Soft Tissue Surgery Flashcards

Question

What are the 6 panniculus muscles of the dog?

Answer 1

cutaneous trunci, platysma, sphincter colli superficialis, sphincter colli profundus, preputialis, supramammarius muscles),

Answer 2

Inflammation, debridement, repair maturation

Answer 3

The first 3 to 5 days are the lag phase of wound healing because inflammation and debridement predominate and wounds have not gained appreciable strength

Answer 4

Monocytes are essential for wound healing; neutrophils are not. Monocytes are major secretory cells synthesizing growth factors that participate in tissue formation and remodeling. Monocytes become macrophages in wounds at 24 to 48 hours. Macrophages secrete collagenases, which remove necrotic tissue, bacteria, and foreign material.

Answer 5

Although healing is severely impaired when macrophage function is suppressed, neutropenia and lymphopenia do not inhibit healing or the development of wound tensile strength in sterile wounds.

Answer 6

3 to 5 days post-injury Macrophages stimulate DNA and fibroblast proliferation Fibroblasts originate from mesenchymal cells and migrate along fibrin strands ahead of new capillary beds, depositing collagen, elastin and proteoglycans to form fibrous tissue. collagen deposition is originally haphazard but begins to follow skin tension lines after the 5th day. Wound fibrin disappears as collagen is deposited. Capillaries invade wounds behind migrating fibroblasts (angiogenesis), leading to the formation of granulation tissue. Epithelialization begins within 4 to 5 days in wounds with adequate granulation bed (or immediately in well-apposed surgical wounds) under the influence of growth factors produced by platelets, macrophages and fibroblasts. Epithelial cells follow collagen fibers. Wound contraction begins after significant fibroblastic invasion of the wound, but is independent of epithelialization. It stops when wound edges meet, tension is excessive or myofibroblasts are inadequate. If contraction stops before granulation tissue is covered, epithelialization may continue and cover the wound.

Answer 7

Granulation tissue

Answer 8

Hours to 3-5 days Chemoattractants encourage neutrophils (6 hours) and monocytes (12 hours) to appear in the wound, preventing infection and phagocytizing organisms and debris. Monocytes synthesize growth factors that participate in tissue formation and remodeling (essential cell line for healing). They also recruit mesenchymal cells, stimulate angiogenesis and modulate matrix production in wounds. Platelets release growth factors important for fibroblastic activity Lymphocytes appear late in the debridement phase and improve the rate and quality of tissue repair

Answer 9

Begins immediately after injury and lasts 3 to 5 days Characterized by increased vascular permeability, chemotaxis of circulatory cells, release of cytokines and growth factors and cell activation (macrophages, neutrophils, lymphocytes and fibroblasts) Blood vessels initially constrict to limit hemorrhage (5 to 10 minutes), then dilate to leak fibrinogen and clotting elements. Platelets release potent chemo attractant in the growth factors necessary for later stages of healing Favorite and plasma translates fill wounds and plug lymphatics, localizing inflammation and “gluing“ wound edges together. A blood clot offers a low degree of world strength but acts as a barrier for infection Platelets, mast cells and macrophages continue to secrete growth factors and cytokines and initiate/maintain the proliferative phase of healing

Answer 10

Early removal of sutures

Answer 11

Wound contraction stops when wound edges meet, when tension is excessive, or when myofibroblasts are inadequate

Answer 12

It begins when collagen has been adequately deposited in the wound (typically around 20 days) and may continue for years. Granulation tissue cellularity and collagen content decrease. Collagen fibers remodel and re-orient improving wound strength along the lines of stress Non-functional oriented collagen fibers are degraded by proteolytic enzymes (MMPs) secreted by macrophages and other cells The most rapid gain and wound strength occurs between seven and 14 days after injury, balloons only ringing about 20% of their final strength in the first three weeks. Only 80% of the original strength will be ever regained.

Answer 13

During the maturation phase, between 7 and 14 days post wound 80%

Answer 14

1) promotes granulation tissue and faster epithelialization 2) promotes autolytic debridement by endogenous enzymes (does not affect healthy tissue); occurs within 72 to 96 hours 3) Low oxygen environment promotes macrophage penetration and activity, as well as angiogenesis and reepithelialization 4) resists infection because white blood cells are abundant in better able to promote phagocytosis. If receiving antibiotics, the drug concentrates in the fluid environment 5) no scab formation, therefore white blood cells are not trapped in the scab but rather migrate freely within the wound bed 6) faster epithelialization. Epithelial cells have a shorter distance to travel and do not dissicate. 7) moist wounds are less painful and pruritic and form less scar. Disadvantages: bacterial colonization (not infection), folliculitis and a maceration of the wound border

Answer 15

Warmth (30°C [86°F]) allows wounds to heal more quickly and with greater tensile strength than if they are at room temperature. A moist wound promotes recruitment of vital host defenses and cells, encouraging wound healing. Bandages help keep wounds warm and moist.

Answer 16

Macrophages resist hypoxia, but epithelialization and fibroblastic protein synthesis are oxygen dependent. Collagen synthesis requires 20 mm Hg partial pressure of oxygen (pO2). HBOT increases tissue oxygen and produces more rapid gains in wound strength. Accumulation of fluid in dead space delays healing because the hypoxic fluid environment of a seroma inhibits migration of reparative cells into wounds. Fluid mechanically prevents adhesion of flaps or grafts to the wound bed.

Answer 17

platelet-derived growth factor epidermal growth factor fibroblast growth factor type-transforming growth factor.

Answer 18

Fibronectins are glycoproteins critical to wound healing. They stimulate cell attachment and migration and are found in soluble form in plasma and in insoluble form in connective tissue matrix. Macrophages, endothelium, fibroblasts, and epithelium synthesize and release fibronectin.

Answer 19

Most chemotherapeutic drugs (e.g., cyclophosphamide, methotrexate, and doxorubicin) inhibit wound healing. Radiation therapy can profoundly inhibit wound healing, depending on dose and time of exposure relative to the time of injury. It reduces the quantity of blood vessels, affects collagen maturation, and causes increased dermal fibrosis. Therefore chemotherapeutic drugs and radiation therapy should be avoided for 2 weeks after surgery.

Answer 20

The “golden period” is the first 6 to 8 hours between wound contamination at injury and bacterial multiplication to greater than 10 ^5CFU per gram of tissue. A wound is classified as infected rather than contaminated when bacterial numbers exceed 105 CFU per gram of tissue.

Answer 21

Avulsion wounds are characterized by the tearing of tissues from their attachments and the creation of skin flaps

Answer 22

Severely traumatized and contaminated wounds, wounds older than 6 to 8 hours, or infected wounds should be treated as open wounds to allow debridement and reduction of bacterial numbers. Most wounds are surgically apposed after infection has been controlled; however, some wounds heal by contraction and epithelialization (healing by secondary intention).

Answer 23

Makes bacteria more susceptible to destruction by lysozymes, antiseptics, and antibiotics. Rapidly lyses P. aeruginosa, E. coli, and Proteus vulgaris Increases antimicrobial effectiveness approximately 1000-fold Precipitates in electrolyte solutions More concentrated solutions are cytotoxic and may slow granulation tissue formation Corneal toxicity

Answer 24

Wide antimicrobial spectrum Good residual activity Not inactivated by organic matter Precipitates in electrolyte solutions More concentrated solutions are cytotoxic and may slow granulation tissue formation Proteus, Pseudomonas, and Candida are resistant Corneal toxicity

Answer 25

The most consistent delivery method to generate 7 to 8 psi is a 1-L bag of fluid within a cuff pressurized to 300 mm Hg; 18G needle.

Answer 26

Low-level laser therapy (LLLT) has been advocated to stimulate wound healing in chronic wounds by shortening the inflammatory phase and enhancing the release of factors that stimulate the proliferative stage of repair. Increased collagen deposition and endothelial cell, fibroblast, and myofibroblast proliferation are the most significant effects.

Answer 27

Autolytic Debridement Autolytic debridement is accomplished through creation of a moist wound environment to allow endogenous enzymes to dissolve nonviable tissue. It is often preferred over surgical or bandage debridement in wounds with questionable tissue viability, as it is highly selective for devitalized tissue and markedly less painful than other methods of debridement; however, it is a much slower process. Autolytic debridement is accomplished with hydrophilic, occlusive, or semiocclusive bandages (see pp. 195–196), which allow wound fluid to remain in contact with nonviable tissue.

Answer 28

Surgical debridement Autolytic debridement Bandage (mechanical) debridement Enzymatic debridement Biosurgical debridement

Answer 29

Ideally, quantitative bacterial counts should be performed before grafts or flaps are placed over granulating wounds. Reconstruction should be delayed if bacterial counts are greater than 105 CFU per gram of tissue.

Answer 30

Selective use of antibiotics may help prevent or control integument infections after injury or surgery. Minimally or moderately contaminated wounds less than 6 to 8 hours old may be cleaned and closed or treated without antibiotics. Severely contaminated, crushed, or infected wounds, or wounds older than 6 to 8 hours, typically benefit from antibiotic therapy. Contaminated wounds and those with established infection should be cultured before antibiotics are given, and antibiotic selection should ultimately be based on culture and susceptibility testing.

Answer 31

Advantages of topical antibiotics over antiseptics in wound management include selective bacterial toxicity, efficacy in the presence of organic material, and combined efficacy with systemic antibiotics. Disadvantages include expense, narrower antimicrobial spectrum, potential for bacterial resistance, creation of superinfections, systemic or local toxicity, hypersensitivity, and increased nosocomial infections. Antibiotic solutions are preferable to ointments and powders. Ointments liberate antibiotics slowly and may be occlusive, promoting growth of anaerobic bacteria. Powders act as foreign bodies and should not be used.

Answer 32

Triple antibiotic ointment (bacitracin, neomycin, polymyxin) is effective against a broad spectrum of pathogenic bacteria commonly infecting superficial skin wounds. However, its efficacy against pseudomonads is poor. Zinc bacitracin is responsible for enhancing reepithelialization of wounds but can retard wound contraction. Because these drugs are poorly absorbed, systemic toxicosis (nephrotoxicity, ototoxicity, neurotoxicity) is rare. The ointment is more effective for preventing infections and treating mildly infected wounds.

