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Small Animal Surgery > SaSx FINAL - old material > Flashcards

SaSx FINAL - old material Flashcards

1
Q

4 classifications of operative wounds

A

Clean - created in Sx, no infection
Clean-contaminated - Sx created but hollow viscus or organ w/ bacteria open, no contents spilled, minor break in technique
Contaminated - Sx but gross spillage in hollow viscus organ, minor break in technique
Dirty - implies infection

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2
Q

Risk of infection ______ every hour

A

doubles

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3
Q

MC source of surgical wound infection

A

patients endogenous flora, skin and GIT

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4
Q

Prophylactic antibiotic for wound contamination

A

Cefazolin IV, 30-60 min prior to incision, q90-120 mins intraop

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5
Q

Therapeutic antibiotics for wound contamination

A

continue 2-3d after resolution of infection

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6
Q

4 stages of wound healing

A
  1. Inflammation
  2. Debridement
  3. Repair
  4. Maturation
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7
Q

Inflammatory phase of wound healing

A

0-5 days
initiated by tissue damage, hemorrhage = 1st response to injury
vasoconstriction - fibrin clot - vasodilation + inc vascular permeability - leukocyte response (macrophages), platelets
WBC leaking from vessels into wound initiates debridement phase

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8
Q

Debridement phase of wound healing

A

2-5 days
neutrophils and monocytes initiate debridement phase
monocytes = primary cells for wound healing
macrophages - secrete collagenases to remove necrotic tissue, secrete chemotactic + growth factors, recruit mesenchymal cells

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9
Q

Repair phase of wound healing

A

3-5 days to 2-4 weeks
macrophages stimulate fibroblast and DNA proliferation
acidic + oxygen rich environment
Granulation tissue - barrier to infection, source of special fibroblasts, surface for epithelial migration
Epithelialization + wound contraction

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10
Q

Maturation/Remodelling phase of wound healing

A

strength of wound optimized d/t changes in the scar, collagen I increases, III decreases
most rapid gain in strength 7-14d post injury

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11
Q

Golden period of wounds

A

within 6 hours - insufficient microbial replication to cause infection, can usually manage with primary closure

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12
Q

T/F: alcohol is ideal to flush open wounds

A

false, damages open tissue, never use

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13
Q

Preferred lavage

A

sterile isotonic saline or LRS

7-8psi (1L saline bag w/ pressure cuff at 300mmHg)

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14
Q

Number one choice for empirical antimicrobial selection to treat a contaminated wound

A

Clavulanic acid - potentiated amoxicillin (clavamox)

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15
Q

2 antibiotics that you should take a culture before using

A

fluoroquinolone and aminoglycosides

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16
Q

Compare TAB to silver sulfadiazine

A

TAB (Triple Antibiotic Ointment)
broad spectrum, prevention, not effective vs Pseudomonas
can retard wound contraction

Silver Sulfadiazine
DOC for wounds, can tx most gram + and - including Pseudomonas
combine w/ aloe vera to reverse wound retardant effects

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17
Q

Layered vs En Bloc debridement

A

Layered - MC, excise contaminated SQ (careful in cats can delay wound healing), remove isthmus connections, excise in layers

En Bloc - entire wound excised then closed primarily

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18
Q 
Debridement mechanism that is highly selective for devitalized tissue only:
A) Layered
B) En Bloc
C) Autolytic
D) Biosurgical
A

C) autolytic

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19
Q

A dog comes in with an infected wound. The owner said they tried to bandage it but it started smelling like tortillas so they came to the vet. You pull off the bandage and notice blue green pigment on the bandage. What is at the top of your differential list?

A

Pseudomonas. TAB wont work, will need silver sulfadiazine.

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20
Q

Penrose Drain

A

passive
fluid travels along drain not inside, don’t fenestrate, MC drain in vet med
remove 5-7d later or risk ascending infection.
daily bandage changes, don’t rely on owner
warm compress to promote drainage, not cold compression
don’t do double exit passive drain
make sure adequately clipped + prepped

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21
Q

Jackson Pratt drain

A

active
fluid travels inside fenestrated tubing, exits dorsal to wound
strict aseptic technique for placement
aggressive en bloc debridement before closure
remove when fluid: 5ml/kg/d or 0.2ml/kg/h

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22
Q

Modified butterfly catheter

A

small animals or wounds in challenging areas

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23
Q 
Most common used bandage in vet med
A) adherent
B) non-adherent
C) Occlusive
D) Semi-occlusive
A

D - semi-occlusive, allows air to penetrate + exudate to escape from wound surface

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24
Q

Can you use a wet to dry bandage on granulation tissue?

A

No! Will disrupt healing tissue when removed

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25
Q

Match the moisture retentive dressing (MRD) with the exudate level.

Dressings: calcium alginate, hydrocolloid, hydrogel, polyurethane foam

Exudate feel: high, moderate, moderately high, low to minimal

A

Calcium alginate - high
Moderately high - polyurethane foam
Moderate - hydrocolloid
Low - hydrogel

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26
Q

T/F: all bite wounds are contaminated

A

true

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27
Q

4 depths of burns

A

1) superficial - 1st degree, outermost epidermis, moist, painful
2) Partial thickness - 2nd degree, epidermis + dermis, oedematous, painful, marked inflammation
3) full thickness - 3rd degree, epidermis + dermis, dark brown, non-painful, eschar
4) extension beyond dermis - 4th degree, needs Sx

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28
Q

Who described gentle tissue handling?

