Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CVSOH1 Clinical Cardiorespiratory > SA URT Surgery > Flashcards

SA URT Surgery Flashcards

1
Q

BOAS Signalment and Hx.

A

Breeds.
Respiratory noise.
GI signs.
Management.
Exacerbating factors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

GI abnormalities.

A

Depends on site.
- e.g. oesophagitis, megaoesophagus.
- e.g. gastritis, displacement/mobile stomach.
- e.g. intestinal issues secondary to upper GI issues.
Signs:
- reflux.
- regurgitation.
- vomiting.
- others e.g. eyes and skin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Respiratory signs.

A

Effort.
Stertor.
Reverse sneezing.
Stridor (laryngeal).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Examination of respiratory anatomical abnormalities under GA.

A

Tonsils - enlarged, everted.
Soft palate - over-elongated, thickened.
Laryngeal saccules - everted if higher grade BOAS.
Aberrant turbinates - w/ advanced imaging.
Trachea - imaging – hypoplastic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Examining brachycephalics.

A

Visual exam conscious or under GA.
- nose (stenosis - can be dynamic).
Functional grading.
Whole Body Barometric Plethysmography (objective measure of BOAS).
GI.
Check eyes.
Check skin all over body.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Other non-surgical components of BOAS.

A

Nasopharyngeal hyperplasia.
Macroglossia - enlarged tongue.
Bronchial collapse.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
  1. First line surgical options for BOAS.
  2. Salvage procedures for BOAS.
A
  1. Nares resection / rhinoplasty / alar fold excision.
    Tonsillectomy.
    Soft palate resection (Staphylectomy).
    Sacculectomy.
  2. Laryngoplasty.
    Tracheostomy.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hiatal hernia and GORD.

A

Gastro-oesophageal reflux disease.
High force inspiratory action.
- abdominal force used too, leading to laxity of the diaphragm and intermittent entry of the stomach through the diaphragm into the thorax (hiatal hernia).
Inflammatory.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Basic pre-op preparation considerations.

A

Drugs - short-acting, appropriate use of steroids.
Equipment ready for if things go wrong.
Induction method.
Experienced team.
24 hour nursing care:
- experience w/ tracheostomies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Post-op BOAS.

A

Close monitoring on recovery.
Leave in ET tube a little longer?
Hospitalise to monitor.
Try to discharge same day if poss.
- reduce stress.
Feeding:
- balls of wet food to hand feed.
- not liquids – nature of surgery causes risk of aspiration.
Consider and prep for post-op complications.
Prognosis good?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  1. Laryngeal collapse signalment.
  2. Clinical signs of laryngeal collapse.
  3. Dx laryngeal collapse.
A
  1. ‘End-stage’ BOAS.
    Primary condition in English Bull Terriers.
  2. Severe dyspnoea.
    Syncope.
    Severe respiratory noise.
  3. Laryngoscopy.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Staging laryngeal collapse.

A

1 = saccule eversion.
2 = partial cuneiform collapse.
3 = complete collapse.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Laryngeal collapse Tx options.

A

BOAS surgery.
Laryngoplasty.
Permanent tracheostomy.
Partial arytenoidectomy (laser ablation).
Cuneiformectomy.
*prevention better than treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  1. When considering Staphylectomy, what is the recommended anatomical landmark for resection?
A
  1. Caudal tonsillar crypt.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Common reasons for laryngeal paralysis.

A

Degenerative.
Idiopathic.
Immune-mediated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  1. Laryngeal paralysis signalment.
  2. Hx.
A
  1. Congenital / young dogs <1yo (less common).
    Geriatric dogs.
  2. Slow onset.
    Gradual progression.
15
Q

Presentations of laryngeal paralysis.

A

Normal at rest.
Increased respiratory effort.
Increased respiratory noises.
Exercise intolerance.
Coughing, gagging.
Dysphonia.
Dysphagia.
Heat stroke.
Aspiration pneumonia.
Cyanosis and collapse.

16
Q

Laryngeal paralysis Dx.

A

Radiography:
- cervical.
- thoracic.
- allows assessment of patient’s overall fitness of surgery – megaoesophagus, aspiration pneumonia etc.
- findings can determine Px and influence choice to perform surgery or not.
Laryngoscopy:
- light GA.
- well-positioned laryngoscope.
- assistant to inform when breathing in and out from chest movements.
- give Doxapram by injection to encourage larynx to move.

17
Q

Tx of laryngeal paralysis.

A

Mild cases:
- drugs – symptomatic (anti-inflammatories etc.)
- home management e.g. harnesses, not collars, no swimming, no going out into the heat, feeding.
Severe and collapsed cases:
- Stabilise.
- Sx.
– Unilateral arytenoid lateralisation (exam) / laryngoplasty / ‘Tie Back’.

