SaSx Test 2 Flashcards
2 main indications for incisional biopsy
Suspect false negative from FNA
If Tx is likely altered by results
Orientation of incision for incisional biopsy
parallel to lines of tension
Tru-Cut incisional biopsy
14, 16 or 18G
any accessible mass
sedation or local anesthetic bc tumor has poor innervation
Punch incisional biopsy
> 6mm for diagnostic sample
do not use for hypodermal masses - risk undetected hemorrhage
can punch out entire mass if small
Wedge incisional biopsy
ulcerated or necrotic tissue or deeply located masses
entire biopsy tract must be removed later
use gelpi retractors to maintain tissue retraction for deeper lying tissues
Gelpi retractors
retract tissues for deep wedge incisional biopsies
Excisional biopsies
post treatment, if invasive or high risk to get biopsy
prevent seeding, eliminate dead space, don’t drain
Pseudocapsule
reactive zone, microscopic extensions of satellite tumor cells
Enneking Classification
intralesional - debulk lipomas
marginal - breach pseudo capsule; extremities, eyes, perianal region
Wide - excise around pseudocapsule
Radical - remove entire body compartment
Mast Cell tumor margins - 2 methods
1) Fulcher - mark out 1, 2 and 3cm from tumor. 100% clean for gr I and II at 3cm and 2 fascial planes deep (grade dependent)
2) Pratschke Modified - widest diameter of tumor = your lateral margin (unless >4cm is always 4cm), 1 fascial plane deep
benign tumor resection margins
1cm lateral and 1cm deep
Inking of biopsies
ink all cut surfaces, let dry 15-20 mins before setting in formalin
Davidson dye - yellow or black
Biopsy submission
incomplete bread loafing
formalin:tissue = 10:1
small samples in cassettes
tissue 0.5-1cm thick
Holding layer of the stomach?
submucosa
_________ resection may be needed when doing a ventral midline celiotomy.
Falciform ligament
Used for retraction in stomach surgeries
Balfour retractors
T/F: the best suture material to close the stomach is braided.
False, don’t use braided
Closure of the stomach (hint, its two layers)
Double inverting Cushing (serosa, muscularis, submucosa) oversewn with Lembert (serosa + muscularis)
Most common indication for a gastrotomy
Gastric foreign body
3 predispositions to pica
- Iron deficiency
- Hepatic encephalopathy
- Pancreatic exocrine insufficiency
Gastric foreign bodies
Dx of choice: RADS
- do rads right before Sx because FB can move
Tx w/ gastrotomy - incise ventral hypovascular area between greater and lesser curvature, lavage with sterile saline (98.6-101.2F)
What is FALSE regarding Congenital Pyloric stenosis?
A) seen commonly in brachycephalics + siamese cats
B) involves hypertrophy of the mucosa of stomach
C) Treated with pyloromyotomy or Transverse Pyloroplasty
D) Clinical signs evident at weaning
B IS FALSE - involves hypertrophy of the circular mm of muscularis layer
Pyloromyotomy
Fredet-Ramstedt procedure
Tx congenital pyloric stenosis
1-2cm incision through serosa and muscularis
Transverse pyloroplasty
Heineke-Mikulicz procedure
Tx congenital pyloric stenosis
3-5cm full thickness incision over pylorus, orient incision transversely and close w/ appositional pattern
A puppy comes into your clinic presenting with intermittent vomiting. Owner tells you he just got the puppy from a breeder who mentioned the puppy had just been weaned. What is your diagnostic test of choice?
A) Rads to look for foreign body
B) Endoscopy to look for mucosal hyperplasia
C) ELISA to look for phycomycosis
D) Contrast rads to look for congenital pyloric stenosis
D - look for apple core sign
A 10y old male intact Shih Zhu is brought to your clinic because he has been vomiting. You conduct abdominal US and notice the muscularis of his stomach is 6mm and the pyloric wall is 10mm in thickness. What do you suspect? What are 2 surgical corrections you can potentially do?