A

Halsted

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29
Q

4 types of pivotal skin flaps

A

1) rotation
2) transposition
3) interpolation
4) distant

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30
Q

Axial pattern flaps

A

rely on direct cutaneous artery + vein at base of flap

  • caudal superficial epigastric
  • thoracodorsal

also, cranial superficial epigastric, vehicular, deep circumflex iliac

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31
Q

A flap composed of skin with muscle, bone or cartilage

A

Composite flap

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32
Q

Skin grafts

A

Phase I - 0-72h - contraction of fibrin strands, graft pulled closer to bed
Phase II - 72h-10d - fibrin to fibroblasts, leukocytes, phagocytes (fibrous adhesion)

1) plasmatic imbibition
2) inosculation
3) revascularization

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33
Q

Nephrolithiasis

A

Ca oxalate + struvite
PE: abdominal discomfort, hydronephrosis
Dx: rads, US (echogenicity to see which stones) check contralateral renal function prior to tx
Tx:
- Nephrolithotomy via ventral midline celiotomy, clamp time = 20 min, sagittal incision, remove stone, culture renal pelvis, flush, catheterize to ensure ureter potency. Close futureless (hold 5 mins for fibrin seal), horizontal mattress. nephropexy to minimize entrapment/torsion
- Pyelolithotomy - incise renal pelvis instead of parenchyma (if dilated or if thats where calculi is) - no occlusion needed, dec hemorrhage risk, no nephron damage
Post op - diuresis, monitor, post op rads

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34
Q

Renal Trauma

A

CS: hematuria
Dx: contrast excretory urography - see contrast media leak into abdomen (uroabdomen)
Tx:
- minor: conservative
- moderate: Sx repair + omental patching
- severe: nephroureterectomy - ensure other kidney functioning

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35
Q

Hydronephrosis

A

dilation of renal pelvis + atrophy of renal parenchyma
death if bilateral
Dx: US
Tx: <1w obstruction = resolution, >4w = may regain 25%, nephroureterectmoy

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36
Q

Pyelonephritis

A

predisposed by damaged parenchyma

Tx: nephroureterectomy

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37
Q

Giant Kidney worm

A

Dioctophyma renale, fish or frog consumption

Tx: nephrotomy if early enough to cut out worm, otherwise nephroureterectomy

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38
Q

Renal neoplasia

A

mostly malignant, MC benign = renal adenoma
renal cell carcinoma - male dogs, older, MST 9m. Tx: nephroureterectomy + chemo
Renal lymphoma - MC cats, chemo
Embryonic nephroblastoma - congenital, young (4m), MST 6m - very aggressive

Dx: US best
Tx: exploratory laparotomy, check for metastatic lesions,, preferred Bx method, unilateral nephroureterectomy

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39
Q

Renal Biopsy

A

high risk of hemorrhage, only do if worth the risk
dont do if coagulopathies, hypertension, chronic hydronephrosis
sample CORTEX not medulla
collect at least 2 samples
US guided = preferred

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40
Q

Renal transplants

A

rare in dogs, more common in geriatric cats w/ chronic renal dz or failure, expensive
immunosuppression required
owner must adopt + take care of donor

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41
Q

Ectopic ureter

A

extramural or intramural
female young husky
CS: incotinence (difficulty potty training)
Dx: excretory urography, CT, US - ureter depositing urine in wrong place
Tx: neoureterocystostomy - transplant distal ureter to new place in bladder
- intramural (MC) - perform cystotomy + create new stoma @ level of trigone
- extramural - ligate + transect then place through cystotomy incision
difficult Sx but good Px

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42
Q

Ureterocele

A

persistent membrane in embryonic development over ureteral orifice
Dx: IV urography - cobra head sign
Tx: intravesicular - ureterocelectomy (remove ureterocele), ectopic - neoureterocystostomy w/ ureterocelectomy

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43
Q

Ureteral Trauma

A 
#1 cause iatrogenic (OHE Sx)
Dx: IV urography - localizes lesion
Tx: nephroureterectomy (make sure other kidney functional
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44
Q

Ureteroureterostomy

A

tx damage to more proximal ureter, resection + anastomosis = difficult

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45
Q

Urinary diversion

A

can’t have urine going through damaged ureter
Ureteral stent - pig tail catheter proximal to anastomosis through bladder to urethra, remove in 5-7d
Nephrostomy tube - divert urine, fenestrated tube from kidney to renal pelvis –> outside patient

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46
Q

Loss of ureter length technique that involves anastomosis of one ureter to the other

A

Transureteroureterostomy

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47
Q

Urolithiasis

A

MC indication for ureteral Sx, cats
dx: rads - most radiopaque CaOx, US - dilation of ureter/pelvis
Tx: cystotomy + retrograde flushing + removal via pyelithotomy

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48
Q

Persistent Urachus

A

urine dribbling from umbilicus, patent urachal canal
omphalitis (umbilical inflammation)
Tx: Sx removal of urachal tube, ventral midline incision

