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1
Q

What are the causes of acute incisional hernia?

A

IAP
Entrapment of fat in closure
Inappropriate suture material
Infection
Chronic steroids
Poor post care

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2
Q

What the effects of abdominal compartment syndrome?

A

Hypotension
Visceral hypoperfusion
Acidosis
MODs
Inc ICP
Abdominal wall ischemia/necrosis
Hypoxia

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3
Q

What makes up the upper and lower esophageal sphincters?

A

Upper: thyropharyngeus and cricopharyngeus
Lower: thickening of the circumferential layer, diaphragmatic crura, angles of stomach-esophagus Jan, folds of GE mucosa

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4
Q

What are contributing factors to esophageal dehiscence?

A

Segmental blood supply
Lack of serosa
Lack of omentum
Constant motion
Tension

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5
Q

Options for esophageal patching

A

Omentum
Pericardium
Muscle flaps (sternothyroid, longus colli, intercostals, diaphragm)
Gastric/jejunal
(Lung)
Xenogeneic/artificial (PSIS, dura mater, mesh, ePTFE)

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6
Q

Options for esophageal substitution

A

Inverse tubed skin grafts
Muscle grafts
Gastric advancement and EG anastomosis
Isoperistaltic or anti peristaltic gastric tubes
SI or colon graft
Free microvascular small intestinal or colonic graft

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7
Q

Treatment options for esophageal strictures

A

Balloon dilation
Bougienage
Stent
Esophagoplasty
RNA
Patching
Substitution
Esophagocutaneous fistula

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8
Q

Types of hiatal hernias

A

Type 1: sliding hiatal hernia
Type 2: paraesophageal hiatal hernia
Type 3: 1+2
Type 4: other organs herniating

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9
Q

Techniques for pyloric stenosis

A

Fredet-ramstedt pyloromyotomy
Heineken-mikulics pyloroplasty
Y-U pyloroplasty
Billroth I
Billroth II

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10
Q

Flaps that can be used for head/face defects

A

Lip to lid (subdermal plexus)
Lip to nose (subdermal plexus)
Labial transposition (subdermal plexus/superior and inferior transposition flap)
Angularis oris
Superficial temporal
Caudal auricular
Pinna composite

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11
Q

Flaps for the palate defects

A

Buccal transposition/ random mucosal rotating (subdermal plexus)
Angularis oris
Sternohyoideus/sternothyroideus muscle flap
Haired angularis oris
Overlapping flap technique
Medially positioned flap technique
Labial-based mucoperiosteal flap
Split palatal U-flap technique
Tongue flap
Free graft (auricular cartilage, tibial bone graft)
Myoperitoneal microvascular flap (transverse/rectus abdominis)
Prosthesis
Superficial temporal

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12
Q

Flaps for thoracic limb defects

A

Thoracodorsal
Omocervical
Axillary fold
Superficial brachial

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13
Q

Flaps for pelvic limb defects

A

Lateral vehicular
Caudal superficial epigastric
Revers saphenous conduit
Flank fold flap

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14
Q

Flaps for trunk defects

A

Latissimus dorsi myocutaneous
Cranial superficial epigastric
Caudal superficial epigastric
Dorsal deep circumflex iliac
Ventral deep circumflex iliac
Flank fold flap, Elbow fold flap
Lateral caudal

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15
Q

Steps of graft take

A

Adherence
Plasmatic imbibition
Inosculation
Revascularization
Reinnervation

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16
Q

Etiologies of acquired megacolon

A

Extraluminal compression
Intraluminal obstruction
Metabolic (hypoK, hypothyroid)
Neuromuscular (sacral cord, Manx, ileus, dysatuonomia, idiopathic, angangliosis)
Idiopathic (most common)

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17
Q

What are the approaches to the cranial, middle, and caudal rectum?

A

Cranial: ventral midlein + pubic/ischial osteotomy
Middle: Dorsal perineal
Caudal:
Anal
Transcutaneous
Transanal
Combined abdominal + transanal

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18
Q

AGASACA staging

A

Stage 1 (primary tumor < 2.5 cm with no metastasis) MST 40mo
Stage 2 (primary tumor > 2.5 cm with no metastasis) MST 24mo
Stage 3a (lymph node < 4.5 cm) MST 15 mo
Stage 3b (lymph node > 4.5 cm) MST 10 mo
Stage 4 (distant metastasis) MST <3mo

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19
Q

What are proposed etiologies of perineal hernia?

A

Rectal/testicular/prostatic abnormalities
Androgens
Gender differences
Relaxin
Prostatic disease
Neurogenic atrophy of pelvic diaphragm mm

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20
Q

What are surgical options for repair of perineal hernia

A

Neuter PLUS
Traditional
IOMT
Superficial gluteal (new: bilateral for ventral repair)
Semitendinosus (ventral, recurrent)
Mesh
Biomaterials (Xenogenic or Autogenous)
Organopexy
New: Sacrotuberous ligament

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21
Q

What are considered “complicated” perineal hernias?