Chronic hypertrophic pyloric gastropathy (CHPG)
- hypertrophy of mucosa and muscularis (normal thickness are <4mm for muscularis and <9mm for pyloric wall)
Two possible Sx:
1) Y-U Advancement pyloroplasty
2) Bilroth I - Gastroduodenostomy
Y-U Advancement Pyloroplasty
single pedicle advancement to Tx chronic hypertrophic pyloric gastropathy
Pro: inc diameter of pylorus, access to excise hypertrophied mucosa
Con: potential necrosis of flap tip (make sure it is a U and not a V)
Bilroth I
Gastroduodenostomy
- remove portion of pylorus including pyloric sphincter and reattach stomach + duodenum
Pro: all dz tissue can be removed
Con: technically demanding, inc risk dumping syndrome + reflux gastritis
Phycomycosis
Gulf coast states, transmural thickening, gastric outflow area, eosinophilic pyogranulomatous infection
antifungals do not work
very poor prognosis
You live in Florida and a dog comes into your clinic with signs of vomiting and diarrhea. You palpate a thickened mass in its abdomen where its stomach is. You perform an ELISA and it reveals P. insidiosum antibodies. What is your next course of action?
A) Give antifungals for 4w
B) hug your client and say sorry because this dog is a goner
C) Gastrotomy
D) It is self limiting, no tx necessary
B - very poor prognosis, this dog will likely die in a month (antifungals DONT work)
Billroth II complications (3)
Gastroenterostomy
1) alkaline gastritis
2) blind loop syndrome
3) marginal ulceration
How can you assess gastric viability?
gastric wall thickening - slip
serosal surface colour
capillary perfusion
peristalsis (pinch it)
Poster breed for GDV?
great danes
T/f: GDV is predisposed in a dog that has a primary relative that has the disease
True
Most common type of gastric displacement
Clockwise torsion (<180)
A dog comes in with GDV (oh no)! You open it up and notice the stomach is covered by omentum. Which way did the stomach turn?
Clockwise (omentum doesn’t cover stomach if counterclockwise)
A large dog comes into your clinic and collapses. You ask the owner to describe any clinical signs leading up to their visit. The owner says the dog was vomiting, drooling, and seemed weak. He was also in a “praying posture”. What do all of these CS lead you to suspect?
GDV
What is the first goal of treating a dog with GDV? A) Untwist the stomach B) Splenectomy C) Stabilization D) gastric decompression
C - stabilize CV, resp and renal systems
What are the best and worst views to visualize GDV on rads?
Best - R lateral, see punching glove stomach
Worst - ventral dorsal, can predispose to reflux or aspiration
What drug can be used as a free radical scavenger for a dog with GDV?
Lidocaine
Which of the following is FALSE regarding surgical management of GDV?
A) Gastropexy prevents dilation and volvulus of the stomach
B) push down on funds with R hand, grasp antrum w/ L hand and rotate counter clockwise
C) spleen should be evaluated
D) confirm proper reduction by assessing gastroesophageal junction
A is false, gastropexy prevents volvulus but does NOT prevent dilation!
Recurrence of GDV with and without gastropexy
without gastropexy - 50%
with gastropexy - 4%
doesnt prevent dilation
Which is TRUE regarding gastropexy and GDV?
A) prevents dilation of stomach
B) circumcostal involves seromuscular flap around 14th rib
C) can be done prophylactically in high risk breeds
D) reduces risk of GDV to 50%
C is true
A) - doesnt prevent dilation
B) - is around 13th rib
D) reduces risk of GDV to 4%
Post op GDV deaths occur: A) never B) 1st day C) first 4 hours D) first four days
D - first four days
MC arrhythmias associated with GDV? When do you treat and with what?
Ventricular arrhythmias
Tx if Vtach >180-190bpm, pulse deficits, weakness, multifocal PVCs
Lidocaine bolus or CRI (monitor ECG)
Prophylactic antibiotic of choice for intestinal surgery
Cefazolin
What suture pattern is great to minimize mucosal eversion (intestinal surgery)?