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49
Q

Vesicouracheal diverticulum

A

MC urachal abnormality in dog
external opening closed, bladder attachment patent, predisposes patient to uroliths + UTI
Dx: positive contrast cystography
Tx: partial cystectomy + diverticulectomy

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50
Q

Bladder rupture

A

trauma (HBC), iatrogenic (catheterization)
Dx: positive contrast urethrocystogram is best - see leakage of contrast into abdomen. US - free fluid, rads - abdominal fluid + absence of bladder. Abdominocentesis - urea in fluid = serum urea, Creat in fluid > serum creat

Tx: stabilize, then urinary diversion - tube cystotomy w/ cystopexy –> then Sx
VD approach to exploratory laparotomy, check for concurrent injury, close bladder wall + omentalize or serosal patch, place catheter in urethra

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51
Q

Cystic calculi

A

common, bladder MC, struvite + Ca oxalate
Dx: rads - can see struvite + CaOx (cystine + urate = radiolucent), double contrast cystography - can see urate (Dalmatians!)
Tx: non surgical - hydropropulsion, transurethral cystoscopy, diet (struvite only), electrohydraulic lithotripsy
Sx: cystotomy - MC sx of bladder, ventral approach preferred, don’t cut lateral ligaments, close w/ simple continuous + inverting, can also do one or two layer inverting pattern, leak test, post op rads

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52
Q

Polypoid cystitis

A

uncommon, middle aged female dogs, resembles TCC but non-neoplastic, hematuria when polyps rupture

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53
Q

Bladder tumors

A

Dog: uncommon, TCC MC, 97% malignant, old Scottish terriers, trigone
Cat: rare, bladder 2nd MC site for UT tumor (renal lymphoma #1), TCC MC bladder tumor, middle aged males, apex

Transitional cell carcinoma
obesity predisposes
Dx: rads, US, transurethral Bx, bladder tumor antigen test - AVOID FNA (readily exfoliates = tumor seeding)
Tx: partial cystectomy w/ >1cm borders, chemo, poor Px

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54
Q

hypospadiasis

A

MC developmental abnormality of male genitalia, incomplete formation of penile urethra, Boston terriers

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55
Q

Urethral prolapse

A

protrusion of urethral mucosa through orifice, young male brachycephalics
PE: bleeding from prepuce, licking, red-purple mass
Tx: mild: reduce + purse string or urethropexy
severe - resection + anastomosis

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56
Q

urethral trauma

A

Dx: positive contrast urethrogram
Tx: urinary diversion w/ urethral catheter or cystotomy tube if incomplete or small laceration, complete rupture –> anastomosis or repair w/ urinary diversion

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57
Q

Urethral obstruction

A

common in dogs + cats, male > females

dog: ischial arch + caudal to os penis, stones
cat: distal 1/3 urethra, mucus plugs, crystals, stones

Dx: rads
Tx: cystotomy after hydropulsion, urethrotomy if unsuccessful (temporary opening in urethra)
Urethrostomy = permanent opening of urethra at new site, dogs = scrotal, cats = perineal

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58
Q

Vestibulovaginal stenosis

A

CS: vaginitis, UTI, painful breeding, hydrocolpos
Dx: aseptic exploration, contract rads, <0.2 = severe stenosis. Vaginoscopy = best, direct visualization

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59
Q

Episiotomy

A

incision of vulvular orifice to access vestibule + vagina

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60
Q

Recessed vagina

A

conformational abnormality, vulva engulfed by skin
medium/large overweight dogs, early OHE not a cause
CS: skin fold dermatitis, vaginitis, recurrent UTI incontinence
Tx: cleansing, weight loss, episioplasty

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61
Q

Vaginal hyperplasia

A

inc estrogen levels during proestrus/estrus
<2y large breeds, one of first 3 cycles, mucosa protrudes from vulva, tissue from ventral vaginal floor
Tx: conservative management, E collar, resolves at end of tissue, OHE to prevent

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62
Q

Vaginal prolapse

A

donut shaped appearance

Tx: manual reduction, hyperosmotics, OHE

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63
Q

Ovarian Remnant syndrome

A

recurrence of estrus after OHE, dogs> cats
CS: vulvular enlargement,t attraction to males, vaginal cytology mimics heat cycle
Tx: Sx, usually at caudal pole of kidney, avoid ureter

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64
Q

Dystocia

A

can’t expel fetus, 75% maternal cause
primary uterine inertia - parturition fails, birth canal/fetus = normal, no neonates born. CS = prolonged gestation
secondary - uterine fatigue

tx: primary w/ oxytocin, c section if doesnt work or secodnary

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65
Q

C sections

A

incision midway b/wn xyphoid + umbilicus to cranial pubis, exteriorize uterus, pack w/ lap sponges, perform hysterotomy
clamp umbilical cord 2-6cm
if hemorrhage or involute not started, oxytocin IM
remove puppies <60s if en bloc resection

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66
Q

Testicular torsion

A

rare, abdominal, inguinal or scrotal
CS: anorexia, lethargy, shock, death
Dx: US + doppler, flow absent

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67
Q

Paraphimosis

A

inability to retract penis into prepuce, congenital or acquired, can lead to necrosis
Tx: lube, hyperosmolar agents, preputiotomy, preputial advancement
recurrent - phallopexy, amputate penis if necrotic