Answer 33

Effective against gram-positive, gram-negative and fungi Serves as anti-microbial barrier, penetrates necrotic tissue Enhances epithelialization Better is combined with aloe vera (less suppression of fibroblasts and polymorphonuclear cells) Can be left in place for seven days Promotes a hydrophilic environment conducive to face healing Absorbs exudate

Answer 34

Gentamicin sulfate is available as a 1% ointment or powder (Garamycin), but solutions are preferred. Products with an oil-in-water cream base slow wound contraction and epithelialization. It is especially effective in controlling gram-negative bacterial growth (Pseudomonas spp., Escherichia coli, Proteus spp.). It is often used before and after grafting and for wounds that have not responded to triple antibiotic ointment. However, gentamicin in an isotonic solution does not inhibit contraction, and it promotes epithelialization.

Answer 35

effective against gram-positive and some gram-negative organisms Provides a high-level of antibiotic in wound fluid Prolonged minimum inhibitory concentration in wounds in comparison to systemic administration 95% bioavailable and rapidly absorbed, systemic levels equal wound fluid levels within one hour

Answer 36

Mafenide (hydrochloride or acetate) is a topical sulfa compound available as an aqueous spray most commonly used for burn wounds in humans. It has a broad spectrum against many gram-positive and gram-negative bacteria, including Pseudomonas spp., Clostridium spp., and methicillin-resistant Staphylococcus aureus; it is particularly useful on severely contaminated wounds.

Answer 37

Effective against pseudomonas Antifungal Anti-prostaglandin and anti-thromboxane properties help maintain vascular patency Stimulates fibroblastic replication Penetrates tissue and provides analgesia Active ingredients such as allantoin stimulate epithelial growth Counteract the inhibitory effects of Silver sulfadiazine when combined Should not be applied to full thickness wounds because it suppresses inflammation

Answer 38

Acemannan stimulates macrophages to secrete interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF-α), which enhance fibroblast proliferation, neovascularization, epidermal growth and motility, and collagen deposition to form granulation tissue. Acemannan may also bind growth factors, prolonging their stimulating effect on formation of granulation tissue. The greatest effects are seen in the first 7 days of application. Excess granulation tissue can occur, especially with the freeze-dried form, which inhibits wound contraction.

Answer 39

Reduces edema • Reduces inflammation • Accelerates wound debridement • Promotes granulation tissue formation • Accelerates epithelization • Antimicrobial

Answer 40

Should be applied early in the course of wound healing and discontinued once a healthy granulation bed is present. Medical grade unpasteurized honey should be used, ideally as an impregnated sterile gauze covered by thick absorbent bandage. Bandages should be replaced once to three times daily depending on the amount of Strikethrough.

Answer 41

Hydrolyzed bovine collagen (Woun’Dres Collagen Hydrogel, Collasate) has hydrophilic properties that help create a moist environment for autolytic debridement in early phases of wound healing and an optimal environment for epithelialization in latter stages. The collagen matrix provided serves as a lattice for ingrowth of fibroblasts, thus facilitating the repair phase of wound healing. It is probably most effective when used in the late inflammatory and early repair phases of healing to accelerate epithelialization.

Answer 42

0.05% What part of 2% stock solution to 40 parts of wound lavage fluid (add 25 ML of 2% stock solution to 1 L of LRS)

Answer 43

Pseudomonas, Proteus and candida

Answer 44

Strongly acidic (pH 3.2) Requires frequent reapplication, residual effect 4 to 6 hours Inactivated buy organic matter such as blood or serous exudate Absorbed through the skin and mucous membranes. Frequently application may lead to transient thyroid dysfunction Damages tissue and potentiates infection Causes contact hypersensitivity in over 50% of dogs Toxic to fibroblasts

Answer 45

SHOULD NOT BE USED Hydrogen peroxide, even in low concentrations, damages tissue and is a poor antiseptic. It is an effective sporicide; therefore it may be beneficial if clostridial spores are suspected. Hydrogen peroxide dislodges bacteria and debris from wounds by effervescent action.

Answer 46

SHOULD NOT BE USED Dakin’s solution is a 0.5% solution of sodium hypochlorite (1 : 10 dilution of laundry bleach). It releases free chlorine and oxygen into tissue, killing bacteria and liquefying necrotic tissue. However, even at half or quarter strength, Dakin’s solution is detrimental to neutrophils, fibroblasts, and endothelial cells and should not be used as a wound lavage solution.

Answer 47

panniculus, preputialis, supramammarius, platysma, and sphincter colli muscles

Answer 48

Increases blood flow •Reduces edema •Increases rate of granulation tissue formation •More rapid reduction in numbers of microorganisms •Removal of exudate •Greater flap survival

Answer 49

Pneumatic tourniquets with pressures below 300 mm Hg for less than 3 hours should be used.

Answer 50

Local separation Deep venous thrombosis Neoplasia Trauma Vascular injury or circulatory compromise

Answer 51

Ischemia, hypoxia, tissue acidosis, neurapraxia, muscle damage

Answer 52

1. Amount of time that has elapsed since injury. Wounds older than 6 to 8 hours are initially treated with bandages. 2. Degree of contamination. Obviously contaminated wounds should be thoroughly cleansed and initially treated with bandages. 3. Amount of tissue damage. Wounds with substantial tissue damage have reduced host defenses and are more likely to become infected; therefore they initially should be treated with bandages. 4. Completeness of debridement. Wounds should remain open if the initial debridement was conservative and if further debridement is necessary. 5. Status of the wound’s blood supply. A wound with questionable blood supply should be observed until the extent of nonviable tissue is determined. 6. The animal’s health. Animals unable to tolerate prolonged anesthesia are best treated with bandages until their health improves. 7. Extent of tension or dead space. If excessive tension or dead space is present, wounds should be bandaged to prevent dehiscence, fluid accumulation, infection, and delayed wound healing. 8. Location of the wound. Large wounds in some areas (e.g., limbs) are not amenable to closure.

Answer 53

Removes exudates and toxic components •Maintains high humidity at the wound-dressing interface •Allows gaseous exchange •Provides thermal insulation •Relieves pain •Protects from secondary infection •Protects from particulate or toxic contaminants •Allows dressing removal without wound trauma

Answer 54

Hypertonic saline •Calcium alginate •Polyurethane foam •Hydrogel •Hydrocolloid •Some topical medications

Answer 55

Acemannan Tripeptide copper complex Occlusive hydrogel dressings Equine amnion Pulsed electromagnetic field radiation Adjustable horizontal mattress sutures Skin stretchers

Answer 56

Corticosteroids Silver sulfadiazine Mafenide acetate Hydrocolloid dressings Porcine small intestine submucosa Thick skin grafts or flaps

Answer 57

Hydrogel Hypertonic saline dressing Medicinal Honey

Answer 58

Hypertonic saline dressing

Answer 59

Moisture barrier ointment Skin sealant Transparent film dressing Bandage

Answer 60

These dressings quickly convert necrotic wounds to moderately exudating and granulating wounds. Debridement is nonselective, so use is limited to one or two applications; these dressings are usually followed with placement of alginate, hydrogel, or foam dressings once granulation tissue has begun to form. Hypertonic saline bandages should be changed at least every 24 hours to prevent saline dilution and wound desiccation.

Answer 61

Calcium alginate

Answer 62

The angles of the Z can vary between 30 degrees and 90 degrees, but 60 degrees is advised. Larger angles give more length gain (45 degrees gives approximately a 50% increase; 60 degrees approximately a 75% increase). Length is gained along the original central limb of the Z when the flaps of the Z are transposed

Answer 63

Combined V technique (Does not remove additional normal skin) Bowtie technique (removes 36% additional skin, so adequate when dog ears are present)

Answer 64

A specific flap may be classified in more than one way. Most flaps are called subdermal plexus flaps; however, those with direct cutaneous vessels are called axial pattern flaps.

Answer 65

The flap is created in the same way as a transposition flap except that the length of the interpolation flap must include the length of the intervening skin segment

Answer 66

latissimus dorsi trapezius cutaneous trunci gracilis semitendinosus

Answer 67

Development of myocutaneous flaps requires the presence of direct cutaneous arteries exiting the muscle surface to supply the overlying skin.

Answer 68

Sternohyoideus and sternothyroideous muscles

Answer 69

Cranial sartorius muscle flap

Answer 70

Cranial sartorius muscle flap

Answer 71

The caudal sartorius receives its blood supply from the Saphenous artery and medial saphenous vein, while the cranial sartorius derives its entire blood supply from the femoral artery/vein

Answer 72

The humeral head of the flexor carpi ulnaris muscle

Answer 73

Temporalis muscle flap

Answer 74

It attaches ventrally to the greater curvature of the stomach and dorsally to the pancreas and spleen. The omental blood supply is from peripheral vessels of the right and left gastroepiploic arteries.

Answer 75

The process by which graft or nourished immediately after implantation. Graft vessels dilate and pull fibrinogen-free, Serum like fluid and cells from the graft bed into the dilated vessels of the graft. Absorption of hemoglobin containing cells give the graft a bluish black color. Edema peaks at 72 hours and improves as lymphatic drainage/venous return are reestablished.

Answer 76

Second phase of grafting, when blood vessels from the graft bed and the graft itself anastomose. This may begin as early as the first day of grafting. Vascular buds from the graft bed follow the fibrin scaffold to meet pre-existing severed graft vessels. Blood flow is initially sluggish but approach is normal by the 5-6 day.

Answer 77

Separation from the graft bed, infection and movement

Answer 78

Infection is detrimental to graft survival because bacteria may cause dissolution of fibrin attachments or produce sufficient exudate to lift a graft from the recipient bed. Plasminogen activators and proteolytic enzymes released by bacteria disrupt the fibrin seal. β-Hemolytic streptococci and pseudomonads produce large amounts of plasmin and proteolytic enzymes. Pseudomonas spp. also produce elastase, which breaks down elastin; elastin adheres to fibrin, facilitating graft adhesion.

Answer 79

Silver sulfadiazine

Answer 80

Hypertonic saline for hydrogel dressing with silver sulfadiazine and biguanide impregnated gauze

Answer 81

Hydrogel or calcium alginate and biguanide impregnated gauze

Answer 82

What are urethane foam and biguanide impregnated gauze

Answer 83

The affected body parts should be rapidly rewarmed in warm water (39°C–42°C [102°F–107.6°F]) for approximately 20 minutes to improve circulation. Affected areas become erythematous and edematous, form large vesicles, and are often painful, necessitating analgesics (see Chapter 13). Topical aloe vera or silver sulfadiazine should be applied to the affected areas. Bandages are used to prevent self-trauma. Conservative therapy should be continued until viable tissue can be distinguished from nonviable tissue (i.e., 3–6 weeks). Necrotic tissue should then be debrided and the area reconstructed if necessary. Healing may be complete beneath the mummified tissue.