Modified Gambee
Principles of transverse wedge intestinal biopsy
<20-25% circumference
full thickness
3-4mm wide
perpendicular to long axis
Difference between the vomiting pattern in a proximal and distal small intestinal obstruction.
Proximal (duodenum or proximal jejunum) - persistent vomiting
Distal (distal jejunum, ileum, ileocecal junction) - occasional vomiting
A 8m old kitten presents with vomiting, depression, and painful abdomen on palpation. You do rads and notice the small intestine is plicated. What do you suspect?
Linear foreign body
Important spot to check on any cat with a linear foreign body
Under the tongue
Where should you remove a non-linear small intestinal foreign body during a complete abdominal exploratory?
A) Aboral to foreign body on the anti mesenteric axis
B) Aboral to foreign body on the mesenteric axis
C) Oral to foreign body on the anti mesenteric axis
D) Oral to foreign body on mesenteric axis
B - Aboral on mesenteric axis
Typhlectomy
removal of the cecum
Classic US lesion associated with intussusception
target lesion
Which is FALSE regarding intussusception?
A) manual reduction increases risk of tearing the serosal layer
B) enteroplication prevents recurrence
C) more common in older dogs
D) resection and anastomosis is done if reduction not possible
C - it is more common in puppies
Mesenteric volvulus
German Shepherds
rare, often fatal
intestines twist on mesenteric axis, ischemia
non-responsive to oronasogastric intonation
Tx w/ rapid fluids, resection/anastamosis if possible
Begin intestinal anastomosis at the ________ border
mesenteric
How do you leak test an intestinal resection/anastamosis procedure?
occlude intestine proximal and distal, inject saline until evenly distended, gently compress, look for leaks
Methods to manage intestinal luminal disparity during an anastamosis?
cut segment at angle
space sutures closer together on smaller segment
fish mouth or Cheattle incision
place mesenteric + anti mesenteric sutures
Highest bacterial population: A) Small intestine B) Stomach C) Large intestine D) ross university gym
C - large intestine
Where is a colopexy done?
Left side of abdomen, attaches the descending colon to transversus abdominis
2 Indications for colopexy
recurrent rectal prolapse or perineal hernia
Another name for feline progressive dysautonomia (large intestine)
Key-Gaskell
Suspected reason that you preserve the ileocecal valve during a colectomy?
prevent bacterial overgrowth
T/F enemas and stool softeners improve efficacy of a colectomy as a treatment for megacolon
False, Sx is already contaminated so this is a baaaad idea
tx of choice for megacolon
Colectomy
When are post op complications most likely to occur after a colectomy tx for megacolon? A) Day 1 B) Day 2-3 C) Day 3-5 D) Never
C - day 3-5
You are going to do a colectomy to treat a kitty with megacolon. What is the antibiotic you are going to give prophylactically (considering the fact that you are dealing with a fecal ridden area)? A) Doxycycline B) Penicillin C) Metronidazole D) Cefazolin
D - Cefazolin is prophylactic AB of choice for intestinal surgery
4 risk factors for dehiscence after intestinal surgery
1) ingest foreign body or trauma
2) pre-op albumin <2.5g/dL
3) post op increase of band neutrophils
4) pre-op peritonitis
A client comes in because their dogs bum looks “messed up.” You perform a PE and notice what appears to be tissue protruding from the dog’s anus. You decide to conduct a probe test. The probe is passed completely through. What does this mean?
Intussusception - surgical emergency!
Perianal fistula
German shepherds, immune mediated cause
Tx w/ cyclosporine
Rectal adenomas
distal rectum
always submit excised mass, 25% come back as more aggressive tumor
Which of the following is FALSE regarding surgical approaches to colorectal adenocarcinoma?
A) Anal - lesions of caudal rectal or anal canal
B) Dorsal - anal canal
C) Rectal pull through - midrectal or distal colonic not approachable through abdomen
D) Swenson’s pull through - extend beyond peritoneal reflection into abdominal cavity
B - dorsal is for midrectum but not anal canal
T/F: it is okay to excise the external anal sphincter
False, dissect around it
Anal sac disease is most common in what sized dogs?
small ones (poodles, chihuahuas)
How would you decide to do an open or closed anal sacculectomy?
Closed - tumors or infected glands
Open - not common, for ruptured sacs
2 words that describe treatment of perianal gland adenomas (male intact dogs hint hint)
Castration + resection
Apocrine Gland Adenocarcinoma
Paraneoplastic hypercalcemia, PU/PD, renal failure
Px: no mets - 16-18m, mets <1y
Safest division to do hepatic surgery?
Left division
R has a lot of vasculature, central has gall bladder
The closer the injury to the liver hilus, the ______ chance of needing surgery
greater
Bile duct stunting is used to relieve obstruction due to
extraluminal compression
If an animal has necrotizing cholecystitis and the gall bladder ruptures, it will have ________
septic peritonitis
Which is FALSE regarding biliary mucoceles?
A) older dogs, breeds = shelties and cocker spaniels
B) Hyperplasia of mucus secreting cells so excessive mucus secretion
C) Classic kiwi sign on ultrasound
D) labs will show decreased liver enzymes
D - liver enzymes will be increased
Tx of choice for a biliary mucocele?
cholecystectomy - take out gall bladder
Cholecystoduodenostomy
Biliary diversion
- initial size of stoma 2.5-3cm long to dec risk of gallbladder becoming impacted w/ ingesta (causing cholangiohepatitis or cholecystitis)
Abdominal effusion that is diagnostic for bile peritonitis?
effusion bilirubin >2x serum bilirubin
For cholecystectomy, where should you transect?
at cystic duct
2 organs not drained by liver? what are they drained by?
Kidneys and adrenals
phrenicoabdominal vein
You are doing an exploratory laparotomy on a yorkie, and notice a large vessel entering the caudal vena cava cranial to the vein draining the adrenal glands. What is the significance of this vessel?
This is likely an extrahepatic portosystemic shunt
- signalment and because the phrenicoabdominal vein (drains adrenals) should be the most cranial vein entering the caudal vena cava
2 veins commonly associated with extrahepatic PSS
left gastric and splenic veins
Intrahepatic PSS
large breeds (labs, goldens, aussies, OES) - patent ductus venosus
Portal vein atresia
ascites, hypoproteinemia
No Sx, only medical management
You are conducting a necropsy on a dog. You notice there are multiple small vessels around the kidneys that appear to be connected to the liver. Which of the following is likely TRUE?
A) This dog shows evidence that it had systemic hypertension
B) This dog shows evidence that it had portal hypertension
C) This dog shows evidence of kidney failure
D) This dog has a intrahepatic shunt
B - multiple acquired shunts are caused by diseases associated with portal hypertension
A middle aged Schnauzer comes into your clinic for a routine check up. The owner mentions the dog seems to be more sensitive to drugs (not sure how the owner knew but very good finding)! You run some liver tests and blood work and find the following:
- bile acids slightly elevated
- protein C >70%
- nuclear scintigraphy - shunt fraction near normal
What is the likely diagnosis?
portal vein hypoplasia
Multiple acquired liver shunts are a result of?
vestigial embryonic communications that can open up to prevent lethal portal hypertension to develop
Cat presents with copper irises, hyper salivation, aggression and a palpable thrill in the abdomen (Bruit). What is likely?
Macrovascular shunt
What is TRUE regarding ammonium biurate crystals? A) Evident on rads B) Associated with macrovascular shunts C) Common finding in all dogs D) Associated with microvascular shunts
B
A- not seen on rads
C - only normally seen in Dalmatians
D - I made this up
A non-invasive way to document PSS?
nuclear scintigraphy
CT angiography is ____ times more likely to diagnose a PSS vs an abdominal ultrasound
5.5
3 important places to look during an abdominal exploratory in regards to PSS
epiploic foramen
omental bursa
esophageal hiatus
Max pressure change when measuring portal pressures?
9-10cmH2O
what vein do you inject contrast in during portography?
mesenteric vein
spleen is attached to the stomach via the
gastrosplenic ligament
Which of the following is NOT an aberrant non-pathology of the spleen? A) Siderotic plaque B) Accessory spleen C) Ectopic splenic tissue D) Splenic neoplasia
D!!!
Siderotic plaques of the spleen caused by
Ca or Fe deposits
T/F: neoplasia is a common cause of splenic torsion
FALSE it doesnt cause splenic torsion
What stomach disease is splenic torsion associated with?
GDV
US appearance of splenic torsion
mottled/diffuse hypo echoic areas, intraluminal echogenic densities in veins, no flow in splenic vessels
T/F: ideally you should deteriorate spleen prior to splenectomy
NO
A Great Dane comes into your clinic with abdominal distension and CV instability. You do an ultrasound and see that there is splenic torsion. You decide to do a splenectomy. What other surgical procedure should you consider doing based on the signalment of the patient?
Gastropexy (reduce risk of GDV)
Why shouldn’t you race to perform Sx on an animal with splenic infarction?
because it is likely a systemic issue - treat the underlying cause
2 causes of diffuse or nodular splenic hyperplasia?
immune stimulation (rickettsia) or splenic hyperactivity (IMHA)
Treatment of splenic trauma
compression bandage, splenectomy
What is the rule of 2/3 in regards to the spleen?
2/3 dogs with splenic masses will have malignancy and 2/3 of the malignancies will be HSA (equivalent to 44% dogs w/ splenic mass will have HSA)
Presence of hemoperitoneum always indicates the chance of malignancy of HSA is 80%
False, this is only true in large dogs
small dog that is predisposed to HSA ?
wheaten terriers
Arrhythmias in a splenectomized patient increase risk of death by
2 times
Px of splenic neoplasia (HSA)
poor bc most have micro metastasis by the time of Dx
Sx: 1-3m
Sx + chemo: 5-6m
Sx + chemo + immunotherapy: 425d if stage 1, no change if stage 2
2 methods of complete splenectomy
1) ligation of individual hilus vessels - time consuming, less risk post op hemorrhage
2) ligation of splenic and short gastric vessels - faster, preserves branch to left limb, risk hemorrhage w/ technique failure
A non-invasive way to document PSS?
nuclear scintigraphy
CT angiography is ____ times more likely to diagnose a PSS vs an abdominal ultrasound
5.5
3 important places to look during an abdominal exploratory in regards to PSS
epiploic foramen
omental bursa
esophageal hiatus
Max pressure change when measuring portal pressures?
9-10cmH2O
what vein do you inject contrast in during portography?
mesenteric vein
spleen is attached to the stomach via the
gastrosplenic ligament
Which of the following is NOT an aberrant non-pathology of the spleen? A) Siderotic plaque B) Accessory spleen C) Ectopic splenic tissue D) Splenic neoplasia
D!!!
Pancreatic abscess
ascites + hypoproteinemia
hyperbilirubinemia, elevated liver enzymes due to EHBO
need feeding tube
bad prognosis
T/F: neoplasia is a common cause of splenic torsion
FALSE it doesnt cause splenic torsion
What stomach disease is splenic torsion associated with?
GDV
US appearance of splenic torsion
mottled/diffuse hypo echoic areas, intraluminal echogenic densities in veins, no flow in splenic vessels
T/F: ideally you should deteriorate spleen prior to splenectomy
NO
A Great Dane comes into your clinic with abdominal distension and CV instability. You do an ultrasound and see that there is splenic torsion. You decide to do a splenectomy. What other surgical procedure should you consider doing based on the signalment of the patient?
Gastropexy (reduce risk of GDV)
Why shouldn’t you race to perform Sx on an animal with splenic infarction?
because it is likely a systemic issue - treat the underlying cause
2 causes of diffuse or nodular splenic hyperplasia?
immune stimulation (rickettsia) or splenic hyperactivity (IMHA)
Treatment of splenic trauma
compression bandage, splenectomy
What is the rule of 2/3 in regards to the spleen?
2/3 dogs with splenic masses will have malignancy and 2/3 of the malignancies will be HSA (equivalent to 44% dogs w/ splenic mass will have HSA)
Presence of hemoperitoneum always indicates the chance of malignancy of HSA is 80%
False, this is only true in large dogs
small dog that is predisposed to HSA ?
wheaten terriers
Arrhythmias in a splenectomized patient increase risk of death by
2 times
Px of splenic neoplasia (HSA)
poor bc most have micro metastasis by the time of Dx
Sx: 1-3m
Sx + chemo: 5-6m
Sx + chemo + immunotherapy: 425d if stage 1, no change if stage 2
What feeding tube is ideal for a patient being treated for septic peritonitis?
a combo gastric jejunal (GJ) tube
hemostatic clips for splenectomy
<4mm vessels
fast + easy but clip instability
leaves non-absorbable material in body
electrothermal bipolar system (ligature) for splenectomy
<7mm, minimal thermal damage to surrounding tissue, minimal complications, fast, no foreign material, $$$
Cats and dogs have two ducts associated with the pancreas - the pancreatic duct and the accessory ducts
false, cats dont have the accessory duct
The pancreatic duct enters the duodenum at the ________ with the ________
major papilla, bile duct
Most islet of lagerhans cells are
B cells (insulin producing) - 60-75%
pancreatitis is a common surgical problem?
no, it is common but is not surgical
An old dog comes into your clinic presenting with anorexia and vomiting. You perform an abdominal ultrasound and notice there is a cystic lesion on the pancreas. A percutaneous FNA determines it is a pseudocyst. What are the two treatment options?
if clinically ill, resect
if aclinical, percutaneous aspiration
Which have the worse prognosis for pancreatic exocrine adenocarcinoma, dogs or cats?
Cats, have Px of <7d compared to dogs 3m
both have poor Px
Whipple’s Triad
Dx insulinoma
1) CS associated w/ hypoglycaemia
2) fasting blood [glucose] <40mg/dL
3) relief of neuro signs with glucose or feeding
2 things aside from surgery to treat an insulinoma
1) glucocorticoids - increase hepatic glucose production and decrease glucose uptake by cells
2) Diazoxide - hyperglycaemic agent that inhibits pancreatic insulin secretion and glucose uptake
Gold standard surgical treatment for insulinoma?
partial pancreatectomy
Gastrinoma
highly malignant
ectopic amine precursor uptake decarboxylase (APUD) produce excess gastrin
Zollinger Ellison syndrome - GI ulceration
Primary vs Secondary peritonitis
primary - spontaneous inflammation in absence of intraperitoneal source (FIP), gram +, monobacterial
secondary - underlying primary disease process, gram -, polymicrobial
Sx is always indicated in cases of peritonitis
No, it is not routine for primary but is requisite for secondary
2 important causal agents of septic peritonitis
E. coli and bactericides fragilis –> synergistic together
gold standard to confirm septic peritonitis?
cytology
describe glucose, lactate, and septic peritonitis Dx
Following are diagnostic:
fluid glucose 20 points less than serum glucose
fluid lactate 2 points higher than serum lactate
What is 4 quadrant antimicrobial selection?
covers anaerobic, aerobic, gram neg and pos
2 examples of quadrant antimicrobial combinations?
IV ampicillin, aminoglycoside, metronidazole
BUT - can potentiate renal failure so,
go to = IV ampicillin, baytril, metronidazole
A patient with compromised kidneys has septic peritonitis. Which of the following drugs would not be part of your antibiotic treatment plan? A) Ampicillin B) Baytril C) Aminoglycosides D) Metronidazole
C - aminoglycosides (potentiate renal failure)
class 4 malocclusion
wry bite (asymmetrical skeletal malocclusions)
Periodontal ligament functions
isolates tooth from surrounding bone and from osteoclasts
if ligament ossifies, tooth is susceptible to osteoclasts
Dental formula of dogs and puppes
puppy: 313/313 = 28
dog: 3142/3143 = 42
Dental formula of kittens and cats
kitten: 313/312 = 26
cat: 3131/3121 = 30
Deliver nutrients to odontoblasts
dentinal tubules
A worried client comes in, thinking her little dog has an oral tumor. You look inside the mouth and see a small raised area behind the maxillary incisors. What is the owner likely worried about?
this is the incisive papilla that overlies the vomeronasal organ
T/F: pulp narrows as an animal ages
true
Triadan Quadrants
right maxilla = 1
left maxilla = 2
left mandible = 3
right mandible = 4
Rule of 4 and 9 with teeth numbering
canine = 4
1st molar = 9
Retained deciduous teeth
toy breeds + cats
canine + incisors MC
erupt lingual to deciduous teeth except maxillary canines which erupt rostral to deciduous canines
Which is TRUE regarding retained deciduous teeth?
A) All adult canine teeth erupt ROSTRAL to deciduous canines
B) All adult canine teeth erupt LINGUAL to deciduous canines
C) Mandibular adult canines erupt ROSTRAL to deciduous teeth while maxillary adult canines erupt LINGUAL
D) Mandibular adult canines erupt LINGUAL to deciduous teeth while maxillary adult canines erupt ROSTRAL
D is correct, maxillary erupt rostral, mandibular erupt lingual
dental crowding
MC in brachycephalics, maxillary 3rd premolars
supernumerary teeth
MC in maxilla, 3rd premolars
T/F if a deciduous tooth is congenitally absent, adult tooth will also likely be missing
true
shelf on palatal surface of maxillary incisors where mandibular incisors occlude
cingulum
MC class 1 malocclusion of teeth
base narrow canines
Lance tooth
sheltie, retained deciduous teeth, extraction
2 cross bites associated w/ class 1 malocclusions
rostral and caudal
Class 2 malocclusions
mandibular brachygnathism, parrot mouth
class 3 malocclusions
mandibular prognathism, undershot
level bite
type of class 3 malocclusion, incisor crowns meet, attrition
class 4 malocclusion
wry bite (asymmetrical skeletal malocclusions)
A dog presents with a painful tooth. Upon examination, you notice a blue hued cyst surrounding a tooth in the dogs mouth. what is it and how would you treat it?
Dentigerous cyst, extract tooth and remove lining of cyst
what drug can cause yellow teeth in puppies?
tetracyclines
damage to ameloblasts during enamel development =
enamel hypoplasia
Attrition vs abrasion of teeth
attrition - wearing due to contact w/ opposing tooth
abrasion - abnormal contact of tooth w/ foreign object
Draining tract associated with teeth
parulis
3 causes of gingival hyperplasia
periodontal disease (focal) generalized (boxers) Ca channel blockers (amlodipine)
MC tooth fractured
upper 4th premolar
complicated vs uncomplicated crown fracture
complicated - pulp exposed
uncomplicated - pulp not exposed
When is vital pulpotomy most successful?
young dogs <18-24m, within 24h of pulp exposure
When is a root canal most successful?
on a mature tooth, >24m
Tooth avulsion
displaced from alveolus, emergency if you want to save tooth, after 30m success goes down, put tooth in milk
4 systemic antibiotics important in treating periodontal disease
1 - clindamycin
2 - clavamox
3 - metranidazole
4 - doxycycline
Which type of tooth resorption is associated with periodontal disease?
type I
clinical signs of a cat with tooth resorption
drop food, chatter, anorexia
How does treatment of type I and II tooth resorption differ?