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68
Q

Phimosis

A

inability to protrude penis

Tx: enlarge preputial orifiice

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69
Q

Prostatic cysts

A

accumulation glandular secretions in prostate of older intact males
CS: related to caudal abdominal ass, asymptomatic, distension, incontinence + dysuria
Dx: palpation, rads, US, FNA
Tx: if small, Sx + castration, if large, resection, drainage, omentalization, castration

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70
Q

Benign prostatic hypertrophy

A

aging, inc sensitivity to testosterone receptors
CS: asymptomatic, dyschezia, ribbon feces
rectal: symmetrical, large, no pain
Tx: castration

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71
Q

Prostatitis

A

middle aged-older, ascends up urethra, E. coli MC
CS: dyschezia, painful urination, purulent discharge
pathognomonic: capsular tissue surrounding fluid, FNA confirms
Tx: mild - castrate, enrofloxacin, TMS; severe - mild + supportive care + drainage

72
Q

Prostatic neoplasia

A

castration has no effect
CS: dysuria, hematuria, straining to defecate, ribbon like feces, lameness (metastasis), large, asymmetrical prostate
Dx: rads, US, FNA
Tx: palliative

73
Q

MC approach to thoracic surgery?

A

lateral thoracotomy

74
Q

Lung lobe torsion

A

rotation of lungs on hilus, venous + lymphatic congestion, consolidation, pleural effusion
deep chested dogs + pugs
CS: acute onset, dyspnea, tachycardia, exercise intolerance, hemoptysis
Dx: pale MM, dec lung sounds ventrally, thoracocentesis - serosanguinous or chylous
Tx: stabilize, DONT UNTWIST, lung lobectomy, chest tube for 3-5d
Px: good for pugs, not for other breeds
monitor bc secondary torsion can occur

75
Q

Idiopathic chylothorax

A

dx: intestinal lymphangiography - oil/cream PO, methylene blue into ileocecal node or H2O sol contrast into catheterized lymphatic
Tx: Sx must include thoracic duct en bloc ligation
chest tube post op

76
Q

Diaphragmatic hernia

A

abdominal organs in thorax, caused by trauma
CS: acute - resp distress, shock. chronic - resp + Gi signs
Dx: US
Tx: stabilize, Sx. stomach herniated = emergency. diaphragmatic herniorraphy - ventral midline abdominal approach, put organs where they belong.

77
Q

Peritoneopericardial diaphragmatic hernia

A

congenital communication b/wn peritoneal cavity + pericardium
CS: resp + GI signs, cardiac + neuro
weimaraners, cocker spaniels, DLH, himalayans
Dx: rads or US, enlarged cardiac silhouette, dorsal deviation trachea
Sx: abs, ventral midline abdominal approach, close defect w/ simple continuous

78
Q

Penetrating chest wound

A

dont remove object penetrating
stabilize, cover wound w/ sterile dressing until stable + can Sx repair
thoracocentesis/thoracotomy as needed to tx pneumothorax

79
Q

Flail chest

A

multiple segmental rib fractures, moves paradoxically w/ chest wall during respiration
Tx: external splint

80
Q

Pectus excavatum

A

congenital deformity, inward concavity of sternum

Tx: external splint

81
Q

Laryngeal paralysis

A

LARPAR
damaged vagus n. and branches –> failure arytenoids to abduct on inspiration
congenital - bouviers (association w/ cranial tibial m paralysis) or rotties (progressive generalized dz)
acquired - labs - idiopathic polyneuropathy (MC cause)
Dx: 3 view thoracic rads, laryngeal exam
Tx: medical (mild CS) - weight loss, exercise restriction, environmental changes
- Sx = recommended Tx - unilateral arytenoid lateralization to widen rima glottis
complication: aspiration pneumonia esp if were to do bilateral Sx

82
Q

whistling noise due to decreased airflow through larynx

A

stridor

83
Q

Tracheal collapse

A

Sx: external prosthetic tracheal rings for cervical trachea only
intraluminal stent - fluoroscopically or endoscopically placed, cervical + thoracic use, complications (stent fracture or migration)
no tx for collapsed bronchi

84
Q

Tracheostomy

A

salvage for untreatable upper airway dz
stoma dec in size 40-50% in most animals so make it big
excessive secretions for weeks post op, no swimming, clip hair as needed, protect from foreign bodies
cats can get mucus plugs –> acute death, Px good for dogs

85
Q

Tracheal trauma

A

rupture or necrosis secondary to ET tube, foreign bodies
CS: SQ emphysema, progression to mediastinal emphysema or pneumothorax if severe
Tx: minor - medical management (cage rest, O2, sedatives, thoracocentesis). persistent or worsening dyspnea = Sx needed - tracheal resection + anastomosis, split cartilage technique = least stenosis post op
complications: SQ emphysema, stricture

86
Q

Diagnosing a nasal disease

A

CR then rhinos copy + nasopharyngoscopy

87
Q

Rhinotomy

A

dorsal - access nasal cavity + sinus

ventral - access ventral cavity + choanae

88
Q

artery you need to avoid during nasal surgery (risk major hemorrhage)

A

major palatine aa.