18
Q
  1. Complications of unilateral arytenoid lateralisation.
  2. Short-term Px.
  3. Long-term Px.
A
  1. Snap suture by barking.
    Haemorrhage.
    Swelling (tracheostomy may be indicated).
    Always life-long risk of aspiration.
  2. V good - 90-95% improvement QoL.
  3. Depends on polyneuropathy but if standard degenerative idiopathic paralysis, good.
19
Q
  1. Tracheal collapse signalment.
  2. Hx.
  3. Types of causes of tracheal collapse.
A
  1. Any age.
    Small breed dogs.
    +/- overweight.
  2. Chronic, dry cogh.
    - ‘goose-honk’.
    Stertor.
    Triggered by excitement.
    Can be progressive.
  3. Degenerative/developmental.
    Infectious/inflammatory.
    - a vicious cycle.
    - primary aspect = cartilage degeneration.
20
Q

Dx for tracheal collapse.

A

Fluoroscopy.
Radiography.
Endoscopy.

21
Q
  1. Dx method for tracheal collapse grading.
A
  1. Tracheoscopy.
  2. I = 25% loss of lumen.
    II = 50% loss of lumen.
    III = 75% loss of lumen.
    IV = total loss of lumen.
22
Q

Tx for mild cases of tracheal collapse.

A

Drugs - symptomatically e.g. anti-inflammatories.
Home management - harness, not collar, avoid over-excitement etc.
Majority of cases respond well enough to Tx that don’t need to progress any further.

23
Q
  1. Tracheal collapse case selection for Sx.
  2. Options for surgical technique.
A
  1. Grade II or higher.
    Younger dogs.
  2. Extra-luminal.
    Intra-luminal.
24
Q

Extra luminal prosthesis technique.

A

Cervical region only!
Invasive.
PVC Home-made (syringe) or manufactured-rings or spirals.
Placed surgically around the trachea by suturing to the tracheal rings.
High chance of complications.
Mortality not v high.

25
Q
  1. Potential complications of extraluminal prosthesis.
  2. Px.
A
    • vascular damage.
      - tracheal ring migration.
      - coughing / dyspnoea.
      - tracheal trauma / perforation / necrosis.
      - laryngeal paralysis.
  2. Good outcomes reported in 75-89% cases (case selection).
26
Q

Intraluminal stenting technique.

A

Less invasive.
All locations of collapse.
Fluoroscopy.
Expensive equipment.
Deploy stent into trachea.

27
Q
  1. Complications of intraluminal stenting.
  2. Px.
A
  1. Migration of the stent.
    Fracture of the stent.
    Stent = FB = coughing.
    Over-granulation.
  2. Depends on surgeon expertise, complications.
28
Q
  1. What is a temporary tracheostomy?
  2. Indications for temporary tracheostomy?
  3. Diameter of tube for tracheostomy?
A
  1. Creation of a temporary stoma in the trachea by placement of a tracheostomy tube.
  2. Intraluminal obstruction.
    Extraluminal obstruction e.g. abscess.
  3. Not > 3/4 tracheal diameter.
29
Q

Temporary tracheostomy technique.

A

Dorsal recumbency.
Sandbag under neck.
Secure FLs.
Ventral neck clip and prep.
Identify larynx and cricoid cartilage.
10cm midline incision.
Divide sternohyoid muscles using Gelpis to expose trachea.
Plan where to incise into trachea.
Place stay sutures around cranial and caudal tracheal rings.
Small transverse incision through annular ligament.
Extend incision to be no more than 50% of the circumference.
Insert the tube and secure it.
Close subcut and skin from each end of the incision.

30
Q

Temporary tracheostomy aftercare.

A

Asepsis.
Hydration.
Drugs.
Stoma.
Nursing care.

31
Q
  1. Tube care and removal.
  2. Things to look for in the tracheostomy patient.
A
  1. Nursing.
    Cannula care every 2-4h.
    Cuff care (re-adjustments).
    Coupage every 4-6h.
    Suction every 4-6h or as required.
    Stoma cleaning every 4-6h.
    Tube changes.
    Put thumb over tube before removal to assess ability of patient to be w/o it.
  2. Coughing.
    Discharge.
    Discomfort.
    Distress.
    Dyspnoea.
32
Q

Temporary tracheostomy complications.

A

Intra-operative – haemorrhage.
Post-op – inappropriate removal by patient, blockages, infections, aspiration pneumonia.

33
Q
  1. What is a permanent tracheostomy?
  2. Indications for permanent tracheostomy?
A
  1. Creation of a permanent stoma in the trachea by removing a section of tracheal rings ventrally and suturing tracheal mucosa to skin.
  2. End stage intraluminal obstruction.
    End stage extraluminal obstruction.
    Owner comms.
34
Q

Permanent tracheostomy approach.

A

Ventral approach.
Muscle sling - strap muscles placed dorsal to trachea to push it ventrally, closer to the skin.
Resection of part of ventral trachea.
Elevate tracheal mucosa.
Suture the mucosa to the skin.

CVSOH1 Clinical Cardiorespiratory (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions