenostomy (if can be apposed without tension
| Cholecystojejunostomy
119
What are the 3 types of panceratic biopsy?
Trucut
FNA
shaving affected tissue w/scalpel
120
How is a partial pancreatectomy formed on single peripheral lesions?
Simple Encircling ligature
121
How is a partial pancreatectomy formed on central or peripheral lesions?
Blunt dissect between lobules
Individually ligate ducts and vessels for tissue being excised
122
what are 2 causes of umbilical hernias?
Excessive traction on umbilical cord
| Severing cord too short
123
When should an umbilical hernia be diagnosed?
1st vaccine
124
Which hernias are hard to diagnose, and therefore need Rx to define?
Inguinal Hernias
125
Where should the surgical incision be made for a simple inguinal hernia repair?
Lateral aspect of swelling - blunt dissect to expose hernial sac
126
Where should the surgical incision be made for a complicated inguinal hernia repair?
Caudal midline coeliotomy
127
What are the 3 most common complications post hernia repair?
Pain
Haematoma
Seroma
128
Via which anatomical "ring" does a scrotal hernia pass?
Vaginal Ring
129
Which sutures can be used to reduce the size of a hernial sac?
Mattress
130
Which animals are most at risk for a perineal hernia?
Old Male Entire Dogs
131
Where are perineal hernias found, relative to the anus?
Ventrolaterally
132
What is normally contained in a perineal hernia?
Prostate
Bladder
Omentum
SI
133
How can patients with perineal hernias be stabilised before surgery?
Decompress bladder
| Correct electrolytes - IVFT, Catheter
134
Which 2 faecal softeners are given as part of long term post-op care following perianal hernia repair?
Isogel
| Lactulose
135
What are the major signs of a traumatic abdominal hernia?
Asymmetry of abdomen
Bulging mass under skin
Pain and bruising
136
How should acute and chronic diaphragmatic hernias be treated?
Acute: stabilise then surgery
Chronic: Surgery
137
What are the signs of acute incisional hernia?
Oedema/swelling
Serosanguineous disch
Evisceration
138
When should debridement of the abdominal wall take place in an incisional hernia?
ONLY if edges are devitalised