89
Q

Brachycephalic airway syndrome components + signalment

A

stenotic nares, elongated soft palate, everted laryngeal saccule (stage 1 collapse) +/- hypo plastic trachea
elongated soft palate - MC component of BAS
laryngeal collapse - stage 1: everted saccule, stage 2: cuneiform cartilage collapse, stage 3: corniculate cartilage collapse
GI comorbidities
2-3y, male > female

90
Q

Brachycephalic airway syndrome treatment

A

Staphylectomy - soft palate resection - over shortening = nasal reflux
Stenotic nares - wedge resection, alar wing amputation
Laryngeal collapse - stage 2: partial arytenoidectomy + ventriculochordectomy, stage 3: permanent tracheostomy
Post op - leave ET in, give O2, analgesia, NPO 24h
Comlpications - aspiration pneumonia
will still snore

91
Q

3 types of incisional biopsies

A

TRU CUT - any accessible mass, sedation or local anesthetic, maintains structural integrity of tissue
PUNCH - >6mm, not for hypodermic masses (undetected hemorrhage)
WEDGE - ulcerated or necrotic tumors or deeply located masses, entire Bx tract removed at later dte

92
Q

Classification of surgical margins for tumors

A

Enneking

intralesional, marginal, wide, radical

93
Q

2 methods of surgical margins for mast cell tumors

A

Fulcher - circle tumor then measure 1, 2 and 3cm, gen rule = 3cm + 2 fascial plane deep

Pratschke - Modified proportional - widest diameter of tumor = lateral margin unless >4cm use 4cm, 1 fascial plane deep

94
Q

Processing/Preparation of tumor for submisson

A

ink all cut surfaces but not skin prior to bread loafing + formalin
Davidson dye = yellow or black
tissue: formalin = 1:10

95
Q

holding layer of the stomach

A

submucosa

96
Q

closure of the stomach

A

2 layer closure
traditional - double inverting Cushing (serosa, muscularis, submucosa) oversewn w/ lembert (serosa, muscularis)
Alternate - simple continuous (mucosa) oversewn w/ Cushing or lembert (serosa, muscularis, submucosa)

97
Q

Assessment of gastric viability (subjective)

A

gastric wall thickening - slip, serosal surface colour, peristalsis, capillary perfusion,

98
Q

Gastric foreign bodies

A

MC indication for gastrotomy, young > old, pica predisposed by Fe def
CS: vomit, lethargy, abdominal pain
Dx: labs, rads, endoscopy
Tx: fluids, monitor (serial rads), induce vomiting (apomorphine in dogs, xylazine in cats), endoscopy. Gastrotomy, lavage w/ warm sterile saline, post op - give food/water w/in 12h, fluids

99
Q

Benign gastric outflow obstruction

A

congenital pyloric stenosis
- hypertrophy of circular mm, brachycephalics, CS at weaning
CS: vomiting
Dx: rads, contrast rads - beak or apple core
Tx: pyloromyotomy - Fredet Ramstedt procedure (only for congenital stenosis), incision through mucosa + muscularis only
Transverse pyloroplasty - Heineke-Mikulicz procedure, full thickness incision, suture transversely

100
Q

Phycomycosis

A

severe inflammation, infiltrative lesion, intense fibrotic rxn. transmural thickening
gulf coast states
CS: vomiting, diarrhea, palpable mass, weight loss
Dx: ELISA for antibodies, Histopath - eosinophilic pyogranulomatous infection
Tx: wide Sx excision, medical Tx ineffective
Px: guarded to poor

101
Q

Chronic Hypertrophic Pyloric Gastropathy

A

acquired mucosal + muscular hypertrophy, small breeds, males, older
unknown cause, maybe inc gastrin secretion, acute stress, inflammatory dz, trauma
CS: intermittent vomiting, looks like congenital pyloric stenosis, look at signalment
Dx: endoscopy - mucosal hypertrophy, US - looks at thickening, muscularis <4mm, pyloric wall <9mm
Grade 1 - muscular hypertrophy
Grade 2 - mucosal hyperplasia w/ glandular cyst dilation
Grade 3 - both
Tx: Y-U Advancement pyloroplasty or Bilroth I (gastroduodenostomy)
Px: good

102
Q

Y-U advancement pyloroplasty

A

single pedicle advancement from antrum across pylorus, inc diameter of pylorus, access to excise hypertrophied mucosa
potential necrosis of flap tip –> make sure a U not a V

103
Q

Bilroth I (Gastroduodenostomy)

A

remove portion of pylorus + put stomach + duodenum back together, removes pyloric sphincter
can remove all dz tissue, technically more demanding, inc risk for dumping syndrome + reflex gastritis

104
Q

Billroth II (Gastroenterostomy)

A

partial gastrectomy then gastroenterostomy
for extensive gastric resection making gastroduodenostomy impossible
Complications
- alkaline gastritis
- blind loop syndrome
- marginal ulceration of jejunal mucosa

105
Q

drug of choice as prophylactic antibiotic in intestinal surgery

A

Cefazolin

106
Q

What stitch helps with everted mucosa? (small intestinal surgery lecture)