type I - extract entire tooth
type II - amputate the crown
Gingivostomatitis
maxillary teeth caudal to canines MC affected
Dx w/ histopath
teeth extraction to Tx
Juvenile onset periodontitis
<9m, siamese, maine coon, DSH
Tx w/ aggressive home care, extractions as needed
depressions between ridges of bone and tooth in alveolar process
juga
eosinophilic granuloma
rodent ulcerations, hard palate erosion
canine ulcerative paradental stomatitis
canine equivalent to feline gengibostomatitis
kissing lesions in gums
MC oral disease/
periodontal disease
1 cause of tooth loss in dogs and cats
periodontal disease
mineralized plaque containing bacteria which release endotoxins that cause gingivitis
calculus
loosely adhered sub gingival plaque that causes inflammatory response (reversible)
gingivitis
Normal sulcus depths
dogs: 1-3mm
cats: 0-1mm
Stage 0 periodontal disease
normal
gingival tissue firm + pink
defined stipling
normal sulcus depth
stage 1 periodontal disease
gingivitis
erythema
gingival swelling, loss of knife like edge at gingival margin
gingiva bleed when probed
loss of stipling
normal sulcus depth
reversible w/ proper treatment + home care
stage 2 periodontal disease
early periodontitis
gingiva bleed when probed
normal-hyperplastic gingiva
minor pockets/gingival recession
<25% attachment loss - evaluate furcation, usually no mobility
periodontitis can be controlled but not reversed
stage 3 periodontal disease
gingival hyperplasia +/- recession - horizontal bone loss
25-50% attachment loss - moderate to deep pocket formation, vertical bone loss
furcation exposure, slight to moderate mobility
stage 4 periodontal disease
advanced periodontitis
gingival recession w/ horizontal bone loss
deep pocket depth w/ vertical bone loss
>50% attachment loss - furcation exposure, advanced mobility, periodical lucencies
extraction recommended
1 preventative method of periodontal disease
mechanical abrasion
T/F - it is especially important to perform extensive dental cleaning and Sx if home care will not be good
false
4 systemic antibiotics important in treating periodontal disease
1 - clindamycin
2 - clavamox
3 - metranidazole
4 - doxycycline
what is an oral speculum
mouth gag
careful not to fully compress greater palatine artery esp in cats
dental instrument with pointed tip and two cutting surfaces
scaler
dental instrument with rounded tip + back with flat face, only one cutting edge, more delicate
curette
used to measure sulcus depth
dental probe
dental instrument with sharp point used to assess access into pulp cavity
periodontal explorer
What drug is given to dogs with sialadeuosis or necrotizing sialometaplasia?
phenobarbital
2 critical steps in dental cleanings
sub gingival calculus removal
polishing
purpose of barrier sealants in dental cleaning
retard plaque formation
curved root tip
dilaceration
expansion of apical portion of tooth root
hypercementation
T/F: retained root tips should always be extracted
false, not if type II or III tooth resorption
close flaps in oral cavity with ____ suture
3-0 or 5-0 absorbable suture
What is key failure in suturing gingiva
TENSION
aftercare of gingival flaps
no crunch for 2 weeks
cat presents with pulmonary edema and chalk white lesion in the mouth. What is likely cause?
electrical burns - oronasal fistula
most common technique to repair an oronasal fistula
single flap technique
Highest incidence of jaw fractures in cat + dog
Cat: symphysis + ramus
Dog: evenly distributed
tension is highest at what part of mandible
dorsal side (inside teeth)
Preferred type of intraoral splint? why?
composite resin because normothermic curing, easy to control application
breeds predisposed to lip fold pyoderma
pendulus lipped breeds (spaniels, retrievers, setters)
Labial avulsion
lower lip MC
suture effective for maxillary lesions but fails with mandibular - limited soft tissue, edema + swelling, suture moves while eating/drinking
Sx considerations for lip reconstruction
suture at lip margin to avoid step deformity
figure of 8 apposes lip margin well
avoid mucosal inversion
2 salivary glands removed together
mandibular and sublingual
sialadenitis
fever, depression, painful, swollen salivary glands
sialadenosis
non painful bilateral enlargement of mandibular gland
retching, gulping, lip smacking, hyper salivation
necrotizing sialometaplasia
similar to sialadeuosis (retching, gulping, lip smacking, hyper salivation) but painful enlargment
What drug is given to dogs with sialadeuosis or necrotizing sialometaplasia?
phenobarbital
Salivary mucocele
sublingual MC, MC presents cervical
MC dz of salivary system
GSD, poodles
accumulation saliva within non-epithelial, non-secretory lining
Sx removal of gland = definition Tx (except parotid sialocele, ligate duct to result in atrophy)
Anatomic landmarks of sublingual gland
lingual nerve is landmark
2 muscles to lift and separate - masseter and digastricus