Answer 84

cutaneous erythema, (2) superficial epidermal (dry) desquamation, (3) moist desquamation from loss of basal layers of epidermis, and (4) necrosis with dermal destruction and irreversible ulceration.

Answer 85

Manage burn wounds in the usual manner for the first 14 days (hydrophilic bandages, hydrocolloid with acemannan, silver sulfadiazine) Debride chronic radiation injury areas conservatively, removing only necrotic tissue. Submit all tissue for histopathology. Avoid free grafts as the vascular supply of the recipient bed may not be healthy enough to support inosculation. Favor vascularized myocutaneous, cutaneous, muscle, or omental flaps.

Answer 86

BEPES-CC Pasteurella multocida, Staphylococcus spp., Enterococcus spp., Bacillus spp., and E. coli; common anaerobic isolates include Clostridium spp. and Corynebacterium spp

Answer 87

Thoroughly lavage and explore puncture wounds to determine depth/extent. Explore body cavities if wounds penetrate. Ultrasonography and radiography can help but may also grossly underestimate the extent of the injury. Manage with hydrophilic bandages for 3 to 5 days before closure. Make sure to debride all divided lysed and necrotic tissue before closure. Consider the use of active or passive drains. Obtain cultures if signs of infection are present. Otherwise provide coverage with beta-lactam antibiotics for approximately 14 days.

Answer 88

The oral cavity and oropharyngeal mucosa heal more rapidly than skin because phagocytic activity (primarily monocytes rather than polymorphonuclear leukocytes) and epithelialization are more extensive and occur earlier in mucosa. An excellent mucosal blood supply, warmer temperatures, higher metabolic activity, and a higher mitotic rate contribute to rapid healing of mucosa. Apposed wounds reepithelialize within a few days, and defects heal by second intention.

Answer 89

The primary palate consists of the lip and pre-maxilla. Incomplete closure is known as primary cleft or cleft lip (harelip). The secondary palate consists of the hard palate and soft palate. Incomplete closure is known as cleft palate.

Answer 90

Genetics (recessive or irregular dominant, polygenic traits) Nutritional (inadequate Folic acid) Hormonal (steroids) Mechanical (in utero trauma) Toxic (including viral)

Answer 91

Boston terriers, Pekingese, Lhasa apso, bulldog

Answer 92

Aspiration pneumonia, middle ear disease

Answer 93

“Locate the mandibular salivary gland between the linguofacial and maxillary veins as they join the external jugular vein (Fig. 18.36A). Incise the skin, subcutaneous tissue, and platysma muscle from the angle of the mandible caudally to the external jugular vein to expose the fibrous capsule of the mandibular gland (see Fig. 18.36B). Avoiding the branch of the second cervical nerve that crosses the capsule, incise the capsule and dissect it away from the mandibular and monostomatic sublingual salivary glands. Ligate the artery (branch of the great auricular artery) and vein as they are “encountered on the dorsomedial aspect of the gland. Continue dissecting cranially, following the mandibular duct, sublingual duct, and polystomatic sublingual glands toward the mouth (see Fig. 18.36B). Incise the fascia between the masseter and digastricus muscles. Expose the entire mandibular and sublingual salivary gland complex by retracting the digastricus muscle and applying caudal traction on the mandibular gland. If necessary, perform digastricus muscle myotomy or tunnel the caudal sublingual gland duct complex under the digastricus muscle to improve visualization. Dissect (digital and sharp) rostrally until the lingual branch of the trigeminal nerve is identified and only ducts remain in the complex. Avoid traumatizing the lingual or hypoglossal nerves. Try to identify the gland-duct defect causing the mucocele, because failure to identify this defect may indicate that the mucocele originated from the contralateral gland-duct complex (Fig. 18.37). Ligate and transect the mandibular sublingual gland-duct complex just caudal to the lingual nerve. “Lavage the surgical site before closure. Appose the digastricus muscle if it has been incised with horizontal mattress or cruciate sutures. Close the dead space with a few sutures in the capsule and deep tissue. Routinely appose superficial muscles, subcutaneous tissue, and skin. Following excision, submit the glands and ducts to rule out neoplasia and submit a portion of the mucocele wall to rule out congenital cysts.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 94

“The vascular supply of the cervical esophagus is from branches of the thyroid and subclavian arteries. Bronchoesophageal arteries and segmental branches from the aorta supply the thoracic esophagus. The abdominal esophagus is supplied by branches from the left gastric and left phrenic arteries. Intramural branches ramify and anastomose in the submucosal layer. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 95

no serosa no Omentum segmental blood supply constant motion and bolus distention intolerance to longitudinal stretching”

Answer 96

“• Choose the most advantageous approach • Preserve vasculature; dissect sparingly • Suction the lumen prior to incising • Make incision through healthy tissue • Make longitudinal esophagotomy incisions • Inspect for contralateral perforations or necrosis • Resect only 3 to 5 cm during esophagectomy • Incorporate submucosa with all sutures • One-layer closure—keep knots extraluminal • Two-layer closure—inner layer: intraluminal knots; outer layer: extraluminal knots • Tension-relieving techniques: circumferential myotomy, gastric advancement, phrenic nerve interruption, pexy sutures • Seal and support with a harvested omental flap or muscle flap • Treat esophagitis with proton pump inhibitors and/or gastric prokinetics” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 97

Preservation of blood supply Avoidance of tension Maintenance of adequate cardiac output Optimal oxygen saturation levels

Answer 98

Shearing forces Bacterial burden Blood supply during shock (PaO2) “Gastrointestinal wound healing differs from healing of the skin in several other ways as well. First, in cutaneous wounds, shear stress is either minimal or can be minimized by bandaging or activity restriction. In the gastrointestinal tract, however, increased intraluminal pressure during peristalsis can inflict significant shear forces upon the healing intestinal wound. Second, the bacterial flora of the gastrointestinal tract is polymicrobial, containing both aerobic and anaerobic bacteria that can significantly and adversely impact anastomotic healing. Skin flora is largely aerobic, and numbers can be reduced by cleansing; thus, healing will not be as negatively impacted. Third, during states of hypovolemic shock, vascular perfusion to the gastrointestinal tract decreases, and this may negatively impact anastomotic healing; vascular perfusion to the skin, however, is relatively constant.62,147 In a retrospective study of 225 dogs undergoing surgery of the gastrointestinal tract, intraoperative hypotension was identified as being significantly associated with the development of septic peritonitis and death following surgery.62 In addition to vasomotor control of perfusion, arterial tissue oxygen pressure (PaO2) is critical for wound tissue oxygenation. Mature collagen formation fails when PaO2 is below 40 mm Hg. Below 10 mm Hg, impairment of the critical components of wound healing (i.e., angiogenesis, epithelialization[…]” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 99

Circumferential myotomy Gastric advancement Phrenic nerve interruption Pexy sutures

Answer 100

“Make an incision through the right fourth or fifth intercostal space. Identify and transect or retract the latissimus dorsi, serratus ventralis (dashed line), scalenus, and external abdominal oblique muscles. (B) Incise the intercostal muscles. (C) Expose the thoracic viscera.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 101

“Position the patient in lateral recumbency as described previously for cranial lateral thoracotomy. Perform a caudal lateral thoracotomy (Fig. 18.45A). Although the caudal esophagus can be approached through an incision in either the left or right eighth or ninth intercostal space, the left ninth space is preferred. Expose the caudal esophagus by transecting the pulmonary ligament and packing the caudal lung lobes cranially. Identify the esophagus, which is just ventral to the aorta (see Fig. 18.45B). Identify the dorsal and ventral vagal nerve branches on the lateral aspect of the esophagus and protect them. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 102

“left ninth space is preferred” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 103

“Place each suture approximately 2 mm from the edge and 2 mm apart. Incorporate the mucosa and submucosa in the first layer of a two-layer simple interrupted closure. Place sutures so that the knots are within the esophageal lumen (Fig. 18.46A–B). Incorporate the adventitia, muscularis, and submucosa in the second layer of sutures with the knots tied extraluminally” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 104

“Augmentation of esophagotomy or esophagectomy sites with omentum or muscle can aid healing by supporting, sealing, and revascularizing the surgical site. Muscle pedicles from the sternohyoid, sternothyroid, intercostal, diaphragm, or epaxial muscles can be mobilized and sutured over the primary repair or esophageal defect (Fig. 18.50A). As an alternative, omentum can be mobilized from the abdomen, brought through a rent in the diaphragm, and sutured over the esophageal site (see Fig. 18.50B). Pedicles from the gastric wall and pericardium have also been used.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 105

Acute onset of regurgitation

Answer 106

“water-soluble, organic, iodine contrast materials or iohexol are recommended. Isotonic iodinated contrast agents are the safest as they will not cause pulmonary edema if aspirated or if there is a bronchoesophageal fistula. Hypertonic iodinated contrast agents should be avoided in these situations. However, one does not generally do a contrast radiograph to look for perforation (see the discussion on endoscopy presented later), and the presence of a foreign body may mask identification of a perforation during an esophagram. If a bronchoesophageal fistula is suspected, a hypertonic iodinated contrast agent should not be used because its hypertonicity may cause pulmonary edema. Foreign bodies can also be diagnosed endoscopically, which is usually the next step after finding a suggestive density on plain radiographs.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 107

“water-soluble, organic, iodine contrast materials or iohexol are recommended. Isotonic iodinated contrast agents are the safest as they will not cause pulmonary edema if aspirated or if there is a bronchoesophageal fistula. Hypertonic iodinated contrast agents should be avoided in these situations. However, one does not generally do a contrast radiograph to look for perforation (see the discussion on endoscopy presented later), and the presence of a foreign body may mask identification of a perforation during an esophagram. If a bronchoesophageal fistula is suspected, a hypertonic iodinated contrast agent should not be used because its hypertonicity may cause pulmonary edema. Foreign bodies can also be diagnosed endoscopically, which is usually the next step after finding a suggestive density on plain radiographs.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 108

Persistent fourth right aortic arch Right dorsal aortic root Rudimentary left ligamentum arteriosum (connects the left pulmonary artery and the descending aorta). Same structure as the ductus arteriosus, but no longer patent.

Answer 109

“The esophagus is encircled by the ligamentum arteriosum (or patent ductus arteriosus) on the left, the base of the heart and pulmonary artery ventrally, and the aortic arch on the right.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 110

Persistent Right Aortic Arch (95% of cases) German shepherds, Irish setters, Boston terriers clinical signs typically begin at the time of weaning with introduction of solid food. Regurgitation is typically observed, possibly with aspiration pneumonia. Esophageal dilation with tracheal deviation to the left around the base of the heart is a typical radiographic sign.

Answer 111

1) Pure transudate 2) modified transudate 3) exudate 4) hemorrhagic 5) chylous 6) "other” (i.e. pseudochylous, biliary effusion across the diaphragm)

Answer 112

1) clear, colorless fluid 2) contains minimal protein (\<1.5 g/dL) and few cells (\<1500 cells/µL) 3) Predominant cell types are mononuclear cells Causes: Pure transudates typically form from decreased oncotic pressure associated with hypoalbuminemia (\<1.5 g/dL). Causes of hypoalbuminemia include malnutrition, hepatic disease, portal vascular anomalies, protein-losing nephropathy, protein-losing enteropathy, vasculitis, malabsorptive disorders, wounds, and burns.2,4 Congestive heart failure can also induce pure transudate pleural effusion.1 With chronicity, pure transudates can convert to modified transudates because of inflammation.

Answer 113

1) Protein concentrations of 2.5-3.5 g/dL 2) Cell counts between 1,500-5,000/µL 3) Mixed cell population including macrophages, neutrophils, lymphocytes, neoplastic cells, mast cells, and eosinophils. Causes: Modified transudates usually form with increased hydrostatic pressure or decreased lymphatic drainage. Causes of modified transudates include congestive heart failure, neoplasia, hepatic disease, renal disease, lymphatic obstruction (e.g. neoplasia), diaphragmatic hernia, pulmonary thromboembolism, lung lobe torsion, pericardial effusion, or heartworm infection.2 Pleural effusion can develop in dogs with right-sided congestive heart failure. In cats, left- or right-sided congestive heart failure can result in pleural effusion.5

Answer 114

1) Exudates may appear turbid, opaque, white, yellow, or red. Fluid may be thick, viscous, and have a foul odor. 2) Higher protein concentration (\>3.0 g/dL) 3) Higher cell counts (\>5000/µL) than pure or modified transudates. I 4) Can contain numerous cell types. Exudates are further classified as septic or nonseptic as follows: a) Nonseptic exudates have no evidence of microorganisms and contain nondegenerative neutrophils. b) Septic exudates typically have degenerative neutrophils as the predominant cell type, and organisms may be present.5,7 Exudates form secondary to increased vascular permeability; decreased lymphatic drainage; or increased lymphatic permeability.2 They can also arise with inflammatory and neoplastic diseases.3 Causes of exudative effusions include pneumonia (e.g. bacterial, fungal, viral, parasitic), penetrating thoracic wounds, lung lobe torsion, pancreatitis, neoplasia, feline infectious peritonitis, perforation of mediastinal structures, lymphomatoid or eosinophilic granulomatosis, uremia, and immune-mediated diseases.2,5 Pyothorax is a type of septic exudate caused by infection of the pleural space.7

Answer 115

Modified Light Criteria, based on effusion Lactate Dehydrogenase (LDH) and serum protein measurements. Exudates have more than 200 UI/L of LDH. This method has been shown to be over 90% accurate in differentiating transudates from exudates. Effusions have traditionally been differentiated based on neutrophil percentage. Pure and Modified transudates have less than 30% neutrophils (Pure transudates have less than 1500 cells/uL, while Modified transudates have 1500 to 5000 cells/uL). Exudates have more than 30% neutrophils, and typically \> 5000 cells/uL. This classification scheme has been proven only 40-53% accurate

Answer 116

1) Packed cell volume (PCV) similar to that of peripheral blood. 2) With chronic effusions, erythrophagocytosis may be seen. 3) Chronic hemorrhagic effusions do not clot and contain no platelets, which contrasts with most cases of acute hemothorax. Causes: trauma, neoplasia, coagulopathy, pulmonary infarction, lung lobe torsion, dirofilariasis, and surgery.2,7

Answer 117

1. triglyceride-rich fluid found in lymphatics. 2. milky-white or pink appearance and contains chylomicrons. 3. Fluid triglyceride concentration is higher than serum triglyceride concentration. Pleural fluid cholesterol:triglyceride ratio is \<1. 4. Protein content is typically 2-6.5 g/dL 5. cell count is usually \<10,000/µL. 6. Predominant cells are small lymphocytes but neutrophils and macrophages may also be present.⁵ [_Chylothorax_](https://www.vin.com/Members/Associate/Associate.plx?DiseaseId=587) can occur with thoracic lymphangiectasia, pericardial effusion, cardiac disease, neoplasia, trauma or rupture of the thoracic duct, and diaphragmatic hernias. Idiopathic chylothorax has been reported in the Afghan hound, shiba inu, and purebred cats.²

Answer 118

Biochemistry analysis: Pseudochylous effusions are caused by the breakdown of cells, and can look similar to chyle. They can be differentiated via cholesterol measurement (higher than chyle), normal levels of triglycerides (similar to serum) and no chylomicrons. Lipid-laden macrophages may be present.

Answer 119

“The most common sites for traumatic abdominal hernias are the prepubic region and the flank.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 120

Cryptorchidism

Answer 121

Peritoneopericardial diaphragmatic hernia Weimaraner

Answer 122

The body wall maybe sutured to the medial fascia of the adductor muscle or a caudal sartorius flap may be created.

Answer 123

“Nerve deficits or severe pain may indicate compromise of the femoral nerve during the repair; reoperation is warranted in such cases.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 124

Primary: Unknown cause, typically gram- positive Secondary: contamination from G.I. tract due to surgical wound dehiscence neoplasia, gallbladder perforation, intussusception, mesenteric avulsion, GDV, necrotizing cholecystitis, prosthetic abscesses and iatrogenic G.I. rupture during endoscopic procedures. Typically Gram-negative

Answer 125

Clinical syndrome associated with irreversible sclerosis of the peritoneum membrane. Reported and the dogs possibly caused by foreign bodies, steatitis, fiberglass ingestion, bacterial peritonitis and leishmaniasis. Typically life-threatening. Treated with glucocorticoids, open abdomen lavage and Tamoxifen (no proven cure)

Answer 126

“The classic radiographic finding in animals with peritonitis is loss of visceral detail with a focal or generalized “ground glass” appearance (Fig. 19.17). The intestinal tract may be dilated with air or fluid or both. Free abdominal air may occur due to rupture of a hollow organ and sometimes from infection with gas-producing anaerobic bacteria. Localized peritonitis may occur secondary to pancreatitis and can cause the duodenum to appear fixed and elevated (a sentinel loop).” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 127

“Escherichia coli, Clostridium spp., and Enterococcus spp. ” Ampicillin with enrofloxacin Amikacin with either clindamycin or metronidazole Second generation cephalosporin (cefoxitin)

Answer 128

Eliminate the cause of contamination Resolve infection Restore normal fluid and electrolyte balance

Answer 129

Plasma (replaces clotting factors)

Answer 130

Low dose heparin “Low-dose heparin (Box 19.5) increases survival and significantly reduces abscess formation in experimental peritonitis. The inflammatory process in peritonitis is associated with an outpouring of fibrous exudate that causes intraabdominal loculation of bacteria. The loculated bacteria are protected from host defense mechanisms and antibiotics that may not be able to penetrate the fibrin clots. Although the exact mechanism of its beneficial effect is still unknown, heparin appears indicated in patients with severe peritonitis. Heparin may also be incubated with plasma and given to animals with disseminated intravascular coagulation ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 131

“Disadvantages include hypoalbuminemia, hypoproteinemia, anemia, and nosocomial infections.” Alternative: Jackson Pratt vacuum assisted suction drainage

Answer 132

“Animals with peritonitis often are endotoxic and hypotensive. Small amounts of endotoxins are normally absorbed from the intestine and transported via the portal system to the liver where they are removed and destroyed by hepatocytes; however, hypotension in dogs is associated with intense portal vasoconstriction. This vasoconstriction causes breakdown of the intestinal mucosal barrier, allowing more intestinal endotoxin to be absorbed. If hepatic function is impaired (a common condition in septic animals), small doses of endotoxin that would normally be harmless may be lethal. Therefore hypotension should be corrected before and prevented during and after surgery in animals with peritonitis.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 133

“Dogs with septic peritonitis treated with vacuum-assisted, closed suction, or OAD are likely to develop nosocomial infection and hypoproteinemia. Administration of albumin and/or early nutritional intervention is often necessary in these cases after surgery (see Postoperative Care and Assessment).” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 134

Retroauricular vein (ventromedial aspect of the inner aspect of the tympanic bulla) External Carotid artery (ventral aspect of the acoustic meatus) Superficial temporal artery (cranial aspect of the acoustic meatus) Caudal Auricular Artery (caudal aspect of the acoustic meatus) Maxillary vein (cranioventral aspect of the accustic meatus)

Answer 135

“Dogs with spontaneous hemoperitoneum have evidence of hypocoagulability, protein C deficiency, and hyperfibrinolysis.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 136

“Surgical intervention is indicated when the PCV of lavage samples taken within 5 to 20 minutes of each other increases substantially or if an animal in shock does not respond to aggressive fluid therapy (Box 19.7).” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 137

“Hemodynamically significant intraabdominal hemorrhage • Evidence of intraabdominal bile leakage • Septic peritonitis • Body wall herniation; prepubic tendon rupturea • Diaphragmatic herniationa • Uroabdomena” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 138

Invasiveness Low specificity, leading to a higher rate of non-therapeutic laparotomy’s Easily misses retroperitoneal lesions and diaphragmatic ruptures.

Answer 139

Ultrasonography (AFAST) High sensitivity, specificity and accuracy May underestimate the degree of injury and delayed complications CT scan remains the gold standard for a stable patient

Answer 140

Hypocalcemia Prolonged coagulation times Hemolysis

Answer 141

Quadrate and right medial

Answer 142

“The portal vein drains the stomach, intestines, pancreas, and spleen and supplies four-fifths of the blood that enters the liver. The remainder of the afferent blood supply is derived from the proper hepatic arteries. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 143

“In the fetal pup, the ductus venosus shunts blood from the umbilical vein to the hepatic venous system. The ductus venosus becomes fibrotic after birth and is known as the ligamentum venosum.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 144

“The portal vein, bile ducts, hepatic artery, lymphatics, and nerves are contained in the lacelike and nonsupporting portion of the lesser omentum known as the hepatoduodenal ligament.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 145

“Before performing the dissection, pass umbilical tape around the portal vein, celiac artery, cranial mesenteric arteries, and caudal vena cava in front of and behind the liver.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 146

“aorta, the azygos and hemiazygos veins, and origin of the thoracic duct from the cisterna chyli” Excerpt From Miller's Anatomy of the Dog Howard E. Evans & Alexander de Lahunta https://books.apple.com/us/book/millers-anatomy-of-the-dog/id875302085 This material may be protected by copyright.

Answer 147

Hypophosphatemia

Answer 148

“Complications can include portal hypertension, ascites, fever, hemorrhage, hypophosphatemia, or persistent bile drainage” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 149

“important hepatotrophic substances from the pancreas (e.g., insulin) and intestines do not reach the liver, resulting in hepatic atrophy or failure of the liver to attain normal size. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 150

65% CEPSS 35% IHPSS

Answer 151

“Multiple shunts most commonly occur in the left renal area and the root of the mesentery ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 152

“Affected animals usually develop portal hypertension and multiple collateral shunting vessels, resulting in acute onset of low-protein transudative ascites between the ages of 2 and 18 months (Figs. 20.8 and 20.9). In contrast, dogs with congenital PSS rarely have ascites.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 153

“small-breed dogs are more likely to have extrahepatic shunts and large-breed dogs are more likely to have IHPSS.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 154

Congenital PSS

Answer 155

“The most common presenting sign in dogs with congenital hepatic AV fistulae is sudden onset of depression, ascites, and vomiting. Despite the chronic nature of this condition, the animal often has an acute onset of gastrointestinal or neurologic signs. The ascites is typically a pure low-protein transudate despite a serum albumin greater than 1.8 g/dL. “Animals with hepatic AV fistulae may be presented for evaluation of gastrointestinal foreign bodies. Presumably gastric irritation causes pica in these animals.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 156

Microhepatica

Answer 157

CT angiography “Angiography has surpassed the ability of ultrasound to detect and define the anatomy of shunts in dogs.12 It was also shown to be superior to intraoperative mesenteric portography.13 CT angiography was better able to depict the portal supply to the liver; however, temporary shunt occlusion during mesenteric portography was helpful and should be considered if the presence of normal portal supply to the liver is questionable at surgery.13 CT scans can also be used to document liver volume and have been used to demonstrate improvement in liver volume after shunt attenuation, whereas CT angiography may show return to normal hepatic arterial perfusion following shunt attenuation.14” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 158

“Hematologic abnormalities may include microcytosis with normochromic erythrocytes, mild nonregenerative anemia, target cells, or poikilocytosis.” “Biochemical tests often reveal a reduction in serum albumin, cholesterol, and/or blood urea nitrogen (BUN) concentrations” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 159

“The serum bilirubin concentration is usually normal. Fasting hypoglycemia rarely occurs. Prothrombin time, activated PTT, and activated coagulation time are usually normal” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 160

“Hyperuricemia and hyperammonemia lead to increased urinary excretion of urate and ammonia, promoting urinary precipitation of ammonium biurate crystals. Hematuria, pyuria, and proteinuria may occur if urate calculi form. The hematologic and biochemical profiles of canine hepatic AV fistulae can be similar to those of dogs with congenital or acquired PSS.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 161

“Protein C is a sensitive test for hepatic insufficiency, and dogs with congenital PSS typically have lower protein C levels than dogs without macroscopic shunting. Dogs with hepatic failure have the lowest levels of protein C of all dogs with hepatobiliary disease. These differences may prove useful in differentiating cases of hepatic failure, congenital PSS, and HMD. Interleukin-6 (IL-6) has been found at higher levels in dogs with portosystemic shunting and may be involved in the pathophysiology of hepatic encephalopathy17; IL-6 has also been found to be elevated in dogs with liver disease.1” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 162

Critical to measure both pre-and post prandial levels Some dogs with very high bile acid concentrations (greater than sign 150 µMol/L) do not have clinical important about it disease while some dogs with only modestly increased levels (50 to 60 µmol/liter) They actually have PSS Substantial bile acid concentration variations occur from day-to-day

Answer 163

“Medical management of patients with symptomatic, congenital PSS was associated with a mortality rate of 48%, with approximately 30% succumbing to shunt-related illness compared with 12% mortality and 10% of deaths related to PSS in cases treated surgically.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 164

NO “Only patients with congenital (as opposed to acquired) PSS are surgical candidates.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 165

“Encephalopathic patients should be stabilized before surgery. The value of pretreating surgical candidates with anticonvulsants is uncertain. Potassium bromide (dogs), phenobarbital (cats), or levetiracetam are typically used to attempt to lessen the incidence of postoperative seizures. Levetiracetam (20 mg/kg PO every 8 hours) administered to patients prior to surgery is believed to reduce or perhaps prevent seizures in animals with PSS. Because of the high incidence of postligation seizures in cats, pretreatment with this drug should be strongly considered. Fluid and electrolyte imbalances should be corrected preoperatively. Perioperative antibiotics (e.g., cephalosporins) are recommended for patients with PSS.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 166

“Intraoperatively, patients often do well until the shunt is partially occluded (which is generally not an issue when an ameroid ring or cellophane band is used). At that time, preload may be markedly reduced, causing a reduction in cardiac output and systemic blood pressure. Because this is not a failure of the heart's ability to contract, the patient may not respond to inotropes (e.g., dobutamine, dopamine). Instead, return of blood flow to the heart needs to be increased by adjustment of the ligature. Central venous pressure measurements can aid in evaluating the consequences of ligation. It is recommended to have central venous pressures not decrease by more than 1 cm H2O from the baseline measurement approximately 3 minutes after ligation.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 167

“the portal system usually originates at the level of the first lumbar vertebra ” “The portal vein is formed by the confluence of the cranial and caudal mesenteric veins and the splenic vein. The splenic vein enters the portal vein at the level of the thoracolumbar junction. The phrenicoabdominal veins terminate in the caudal vena cava approximately 1 cm cranial to the renal veins. Any vein that enters the caudal vena cava cranial to the phrenicoabdominal veins (before the hepatic veins) may be considered an anomalous structure.” Examine the caudal vena cava carefully. The only vessels that should enter the caudal vena cava between the renal veins and the hepatic veins are the small phrenicoabdominal veins.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 168

“Perform a midline abdominal incision. Identify the portal vein by retracting the duodenum to the left and ventrally. Locate the caudal vena cava, renal veins, phrenicoabdominal veins, and portal vein (ventral to the caudal vena cava at the most dorsal aspect of the mesoduodenum).” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 169

“ If jejunal portography was not performed (see later), exteriorize a segment of jejunum and insert a 20- to 22-gauge over-the-needle catheter (e.g., Angiocath) into a jejunal vein. Do not damage the corresponding jejunal artery. Obtain baseline portal pressures. Temporarily occlude the shunt and observe portal pressures during this manipulation. Occlusion of the shunt should result in a rapid increase in portal pressure, which aids in confirmation that it is an anomalous vessel. Check portal pressures carefully before and during shunt ligation. If you are unsure whether complete ligation should be attempted, err on the conservative side and attenuate the shunt. If you are uncertain whether the vessel you have occluded is the shunt, perform jejunal portography.” “Once you have positively identified the shunt, slowly tighten the ligature while monitoring the portal pressure. If possible, completely occlude the shunting vessel, but do not allow postligation portal pressures to exceed 10 cm H2O (8 mm Hg) above baseline pressures, or 20 to 23 cm H2O (15–18 mm Hg)” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 170

“Positive contrast radiographs can determine whether the shunt is extrahepatic or intrahepatic. If the caudal extent of the congenital PSS is cranial to T13, the shunt is probably intrahepatic. If the caudal extent of the shunt is caudal to T13, it probably is extrahepatic.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 171

Paired vein. Located on the ventral aspect of the thoracolumbar vertebrae. Receives blood from the lumbar, dorsal costoabdominal, dorsal intercostal and bronchoesophageal veins. Empties into the cranial vena cava

Answer 172

Transvenous retrograde portograph: A baloon catheter is introduced into the external jugular vein, extended into the cranial vena cava and into the azygous vein. The balloon is inflated to occlude the vein. Contrast medium is administered as radiographs or fluoroscopy are performed. If a shunt is present a column of contrast can typically be seen following a tortuous vessel connecting the azygous vein to the portal system. If the azygous vein is normal, the same process is repeated in the caudal vena cava.

Answer 173

Typical signs of portal hypertension include painful abdomen, hemorrhagic diarrhea, and endotoxic shock and death.

Answer 174

Pancreatitis

Answer 175

“Prolonged EHBO may cause vitamin K malabsorption, resulting in deficiencies of factors VII, IX, and X. Animals with clinical evidence of bleeding or increased mucosal bleeding time should receive vitamin K1 (subcutaneous [SC], not intravenous [IV] or intramuscular [IM]) for 24 to 48 hours before surgery (Box 21.1) or fresh whole blood ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 176

“Necrotizing cholecystitis occurs when bacteria devitalize the gallbladder wall, often resulting in peritoneal spillage of bile (Fig. 21.1). This frequently leads to the development of severe, generalized septic peritonitis. Sometimes bile becomes inspissated before the gallbladder ruptures, and spillage of the relatively thick, gelatinous mass into the cranial abdomen causes a localized peritonitis. Adhesions or fistulous tracts occasionally occur around the gallbladder. See p. 583 for a discussion of the preoperative management of animals with bile peritonitis.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 177

“Animals with EHBO should be differentiated from those with intrahepatic cholestasis causing partial obstruction; the former rarely needs surgery, but the latter almost never require surgical correction. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 178

“The canine bile duct terminates in the duodenum near the opening of the minor pancreatic duct. This combined opening of the minor (accessory) pancreatic duct and the bile duct is the major duodenal papilla.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 179

“Chronic stenting may be associated with ascending infection.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 180

“After abdominal exploration, perform a longitudinal duodenotomy of the antimesenteric border of the duodenum over the major duodenal papilla. Flush the biliary tract as necessary, and treat primary disease (cholecystotomy, cholecystectomy, biliary duct repair). Pass a 5 to 10 cm fenestrated segment of red rubber catheter up the common bile duct via the duodenal papilla so that approximately one-half of the stent lies within the common bile duct and the other half resides within the duodenal lumen. Suture the stent to the submucosa of the duodenum aboral to the duodenal papilla using absorbable suture. Stents should be passed in the feces in 1 to 11 months or can be removed endoscopically if inflammation or infection is suspected.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 181

“cholecystectomy, which has a lower morbidity/mortality rate, is the preferred technique.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 182

“Expose the gallbladder and use Metzenbaum scissors to incise the visceral peritoneum along the junction of the gallbladder and the liver (Fig. 21.4A). Apply gentle traction to the gallbladder and use blunt dissection to free it from the liver. Free the cystic duct to its junction with the common bile duct. Be sure to identify the common bile duct and avoid damaging it during the procedure. If necessary, identify the common bile duct by placing a 3.5- or 5-Fr soft catheter into the duct via the duodenal papilla. Make a small enterotomy in the proximal duodenum, locate the duodenal papilla, and place a small red rubber tube into the common bile duct (see Fig. 21.4B). Flush the duct to ensure its patency. Clamp and double ligate the cystic duct and cystic artery (see Fig. 21.4C) with nonabsorbable suture (2-0 to 4-0). Sever the duct distal to the ligatures and remove the gallbladder. Submit a portion of the wall, plus bile, for culture if infection is suspected. Submit the remainder of the gallbladder for histologic analysis if indicated (for cholecystitis or neoplasia). Close the duodenal incision in a simple interrupted pattern with absorbable suture (2-0 to[…]” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 183

“If cholecystojejunostomy is performed, the proximal jejunum should be used to reduce the incidence of postoperative maldigestion of lipids. In dogs, it has been recommended that the stoma between the bowel and the gallbladder should be at least 2.5 cm long to minimize the potential for obstruction of bile flow or retention of bowel contents in the gallbladder. Making the stoma too small is more apt to result in ascending or chronic cholecystitis than is making the stoma too large.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 184

“If possible, avoid biliary diversion in dogs with pancreatitis. Almost all affected animals improve with medical management, making this potentially dangerous technique unnecessary.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 185

“Biliary surgery in dogs is associated with a mortality of approximately 15% to 25%; those surviving the immediate postoperative period often have good long-term outcomes, although infection is common when cholecystoenterostomy is performed. Biliary diversion techniques have a worse prognosis than cholecystectomy. Development of postoperative dyspnea and hypotension may be associated with decreased survival.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 186

“Biliary diversion in cats may be associated with high early mortality, and surviving cats may have chronic vomiting and anorexia. Vomiting is typically transient in nature and is responsive to antibiotics. Thus biliary diversion should be avoided unless no other viable alternatives exist.

Answer 187

“Potential complications after cholecystectomy (particularly if perforation was present) include generalized peritonitis, shock, sepsis, hypoglycemia, hypoproteinemia, and hypokalemia.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 188

“The relative rarity of canine cholelithiasis may be due to (1) decreased concentrations of cholesterol in canine bile, (2) absorption of ionized calcium from the gallbladder, limiting the amount of free ionized calcium in bile, and (3) failure to recognize choleliths.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 189

Radiolucent Hyperechoic casting an acoustic shadow

Answer 190

Cholecystectomy

Answer 191

Gallbladder mucocele

Answer 192

“Mucoceles are characterized histologically by hyperplasia of mucus-secreting glands within the gallbladder mucosa, resulting in an abnormal accumulation of thick mucus within its lumen” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 193

“Shetland sheepdogs, cocker spaniels, Scottish terriers, and miniature schnauzers ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 194

Rupture of the extrahepatic biliary tree Necrotizing cholecystitis Chronic obstruction also may lead to buy leakage, although this is quite rare

Answer 195

Diagnostic peritoneal lavage “Comparing bilirubin concentrations in serum and abdominal fluid is 100% effective in diagnosing bile leakage. Bilious effusions have bilirubin concentrations greater (typically two times) than those found in serum.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 196

“Submit samples of bile, gallbladder wall, and liver parenchyma for aerobic and anaerobic culture and susceptibility testing. This is important because of the resistant nature of the bacteria involved and also because many of these patients have previously been or are currently being administered antibiotics.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 197

“In this study, 100% and 33% of gallbladder and liver cultures, respectively, were positive. E. coli was most often cultured, but other isolates included Enterococcus spp., Clostridium perfringens, and occasionally Enterobacter cloacae, Klebsiella, Proteus, and Bacteroides spp” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 198

“The left adrenal is slightly larger than the right. The left gland lies ventral to the lateral process of the second lumbar vertebra; the right adrenal is more cranial, lying ventral to the lateral process of the last thoracic vertebra” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 199

“Because of the proximity of the right adrenal to the caudal vena cava, surgical removal of neoplastic glands can be difficult. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 200

“Approximately 25% of adrenal neoplasms invade the caudal vena cava, phrenicoabdominal veins, or renal vasculature” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 201

“PTE is a potentially life-threatening complication of adrenal surgery, particularly in dogs with adrenal neoplasia. Sudden, severe postoperative respiratory distress may indicate PTE. Lung perfusion scans may help identify lung regions that are underperfused. To help prevent this have the dog walk every 2 to 3 hours to promote circulation. Sufficient analgesics should be provided so that the dog can be coaxed to walk 4 hours after it wakes up. Treatment with strict cage rest, oxygen, anticoagulants (e.g., clopidogrel, aspirin, heparin), and thrombolytic agents (e.g., streptokinase, tissue plasminogen activator) has been proposed in the past, but the value of these pharmacologic agents is uncertain (see Box 29.1). Animals treated for PTE with thrombolytics should be assessed frequently for evidence of hemorrhage, and the hematocrit should be checked every 2 hours. If the packed cell volume (PCV) drops or hemorrhage is noted, the thrombolytic infusion should be discontinued.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 202

Basisphenoid bone Apophysis (Pituitary gland)

Answer 203

Diabetes Insipidus Treated with Desmopressin (synthetic vasopressin/ADH) for 2 weeks

Answer 204

Transsphenoidal

Answer 205

“The cranial and caudal thyroid arteries are the principal blood supply of the thyroid. The cranial thyroid artery arises from the common carotid artery; the caudal thyroid artery typically arises from the brachiocephalic artery. The cranial and caudal thyroid arteries anastomose on the dorsal surface of the gland, where they send numerous vessels that supply the gland. The cranial thyroid artery in dogs usually sends a branch that supplies the external parathyroid gland before entering the thyroid parenchyma. In cats, the branch that supplies the external parathyroid gland may arise from the cranial thyroid artery after it has perforated the capsule. Caudal thyroid arteries may not be present in cats. Innervation to the thyroid is provided via the thyroid nerve, which is formed from the cranial ganglion and the cranial laryngeal nerve.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 206

“The extracapsular approach is used in dogs with malignant thyroid tumors (e.g., carcinomas; see p. 628), and no attempt is made to spare the ipsilateral parathyroid glands. Intracapsular and modified extracapsular approaches have been described for thyroidectomy in cats ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 207

Re-implant the tissue at a nearby muscl belly (sternohyoideus muscle). It is very likely to revascularize and become functional

Answer 208

“Make a skin incision from the larynx to a point cranial to the manubrium. Bluntly separate the sternohyoid and sternothyroid muscles. Use a self-retaining (e.g., Gelpi) retractor to maintain exposure. Identify the enlarged thyroid gland and the external parathyroid gland (Fig. 22.21). Make an incision on the caudoventral surface of the gland in an avascular area (Fig. 22.22), and extend it cranially with small scissors (e.g., iris scissors). Using a combination of blunt and sharp dissection, carefully remove the thyroid tissue from the capsule. Perform the dissection carefully to prevent damage to the parathyroid gland or its blood supply. Use bipolar cautery to achieve hemostasis, but avoid damaging the gland's blood supply. After the thyroid parenchyma has been removed, excise most of the thyroid capsule; however, do not excise the capsule that is intimately associated with the external parathyroid gland. If the parathyroid gland is inadvertently excised, or if its blood supply is damaged, transplant the gland to a nearby muscle belly (see p. 613). Close subcutaneous tissue in a simple continuous suture pattern (e.g., 3-0 or 4-0 absorbable). Close the skin in a simple continuous or simple interrupted suture pattern (e.g., 3-0 nonabsorbable).” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 209

“hypocalcemia, hypothyroidism, recurrence of hyperthyroidism, worsening of renal disease, Horner syndrome, laryngeal paralysis.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 210

“Visualization of the abnormal parathyroid gland may be facilitated by infusion of IV methylene blue in saline solution (see Box 22.13). Abnormal parathyroid tissue may stain dark blue with this procedure. A potential side effect of methylene blue administration is hemolytic anemia caused by Heinz body formation. Severe and occasionally fatal Heinz body anemia has been reported after the use of methylene blue. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 211

“percutaneous ultrasound-guided radiofrequency heat ablation was successful in 69% of dogs, whereas percutaneous ultrasound-guided ethanol ablation was successful in 85% of dogs.29,30” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 212

Great Danes German shepherds English bulldogs “This same study found castrated males to be more commonly affected than females or intact males.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 213

-notably enlarged spleen that is diffusely hypoechoic with linear echoes separating large, anechoic areas - Enlargement of hilar splenic vessels - B-mode evaluation of the splenic veins for intraluminal echoes and spectral or color Doppler evaluation for absent velocity flow may be important assessments to make in dogs with splenic torsion and/or infarction. - Visible splenic vein intraluminal echogenicities compatible with thrombi may be seen ultrasonographically in dogs with splenic torsion that have vascular congestion and compression and thrombosis of the splenic vein. - Spectral Doppler and color Doppler imaging of the splenic vein will show an absence of flow in affected dogs.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 214

“Laboratory analysis may reveal anemia, leukocytosis, hemoglobinuria, elevated serum alkaline phosphatase activity, thrombocytopenia, and/or elevated alanine transaminase activity. Proactive monitoring of coagulation parameters to allow for early recognition of signs of coagulopathy and prompt administration of appropriate treatment may help decrease the mortality rate associated with this condition.19” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 215

“In a 2012 study of 249 dogs with splenic masses, nearly half were found to have nonmalignant disease.21 The most common splenic tumor in dogs is HSA; this tumor is more commonly diagnosed in large dogs (\>27.8 kg) than small dogs.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 216

Hemangiosarcoma liposarcoma lymphoma blastoma adenocarcinoma ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 217

“Fibroma Hemangioma Lipoma Myelolipoma” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 218

8.7% Boston, SE et al, 2011

Answer 219

liver, omentum, mesentery, and brain.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 220

HSA Mastocytoma lymphosarcoma myeloproliferative disease Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 221

“Splenic involvement is a consistent finding in cats with noncutaneous systemic mastocytosis. It is not associated with the feline leukemia virus and is primarily a disease of older cats. Mast cell infiltrates may be recognized in other organs (e.g., liver, lymph nodes, and bone marrow), and circulating mastocytosis may be present in 50% of affected cats. Splenomegaly is one of the most common gross findings in feline mast cell disease, which is usually diagnosed by finding neoplastic cells in the circulation or on bone marrow examination.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 222

“Importantly, large splenic masses may be more likely to be benign than malignant. Dogs with benign splenic masses often have larger and heavier spleens than dogs with HSA.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 223

“In one study, no dogs with grossly normal livers had metastasis detected on liver pathology; however, nodules (whether multiple, dark-colored, and/or actively bleeding) were highly associated with malignancy.28” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 224

“In one study, the median life expectancy of dogs with benign and malignant lesions was 436 and 110 days, respectively.” Cleveland, MJ et al, 2013 Dogs with hemoperitoneum, anemia, ventricular arrhythmias or thrombocytopenia may have a shorter survival Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 225

“Median survival time of dogs with splenic HSA treated with splenectomy alone was 1.6 months in a 2015 study.” New significant difference when the entire follow-up is considered, but significantly prolonged survival during the first 4 months if conventional or metronomic chemotherapy is utilized. Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 226

“Over 50% of dogs with splenic lymphoma treated by splenectomy alone will survive at least 1 year, and animals surviving to a year are unlikely to die of this disease. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 227

Weight loss “For cats with weight loss, the time was 3 days; for those without weight loss, the time was 293 days” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 228

“A wound is classified as infected rather than contaminated when bacterial numbers exceed 10^5 CFU per gram of tissue.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 229

“Although the total peripheral white blood count appears to be a poor indicator of intestinal dehiscence, an increase in the band neutrophil count may be more suggestive of peritoneal contamination” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 230

“Burn wounds are sterile or colonized only by superficial bacteria during the first 24 hours. The large volume of dead tissue provides an excellent medium for bacterial growth, and occlusion of local blood supply impairs delivery of humeral and cellular defense mechanisms and systemic drugs to the wound. Superficial bacteria proliferate and invade the deeper tissue under the eschar within 4 to 5 days of injury. Initially, most organisms are gram-positive cocci, but by 3 to 5 days, the wound is colonized with gram-negative bacteria, typically Pseudomonas spp. Early removal of eschar and application of topical antibiotics are necessary to minimize the progression of damage.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 231

1) Treat/prevent shock 2) Minimize tissue loss 3) Prevent sepsis

Answer 232

“rule of nine: each forelimb of the animal represents approximately 9% of the total body surface area (TBSA); each rear limb is 18% (two nines); and the dorsal and ventral thorax and abdomen are each 18%. Animals with partial-thickness burns involving less than 15% TBSA require minimal supportive therapy, whereas those with burns involving more than 15% TBSA require emergency supportive care. Euthanasia should be considered for those with burns involving more than 50% TBSA” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 233

“ Silver sulfadiazine is bactericidal with activity against gram-positive and gram-negative bacteria and Candida spp. However, aloe vera is associated with faster rates of reepithelization in partial-thickness burns. Paraffin gauze dressings have been shown to be associated with short healing times in superficial burns, and silver-based dressings are of most benefit in deeper burns. Alginate silver (e.g., Silvercel, Algidex AG) is an advanced wound dressing that combines the antimicrobial properties of silver with the absorptive wound management properties of calcium alginate and polyurethane foam; application to partial-thickness burns is associated with decreased pain scores and overall good wound outcome. Nanocrystalline silver dressings (Acticoat) have stronger antibacterial activity and are associated with less pain and reduced frequency of bandage changes.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 234

“Estimate the burn depth and calculate the size of the burn in relationship to the TBSA obtained from a weight conversion chart (see previous discussion and Table 15.5). Clip the wound and surrounding hair before gently lavaging with an antiseptic solution (e.g., 0.05% chlorhexidine diacetate). Cover the wound with a topical aloe vera compound or silver sulfadiazine (see p. 186), and then apply a hydrophilic bandage. After the first 24 hours, apply water-soluble, 1% silver sulfadiazine cream (Thermazene, Silvadene) to the wound once or twice daily or a slow-release silver sulfadiazine dressing (SilvaSorb) once every 3 to 7 days (see p. 200). Alternatively, apply medicinal honey to the wound (see p. 187). Bandage the wound, and aseptically manage it during subsequent bandage changes performed at intervals appropriate for the contact layer and amount of exudation (see Boxes 15.7–15.10 and Tables 15.2, 15.3, and 15.6). Medicinal honey bandages may require bandage changes several times daily. Remove the proteinaceous gel from the surface of the wound during bandage changes and before reapplication of topicals. Use gentle hydrotherapy to remove debris and clean the wound.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 235

“Low-voltage electrical current (\<1000 V) follows the path of least resistance, which is usually along blood vessels. Low-voltage burns char tissue at the initial site, which decreases conductivity and limits further current flow, minimizing further injury. The initial contact point with high-voltage currents (\>1000 V) negligibly decreases conductivity; therefore injury is extensive. Tissue necrosis occurs from vascular thrombosis and release of vasoactive substances. Tissue damage may be massive because of deep extension of the generated heat.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 236

“Interdigital pyoderma (granuloma, acne, furunculosis, folliculitis) is a bacterial pododermatitis that may coexist with other conditions. Sometimes erroneously called an interdigital cyst, pododermatitis may be caused by parasites, allergies, mycoses, irritants, neoplasms, and metabolic, neurologic, or autoimmune disease. Bacterial infections usually occur secondary to demodicosis, allergy, hypothyroidism, or hyperglucocorticoidism. Immunosuppression is suspected in some animals. The primary bacterial pathogen is Staphylococcus pseudintermedius; secondary opportunistic bacteria include Proteus spp., P. aeruginosa, and E. coli. The condition is seen frequently in West Highland white and Scottish terriers, Pekingese, and English bulldogs.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 237

“Conservative surgical treatment involves incision, exploration, and debridement of all fistulous tracts. Lesions should be medicated with antibacterial agents (e.g., chlorhexidine, povidone-iodine, and nitrofurazone) and bandaged for 24 to 48 hours. Subsequently, they should be soaked with an antibacterial solution for 15 to 20 minutes twice daily. Oral antibiotics based on sensitivity testing are administered for 6 to 8 weeks. Lesions that fail to respond to this treatment may require fusion podoplasty (see p. 265). Excision of all the interdigital tissue is usually curative in cases that fail to respond to medical therapy.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 238

“Before performing the dissection, pass umbilical tape around the portal vein, celiac artery, cranial mesenteric arteries, and caudal vena cava in front of and behind the liver. The tape is passed through rubber tubing, which can be used to occlude the hepatic blood supply if uncontrollable hemorrhage occurs.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 239

“For specific dissection of the left lateral liver lobe isolate, ligate and divide the left lateral lobar hepatic artery and biliary duct. Retract the left lateral lobe laterally, and retract the left medial lobe medially. Expose the left lateral portal vein and hepatic vein(s), the latter being cranial and to the left. Isolate, ligate, and divide the left lobar portal vein, then separate the parenchyma of the left lateral lobe from the left hepatic vein using the inner cannula of a Poole suction tip. Divide the triangular ligament, and ligate and divide the left lateral lobar hepatic vein.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 240

“The most common presenting sign in dogs with congenital hepatic AV fistulae is sudden onset of depression, ascites, and vomiting. Despite the chronic nature of this condition, the animal often has an acute onset of gastrointestinal or neurologic signs. The ascites is typically a pure low-protein transudate despite a serum albumin greater than 1.8 g/dL.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 241

Ptyalism and copper-colored eyes

Answer 242

“A 2014 study evaluated long-term survival and quality of life in 97 dogs that underwent surgery and 27 dogs that were medically managed for congenital portosystemic shunting.19 Fourteen medically treated dogs had intrahepatic portosystemic shunting; 78% of the medically treated dogs had extrahepatic portosytemic shunting. Mortality rate was 89% (n = 24) for medically managed and 22% (n = 21) for surgically treated dogs. Median survival time for medically managed dogs was 836 days. Because of the large number of surgically treated dogs that were alive at the time of the report, median survival time was not reported for this group. Acute mortality associated with surgery was 4%.19 Quality-of-life scoring based on neurologic, gastrointestinal, and urinary signs was better at all follow-up times in the surgery group compared with the medically managed group. However, it is important to note that all patients were clearly symptomatic due to their shunts, and that there was no control over case allotment into surgery or nonsurgery categories.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 243

“Examine the caudal vena cava carefully. The only vessels that should enter the caudal vena cava between the renal veins and the hepatic veins are the small phrenicoabdominal veins.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 244

The liver has a very robust blood supply and phagocytic ability (reticuloendothelial cells). Reported causes include Diabetes Mellitus, ascending biliary tract infections, hematogenous, hepatic trauma (Sx, penetrating wounds, blunt trauma), neoplasia. Puppies develop due to omphalophlebitis (usually a necropsy finding).