A

modified gambie

107
Q

Small intestinal obstruction

A

proximal - acute/severe signs, persistent vomiting, gastric secretions
distal - vague, intermittent anorexia, lethargy, occasional vomiting
Dx: CS, Hx, rads
Tx: complete abdominal exploratory, removal through enterotomy aboral (distal) to foreign body
resection + anastomosis if non viable

108
Q

Linear foreign bodies

A

cats
CS: vomiting, depression, abdominal pain, palpable bunching of intestines, check under tongue
Tx: remove from base of tongue or gastrotomy, examine mesenteric border of intestines for perfs

109
Q

Intussusception

A

Dx: rads, US - target lesion, colonoscopy
Tx: Sx - exploratory celiotomy, manual reduction (gentle), resection + anastomosis, enteroplication

110
Q

Mesenteric volvulus

A

rare, often fatal, intestines twist on mesenteric axis, GSD
Tx: rapid fluid resuscitation + immediate abdominal exploratory, derotation + resection, segmental w/o derotation better (reperfusion injury)

111
Q

Megacolon

A

cats > dogs
congenital - ganglionic distal colonic segment - absence of inhibitory neurons, functional obstruction
Neuro - lumbosacral dz, key Gaskell (feline progressive dysautonomia), sacral spinal cord deformity (manx)
Pelvic trauma, obstructive, idiopathic
Tx: medical - diet, hydration, enema, prokinetics (cisapride), stool softener (lactulose)
Sx - colectomy, preserve ileocecal valve
post op complications day 3-5, not day 1

112
Q

Rectal prolapse

A

probe test to differentiate from intussusception (sx emergency)
Tx: underlying cause, reduce + purse string, amputate if non-viable, colopexy if recurrent

113
Q

Perianal fistula

A

GSD, immune mediated dz
CS: painful, perianal draining, fistulous tracts
Tx: diet, cyclosporine +/- ketoconazole, glucocorticoids, tacrolimus, azothioprine, metronidazole

114
Q

Rectal adenoma

A

CS: hematochezia, tenesmus/dyschezia, visible mass
most in distal rectum
Dx: rectal palpation, direct observation, Bx
Tx: Sx excision - transanal, dorsal approach

115
Q

Colorectal adenocarcinoma

A

50% abdominal
Sx approaches
anal - lesions of caudal rectum or anal canal, epidural block, caudal 4-6cm
dorsal - midrectum but not anal canal
rectal pull through - distal colonic or mid rectal lesion not approachable through abdomen

116
Q

Anal sac Disease

A

anal impaction, sacculitis, abscess
common in small dogs
Tx: medically until inflammation resolves
closed anal sacculectomy or open anal sacculectomy

117
Q

Perianal gland adenoma/adenocarcinoma

A

male intact, benign masses
castration + resection to tx
Px good if benign, guarded to poor if malignant

118
Q

Anal sac tumors - apocrine gland adenocarcinoma

A

paraneoplastic hypercalcemia, PU/PD, renal failure

119
Q

Gastric displacement

A

clockwise = MC, torsion <180, volvulus >180
pylorus moves along ventral abdominal wall to L side, stomach covered by omentum

counterclockwise = rare, <90, Hx chronic GI signs, stomach not covered by omentum

120
Q

Gastric Dilation-Volvulus

A

CS: acute restlessness, hyper salivation, praying posture, vomiting, non-productive retching, weakness, collapse
Dx: PE, signalment, blood
Tx: initial stabilization - aggressive fluid tx (stabilize CV, renal + resp systems), Gastric decompression - orogastric intubation
- rads R lateral, Sx as soon as stabilized

121
Q

Sx management of GDV

A

1) gastric repositioning - decompress stomach if still distended
2) assess gastric viability
3) evaluate spleen
4) gastropexy (doesnt prevent dilation but reduces risk of volvulus to 4%)

Methods: incisional, belt loop, circumcostal (strongest, around rib), laparoscopic assisted

122
Q

Prophylactic Gastropexy for GDV

A

breed risk, risk factors, owner request

doesn’t prevent dilation

123
Q

Surgical anatomy of the liver

A

central division - gall bladder

right division - blood supply

124
Q

Liver trauma

A

CS: acute blood loss signs
Tx: ligate severed vessels, partial hepatectomy, Pringle maneuver - close to hilus = Sx needed

125
Q

Bile duct stenting

A

relieve obstruction d/t extraluminal compression

temporarily divert bile after suturing bile duct

126
Q

Partial lobectomy of liver

A

Bx, neoplasia, trauma, abscess, cyst

parenchymal fracture + ligation - most blood loss, overlapping suture, stapling technique, surgities

127
Q

Cholecystitis/cholangiohepatitis

A

rupture = septic peritonitis

Tx: medically if not ruptured, Sx assess extrahepatic billiary tree, cholecystectomy

128
Q

Biliary mucocele

A

older, small dogs, shelties + cocker spaniels
hyperplasia of mucus secreting cells + excessive secretion, accumulation of inspissated bile, over distension –> rupture
CS: none, V/D, lethargy, icterus, PU/PD, pain, fever
Dx: inc ALP, ALT, GGT, Tbilli
US - enlarged gallbladder w/ immobile echogenic bile, KIWI sign
Tx: cholecystectomy, duodenotomy w/ catheterization of bile duct