A

Bilateral
Significant rectal dilatation
Concurent prostatic disease
Retroflexed bladder
Recurrent

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22
Q

Etiologies for GB Mucocele

A

Genetics
Cholestasis
Hyperadenocroticism
Hypothyroid

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23
Q

Causes for acquired extra hepatic shunts

A

Hepatic fibrosis/cirrhosis
PVH with portal hypertension
Hepatic AV malformations
Shunt attenuation

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24
Q

Objective measures of shunt attenuation

A
  1. Maximum portal pressure of 17-24 cm H2O
  2. Maximum increase in portal pressure by 9-10 cm H2O
  3. Maximum decrease in CVP by 1 cm H2O
  4. Maximum decrease in arterial pressure by 5 mm Hg or <15%
  5. Heart rate should not increase dramatically
  6. Ultrasound – shunt and portal vein flow should remain hepatopetal
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25
Types of atresia ani
Type 1: stenosis of the anus Type 2: persistence of anal membrane, rectum ends immediately cranial to this membrane (imperforate anus/dimple) Type 3: persistence of anal membrane, but rectum ends more cranially Type 4: anus and terminal rectum develop normally, but cranial rectum ends as a blind pouch
26
What are the 3 stages of laryngeal collapse
Stage I = laryngeal saccule eversion Stage II = medial displacement of cuneiform processes Stage III = medial displacement of corniculate processes
27
Surgical options for LarPar
Unilateral cricoarytenoid lateralization Unilateral thyroaryntenoid lateralization Transoral partial laryngectomy Ventral laryngotomy for partial laryngectomy Castellated Laryngofissure Permanent tracheotomy
28
Grades of tracheal collapse
I: 25% II: 50% III: 75% IV: 100%
29
Options for a fractured tracheal stent
Medical mgmt New stent within fractured stent Extraluminal rings Remove stent vis tracheotomy
30
What causes a rightward shift of the oxygen-hemoglobin dissociation curve?
Acidosis Increased temp 2-3 diphosphoglycerate in RBCs CO2 (All these things inc with exercise --> better offloading --> happy peripheral tissues)
31
Causes of hypoxemia
Hypoventilation Low fraction of inspired oxygen diffusion impairment V/Q mismatch Shunting (right to left)
32
Muscle flap options for thoracic wall lesions
Diaphragmatic advancement, Diaphragm Latissimus dorsi External abdominal oblique Transversus abdominis Pectoral
33
Chylothorax treatment options
Medical: Rutin, low fat diet TDL ligation or embolization Cisterna chyli ablation Pericardectomy Omentalization Pleurodesis Decortication If recurrent: Pleural port Pleuropericardial shunts
34
Options for PDA after rupture
Jackson-Henderson Buttressed mattress sutures Division between clamps and pledget buttress continuous or interrupted mattres suture + oversew
35
Options for pulmonic stenosis
Endovascular balloon valvuloplasty (type A) Surgical pulmonic dilatation valvuloplasty (type A) Open patch-graft valvuloplasty (type A or B)
36
Types of Pulmonic stenosis
Type A: Normal diameter but fusion or thickened leaflets Type B: Hypoplastic annulus diameter
37
Components of Tetralogy of Fallot
Pulmonic stenosis Dextropositioned overriding aorta Perimembranous ventricular septum defect Secondary right ventricular hypertrophy
38
Medical mgmt of BPH
ANtiandrogens (delmadinon acetate, flutamide) LH inhibitors (megestrol acetate, medroxyprogesterone) GNRH agonists (Deslorelin acetate, Azagly-nafarelin, Leuprolide) 5-alpha reductase inhibitors (Finasteride) Estrogens
39
What are the components of Birt-Hogg-Dube in GSD?
The disease is characterized by bilateral, multifocal tumors in the kidneys, uterine leiomyomas and nodules in the skin consisting of dense collagen fibers AKA Hereditary multifocal renal cyystadenocarcinoma and nodular dermatofibrosis
40
What cells produce testosterone, estrogen, and progesterone?
Leydig (interstitial) cells, Granulosa cells
41
Treatment options for prostatitis/abscess
Castration + finasteride + Abx for 4 wk US guided drainage (Marsupialization/prostatocutaneous stoma) (Passive drainage) Active drainage Omentalization Partial prostatectomy
42
Treatment options for prostatic cysts
Neuter +... US guided drainage Complete resection Partial resection + omentalization (Marsupialization/partial prostatectomy)
43
Phases of IV pyelogram or excretory urogram
Phase 1: renal angiogenic phase Phase 2: renal phase Phase 3: excretory phase
44
Ways to measure GFR
Dynamic renal scintigraphy Plasma clearance studies
45
Options for kidney stones
Extracorporeal shockwave lithotripsy (not cats) Nephrotomy Pyelolithotomy Endoscopic nephrolitotomy Nephrectomy
46
Kidney Biopsy contraindications, risk factors for complications
- Uncontrolled coagulopathy - Uncontrolled hypertension - Large/multiple renal cysts/abscesses - Extensive pyelonephritis - Ureteral obstruction - Severe hydronephrosis - If biopsy is unlikely to alter disease course (CKD/end-stage renal dz) - If owners are unwilling to pursue further treatment 1. Thrombocytopenia 2. Prolonged clotting times 3. Uncontrolled hypertension 4. NSAIDs within past 5 days 5. Serum creatinine concentrations >5 mg/dL 6. Age > 5 yrs 7. Body weight < 5 kg 8. Severe hemorrhage (10%): uncontrolled hypertension, NSAIDs w/in past 5 days. Death in 3%
47
Treatment options for ureteral stones
Medical mgmt: Diuresis, +/- amitriptyline, glucagon Lithotripsy (dogs only) Stent Ureterotomy SUBS Neoureterocystostomy Intravesicular Extravehicular Ureteral RNA Ureteronephrectomy
48
Cystectomy augmentation techniques
o Seromuscular colonic augmentation procedure o Ileocystoplasty procedure o Rectus abdominis flap o Urinary diversion to the prepuce/vagina (colon high morbidity)
49
Options for bladder stone removal
Catheter assisted retrieval Transurethral scope removal Voiding hydropulsion Lithotripsy PCCL/ lap assisted Cystotomy
50
Options for bladder neoplasia
Chemo, NSAIDs Partial cystectomy (Total and rerouting) Tube cystostomy Stent Cytoscopic laser ablation Radiation
51
Urethral reinforcement
Rectus abdominus Internal obturator Omentum Papers: buccal mucosal graft, PSIS
52
Treatments for urethral stricture
RNA Urethrostomy Balloon dilation STent (Urethral replacement)
53
Etiologies of USMI
Congenital abnormalities Urethral tone and length Bladder neck position Body size and breed Gonadectomy Hormonal Status Genital Confformation
54
Treatments for USMI
Medications PPA Estriol GnRH analogues (Androgens) Increase urethral length/relocate bladder Colposuspension Urethropexy/Cystourethropexy Increase urethral resistance Transpelvic urethral sling Transobturator vaginal tape Bulking agents Artificial urethral sphincter
55
Complications of renal transplant and the major risk factors for death (*)
Renal dysfunction Acute* or chronic rejection Hemolytic uremic syndrome CaOx Retroperitoneal fibrosis Ureteral obstruction Delayed graft function Allograft rupture Infection * DM Neoplasia
56
Complications with adrenalectomy if cortisol secreting
Immunosuppression Delayed healing Hypercoagulable (PTE) Hypertensive HOC postop Pancreatitis
57
Pretreatments for Cortisol tumor? Pheochromocytoma?
Cortisol: Trilostane, ace-inhibitor or angiotensin receptor blocker Want ACTH stim 2-5 ug/dL PCC: phenoxybenzamine
58
Treatment for PTE
Oxygen IVF Anticoagulant (unfractionated heparin) Theophylline SIldenafil
59
Medical mgmt for hyperthyroid
Methimazole Iodine restricted diet Beta agonist (tachycardia/arrhythmias)
60
Surgical techniques for thyroidectomy
Extracapsular Modified extra capsular Intracapsular Modified intra capsular Parathyroid autotransplant Staged bilateral ?
61
What can affect scintigraphy uptake in the thyroid gland?
Iodinated contrast thyroid hormone supplementation
62
Complications of thyroidectomy
Hemorrhage Horners Larpar (bilateral) Hypothyroid Dyspnea MegaE (bilateral) (HypoCa)(bilateral)
63
Differentials for hypercalcemia
H: HyperPTH A: Addisons R: Renal disease, raisins D: Vitamin D I: Idiopathic, Infectious (granulomatous dz) O: Osteolytic N: Neoplasia (HHM), Nutritional
64
When is FNA NOT the answer?
Bladder, Ovarian, Thyroid masses
65
Medical mgmt of HyperCa
Diuresis Furosemide Glucocorticoids Bisphosphonates Calcitonin
66
Causes of entropion and treatment
Conformational Cicatricial Involutional Spastic Temporary tacking Holtz-Celsus procedure (crescent) Stades procedure (leave strip of granulation tissue)
67
Ectropion treatment
Modified Kuhnt-Szymanowski procedure V-Y PLasty
68
MCT Grading
Patnaik Grade I: well differentiated (20-35%, <10% met) Grade 2: intermediate (40-65%, <20% met) Grade 3: undifferentiated (5-25%, 95% met) Kiupel Low grade (MST 700-1400d) High grade (MST 100-200d)

Phase 2 (4 decks)

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