129
Q

Biliary diversion

A

irreparable damage to common bile duct

cholecystoduodenostomy - stoma 2.5-3cm

130
Q

Bile peritonitis

A

Dx: abdominal effusion - positive if fluid bilirubin >2x serum bilirubin
Px poor if infected bile = septic peritonitis

131
Q

2 abdominal organs not filtered by liver

A

kidney and adrenals

132
Q

Extrahepatic portal systemic shunts

A

small dogs, cats
veins that should join portal vein enter caudal vena cava or azygous vein, left gastric vein + splenic vein MC involved
anything entering caudal vena cava cranial to phrenicoabdominal = abnormal, likely shunting vessel

133
Q

intrahepatic portal systemic shunts

A

large breeds

patent ductus venosus, intrahepatic branches of portal vein enter vena cava or hepatic vein bypassing hepatic parenchyma

134
Q

Portal vein atresia

A

no development, affects major pre-hepatic vessels
CS: ascites, hypoproteinemia, portal hypertension (not systemic)
Tx: no Sx, only medical management

135
Q

Portal vein hypoplasia

A

microvascular shunting w/in the liver
middle aged dog shows up w/ “drug sensitivity”
Dx: mild inc bile acids, protein C >70%, nuclear scintigraphy - shunt fraction near normal (vs PSS >70%)
Tx: Medical management

136
Q

Multiple extrahepatic PSS

A

secondary to dz that cause portal hypertension, secondary to macrovascular shunt ligation, cirrhosis, non-cirrhotic portal hypertension
small vessels open up bc liver can’t handle blood flow, vestigial embryonic communications that can open up to prevent lethal hypertension from developing, form around kidneys

137
Q

Macrovascular shunt

A

CS: general - poor growth, weight loss, drug intolerance. neuro - d/t hepatic encephalopathy, GI: anorexia, VD, urinary: PU/PD, cystitis, urolithiasis
Dx: PE: cats = copper irises, ammonium biurate crystals, NUCLEAR scintigraphy = noninvasive method, but doesn’t tell you which type of microvascular shunt, CR angiography, portography – invasive, not commonly performed
Tx: diet, lactulose, antibiotics, seizure control, control parasites

138
Q

Max change in portal pressures

A

9-10cmH2O

139
Q

Spleen attached to stomach via

A

gastrosplenic ligament

140
Q

aberrant non-pathologies of spleen

A

siderotic plaques (Ca/Fe deposits), ectopic splenic tissue, accessory spleen

141
Q

Splenic torsion

A

GDV, large breeds
CS: acute abdomen, pain, abdominal distension, dysarrhythmias. chronic - vague intermittent signs
Dx: US - mottled/diffuse hypo echoic areas, no flow in splenic vessels
Tx: exploratory laparotomy, splenectomy, gastropexy GDV breeds - dont deteriorate spleen prior to splenectomy
neoplasia not a cause
Arrhythmias - ventricular

142
Q

arrhythmias + GDV

A

ventricular d/t ischemia, electrolyte abnormalities, etc

Tx: if Vtach w/ rate >180-190, lidocaine bolus or CRI

143
Q

Diffuse nodular splenic hyperplasia

A 
immune stimulation (tick dz) or splenic hyperactivity (IMHA)
hyperplasia = sites of extra medullary hematopoiesis
144
Q

Tx of splenic traum

A

commpression bandage, supportive care, partial splenectomy unless at risk breeds

145
Q

Splenic neoplasia

A

dogs = hemangiosarcoma, cats = MST
rule of 2/3 - 2/3 dogs w/ splenic mass will have malignancy and 2/3 of malignancies will be HSA
small breeds, wheaten terriers
Px: poor, nearly all microscopic metastasis at time of Dx
Sx = 1-3m, Sx + chemo = 5-6m, Dx + chemo + immune tx = 425d if stage 1, no effect if stage 2
Tx: C-versicolor, eBAT

146
Q

Complete splenectomy

A

1) individual ligation of hilarity vessels - preserve branches to pancreas + stomach, time consuming to do but less risk PO hemorrhage, isolate + double ligate vessels at hilus, preferred if anatomical distortion of vasculature
2) ligation of splenic + short gastric aa w/o compromising blood glow to greater curvature of stomach, dec Sx time, inc risk major hemorrhage, preserves branch to L limb of pancreas

147
Q

Islet of langerhans cells

A

a - glucagon
b - insulin (60-75% islet cells)
d - somatostatin
f - pancreatic polypeptide

148
Q

Pancreatic pseudocyst

A

collections of secretions + debris w/in fibrous sac or wall of granulation tissue, lacks epithelial wall so not true cyst
middle aged dogs
CS: asymptomatic, anorexia, vomiting
Dx: US TOC
Tx: percutaneous aspiration, resection if clinically ill

149
Q

Surgical techniques of the pancreas

A

Surgical Bx - guillotine technique, if diffuse dz present, sample distal aspect, R limb easiest to access, procure multiple

Partial pancreatectomy - tumor removal, excise omentum + capsule, dissect between lobules to isolate vessels + ducts in portion of gland to be removed, hemoclips or bipolar cautery best, if remaining duct patent can remove 80% pancreas

150
Q

Pancreatic abscess

A

secondary bouts of pancreatitis, inflammation + fibrosis d/t escaped enzymes into surrounding tissue
CS: variable, anorexia, depression, V/D, icterus, pyrexia, palpable mass
Dx: rads - ascites + peritonitis, hyperbilirubimemmia, elevated liver enzymes d/t EHBO
Tx: resect, debride, drain, omentalize
Px: guarded in dog

151
Q

Exocrine pancreatic adenocarcinoma

A

malignant, invade locally, metastasis 50-78% at Dx
CS: vomiting, pain, weight loss, EHBO
Tx: Sx if possible, 75% feline = diffuse
Px poor, <7d cats

152
Q

Insulinoma

A

B cells in islets secrete insulin despite hypoglycaemia
90% malignant
CS: weakness, seizures, polyneuropathy
Dx: Whipple’s triad - CS assoc w/ hypoglycaemia, fasting blood plc <40mg/dl, relief of neuro signs w/ feeding
insulin >70
Tx: small frequent meals, glucocorticoids, oral hypoglycaemic agents (diazocide), partial pancreatectomy = gold standard

153
Q

Gastrinoma

A

rare, highly. malignant, APUD cells in pancreas produce excess gastrin = duodenal ulceration
Zollinger Ellison syndrome - gastric acid hyper secretion
Dx: serum gastrin levels
Px: poor

154
Q

Classification of peritonitis

A

primary - spontaneous inflammation in absence of intraperitoneal source, hematogenous/lymphogenous spread, bacterial migration from GIT - gram+, monobacterial

secondary - from underlying primary dz process, common, bowel leakage, neoplastic invasion, pancreatitis - gram-, polymicrobial

Sx not done for primary but requisite for secondary

155
Q

Septic peritonitis

A

GI origin, E. coli or bacterioides fragillus (synergistic together)
ruptured GB mucocele, pancreatitis, pyometra, BDLD bit etc
CS: hyper dynamic then hypo dynamic, cats have no pain on palpation + relative bradycardia
Dx: abdominal US + cytology gold
peritoneal [glc] effusion 20 pts < serum [glc]
effusion [lactate] 2 its > serum [lactate]
creatine [ ] > serum creatinine [ ]
fluid [bili] 2.5x > serum [bili]

156
Q

Tx of septic peritonitis

A

antimicrobials based on cytology + gram stain, 4 quadrant. go to = IV ampicillin, baytril, metronidazole (if use amino glycoside instead of baytril can potentiate renal problems)

157
Q

Retained deciduous teeth

A

failure of primary tooth’s root to undergo resorption
toy breeds + cats
all teeth erupt lingual to deciduous except maxillary canines which erupt rostral

158
Q

Crowding of teeth

A

brachycephalics

maxillary 3rd premolars MC

159
Q

Shelf on palatal surface of maxillary incisors where mandibular incisors occlude

A

cingulum

160
Q

Classes of malocclusions

A

1 - neutroclusion, base narrow canines, rostral cross bite, caudal cross bite
2 - mandibular brachygnathism, overshot, parrot mouth
3 - mandibular mesiocclusion, mandibular prognathism, undershot, level bite
4 - wry bite

161
Q

Dentigerous cyst

A

fluid filled cyst surrounding crown of uninterrupted tooth resulting from persistence of portions of enamel forming epithelium
CS: missing teeth, swelling (blue hue), pain
Rx: extract impacted tooth, remove lining of cyst

162
Q

Enamel hypoplasia

A

d/t high fevers, distemper, periapical inflammation or trauma

163
Q

Attrition vs abrasion (dental)

A

attrition - pathologic wearing d/t contact w/ opposite tooth

abrasion - abnormal contact w/ crown surface by foreign object

164
Q

Draining tract associated w/ teeth

A

parulis

165
Q

MC tooth fractured

A

upper 4th premolar

166
Q

Tx of tooth fractures

A

Vital pulpotomy - young animals <18-24m, sooner = better

Root canal - older mature animals >24m, maintains tooth function but tooth is dead

167
Q

Tooth luxation/avulsion

A

true emergency if you want to save tooth, after 30m success goes down, keep tooth in milk

168
Q

Tooth resorption

A

lesions are not cavities
Type 1 - periodontal dz, classic neck lesions at cement-enamel junction, gingivitis, painful
Type 2 - minimal or no evidence of periodontal dz, resorption of roots, periodontal ligament gone
Type 3 - multi rooted, type I or II

CS: drop food, chatter, anorexia
Tx: type 1 = extract tooth, type 2 = amputate crown

169
Q

Gingivostomatitis

A

maxillary teeth caudal to canines MC

extract teeth sooner = better

170
Q

Periodontal dz -

A 
MC oral dz
#1 cause tooth loss
calculus, gingivitis, periodontitis
171
Q

normal sulcus depth

A

cats - 0-1mm, dogs - 1-3mm

172
Q

intraoral splint

A

composite resin/acrylics - preferred, normothermic curing, easy application

acrylics - exothermic curing

173
Q

Lip avulsion

A

shearing trauma along mucogingival line, lower lip MC

174
Q

what = failure in regards to suturing gingiva

A

tension

175
Q

highest incidence of fracture in cat mouth

A

symphysis and ramus of mandible

Small Animal Surgery (4 decks)

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