Answer 245

“Percutaneous ultrasound-assisted drainage and alcoholization using 95% ethanol may be considered.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 246

Mammary Glands 1 and 2: Ventral and lateral branches of the intercostal, internal thoracic, and lateral thoracic vessels Mammary Glands 2 and 3: Cranial superficial epigastric vessels Mammary Glands 4 and 5: Caudal superficial epigastric vessels Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 247

“The axillary lymph node drains the three cranial glands, and the inguinal lymph node drains the two caudal glands. However, there are lymphatic connections between glands and across the midline.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 248

“Fibronectins are glycoproteins critical to wound healing. They stimulate cell attachment and migration and are found in soluble form in plasma and in insoluble form in connective tissue matrix. Macrophages, endothelium, fibroblasts, and epithelium synthesize and release fibronectin.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 249

“Early dehiscence of the lip occurs if the orbicularis oris muscle has not been apposed. Contraction of the unapposed muscle during lip movement causes excess tension on the suture line” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 250

“Tissues are friable after dehiscence; therefore repair of early dehiscence should be delayed for 4 to 6 weeks to allow tissues to revascularize and regain strength” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 251

“Make a skin incision from the dorsal border of the scapula, over the scapular spine, to the proximal third of the humerus. Continue the skin incision around the forelimb at this level (Fig. 36.8A). Transect the trapezius and omotransversarius muscles at their insertions on the scapular spine. Transect the rhomboideus muscle from its attachment on the dorsal border of the scapula, and retract the scapula laterally to expose its medial surface (Fig. 36.8B). Next, elevate the serratus ventralis muscle from the medial surface of the scapula (Fig. 36.8C). Continue to retract the scapula to expose the brachial plexus and axillary artery and vein. Ligate the axillary artery and vein with a three-clamp and transfixation suture technique (Fig. 36.9). Transect the brachial plexus. Transect the brachiocephalicus muscle, deep and superficial pectoral muscles, and latissimus dorsi muscle near their humeral insertions (Fig. 36.8D–E). Remove the forelimb. To close the wound, approximate the muscle bellies to cover the brachial plexus and vessels, and then suture subcutaneous tissue and skin (Fig. 36.8F).” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 252

“Make a skin incision around the rear limb at the level of the middle third of the femur (Fig. 36.10A). The lateral aspect of the skin incision should extend farther distally than the medial aspect. On the medial side, open the femoral triangle by incising between the pectineus muscle and the caudal belly of the sartorius muscle to expose and ligate the femoral artery and vein (Fig. 36.10B) using a three-clamp technique. Transect the sartorius, pectineus, gracilis, and adductor muscles approximately 2 cm from the inguinal crease (Fig. 36.10C). Isolate the medial circumflex femoral vessels over the iliopsoas muscle and ligate them. Transect the iliopsoas muscle at its insertion on the lesser trochanter, and reflect it cranially to expose the joint capsule (Fig. 36.10D). Incise the joint capsule and cut the ligament of the head of the femur (Fig. 36.10E). On the lateral side, transect the biceps femoris muscle and the tensor fascia lata at the midfemoral level, and reflect them proximally to expose the greater trochanter and sciatic nerve (Fig. 36.10F). Sever the sciatic nerve distal to its muscular branches to the semimembranosus, semitendinosus, and biceps femoris muscles. Transect the gluteal muscle insertions close to the greater trochanter. Transect the semimembranosus and semitendinosus muscles at the level of the proximal third of the femur. Sever the external rotator muscles and the quadratus femoris muscle at their attachments around the trochanteric fossa. Elevate the rectus femoris muscle from its origin on the pelvis. Incise the joint capsule circumferentially and remove the limb. Close the wound by flapping the biceps femoris muscle medially and suturing it to the gracilis and semitendinosus muscles. Flap the tensor fascia lata caudally, and suture it to the sartorius muscle. Suture subcutaneous tissue and skin” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 253

“Sever the sciatic nerve distal to its muscular branches to the semimembranosus, semitendinosus, and biceps femoris muscles” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 254

Sublingual gland and duct

Answer 255

Lingual artery Hypoglossal nerve Lingual nerve

Answer 256

Hypokalemia, hypochloremia, and metabolic alkalosis with or without aciduria would suggest gastric or proximal duodenal obstruction.

Answer 257

• Scintigraphy: considered the most accurate determination of gastric emptying but requires radioactive isotopes and has limited availability outside a referral setting. Gastric emptying time is 100-180 minutes.

Answer 258

20% mortality in the first 2 weeks -if cat survives 2 weeks, long-term survival is likely Hypoadrenal crisis Sepsis due to wound healing complications/large wounds Pancreatitis Renal Failure Hemorrhage Thrombosis (Source: Daniel et al, J Fel Vet Sur 2016)

Answer 259

* Parathyroid adenoma (62%) * PU/PD/hyporexia, weakness * Parathyroid carcinoma (21%) * Two cats were diagnosed with laryngeal paralysis secondary to presumed iatrogenic intraoperative trauma of the recurrent laryngeal nerve. * Long term prognosis is excellent; MST \>1000 days * Survival time was not associated with preoperative iCa group, hypocalcemia at discharge, hypercalcemia at discharge, or diagnosis of carcinoma. Singh, A, Giuffrida, MA, Thomson, CB, et al. Perioperative characteristics, histological diagnosis, and outcome in cats undergoing surgical treatment of primary hyperparathyroidism. Veterinary Surgery. 2019; 48: 367– 374. https://doi.org/10.1111/vsu.13165

Answer 260

Great Dane and Weimaraner Evans K, Adams V. Mortality and morbidity due to gastric dilatation-volvulus syndrome in pedigree dogs in the UK. *The Journal of small animal practice*. 2010;51:376-381. doi:[10.1111/j.1748-5827.2010.00949.x](https://doi.org/10.1111/j.1748-5827.2010.00949.x)

Answer 261

30% Evans K, Adams V. Mortality and morbidity due to gastric dilatation-volvulus syndrome in pedigree dogs in the UK. *The Journal of small animal practice*. 2010;51:376-381. doi:[10.1111/j.1748-5827.2010.00949.x](https://doi.org/10.1111/j.1748-5827.2010.00949.x)

Answer 262

Angularis oris, superior labial, lateral nasal, and their anastomoses Page 5 Guzu M, Rossetti D, Hennet PR. Locoregional Flap Reconstruction Following Oromaxillofacial Oncologic Surgery in Dogs and Cats: A Review and Decisional Algorithm. *Front Vet Sci*. 2021;8:685036. doi:[10.3389/fvets.2021.685036](https://doi.org/10.3389/fvets.2021.685036)

Answer 263

Aural cholesteatoma, an epidermoid cyst forming within the tympanic cavity, should be identified before considering surgery because owners should be warned that recurrence of this disease after TECA LBO is common (Hardie et al. 2008). Most dogs have acquired forms of this condition, since most have a history of chronic ear disease, and epithelial migration is thought to occur through a perforate tympanic membrane into the tympanic cavity. CT and radiographic changes consistent with this disease include osteoproliferation (particularly when expansion of the bulla is seen), bulla lysis, and bone lysis of the petrosal or squamous portion of the temporal bone (Hardie et al. 2008).

Answer 264

Cefazolin is not recommended as a perioperative antibiotic since many of these subcutaneous contaminants are not susceptible to this antibiotic (Vogel et al. 1999; Hettlich et al. 2005). Prophylactic intravenous antibiotic therapy should be initiated before the skin.

Answer 265

Primary closure - Also known as first-intention healing. Involves immediate apposition of wound edges Delayed primary closure - Closure within 3-5 days of wounding, before granulation tissue is visible in the wound bed Secondary closure- Closure 5 or more days after wounding, once a healthy granulation bed is developing over the wound surface Second intention healing - Wound heals by contraction and epithelialization, without surgical closure

Answer 266

Delayed primary closure may be indicated when there is a mild degree of contamination that cannot be removed with cleansing or debridement or when the health of the skin along the wound edges is questionable (eg, bite wounds). Secondary closure is commonly preferred when severe infection is present or periwound skin is unhealthy and cannot be fully resected. Delayed primary closure and secondary closure require initial open wound management until the periwound skin and wound bed are healthy.

Answer 267

Vomiting Diarrhea Palpable mass Abdominal pain

Answer 268

Iliocolic junction

Answer 269

Iliocecal junction

Answer 270

Jejunal-jejunal

Answer 271

German Shepherd

Answer 272

6 to 27%, usually proximal to the initial site

Answer 273

Cervical, sublingual (rânula) or pharyngeal

Answer 274

Neoplasia Chylothorax, Cardiac disease, Pyothorax

Answer 275

Inject methylene blue Heinz body anemia

Answer 276

Coefficient of friction

Answer 277

Pulmonary atelectasis Plural effusion Tracheal foreign body Tracheobronchial Mass Esophageal intubation Pulmonary hemorrhage (severe) Diaphragmatic hernia, Pulmonary edema

Answer 278

Pancreatitis Ligation of ureter Peritonitis (septic) Peritonitis (forgotten sponge) NSAID adverse reaction

Answer 279

When the tissue is going to be discarded

Answer 280

Adson: two opposing teeth, Brown-Adson: multiple opposing teeth (less traumatic)

Answer 281

Delayed primary closure: the wound is closed before granulation bed forms. Typically within 24 to 72 hours. Third Intention healing: the wound is closed after granulation bed forms.

Answer 282

Segmental splenic infarction alone is not an indication for surgery, because patients tend to be hypercoagulable and more prone to thromboembolic events.

Answer 283

NO! Derotation can release bacteria and thrombi into the systemic circulation. Ligate and excise without derotating.

Answer 284

Troponin is a marker of myocardial ischemia; the levels peak 48 to 72 hours post-onset and correlate well with EKG abnormalities.

Answer 285

cryosurgery is controlled application of the mechanism of frostbite. The process is divided into direct and indirect phases. Direct phase: results in direct injury via formation of ice crystals, both intra and extra-cellular. Intracellular crystals rupture the cells outer membrane. Extra cellular crystals, cause dehydration of the cellular environment, resulting in lethal electrolyte concentrations, and pH shifts. Indirect or delayed phase: results in vascular stasis and increased vascular permeability leading to loss of plasma. Damage to the vascular endothelium causes adherence of red blood cells and platelets to the vessel wall, the leading to thrombosis and ischemia.

Answer 286

Five hours

Answer 287

1) trace the ductus deferents from prostate to testicle 2) trace testicular artery from aortic origin to testicle 3) trace testicular vein from vena cava to testicle 4) trace gubernaculum testes to testicle

Answer 288

They are normal, permanent skin, creases, resulting from the principal axis of orientation of the subcutaneous connective tissue fibers of the dermis. They are clinically significant as incisions made parallel to them heal well, and produce last visible scarring.

Answer 289

Hypocalcemia 5-6 days (keep hospitalized)

Answer 290

1) methimazole therapy (Renal failure) 2) surgical thyroidectomy (hypocalcemia) 3) radioactive iodine (hypothyroidism) 4) Intra-thyroid infusion of ethanol (laryngeal paralysis)

Answer 291

Internal obturator muscle Sacrotuberous ligament Superficial gluteal muscle

Answer 292

Facial nerve paralysis Draining tract formation

Answer 293

“Its boundaries include the caudal vena cava dorsally, the hepatic artery and portal vein ventrally, and the celiac artery caudally.61,230 The epiploic foramen can be exposed by gently retracting the duodenum ventrally and to the left. In normal dogs and cats there are no large vessels entering the caudal vena cava between the right renal and hepatic veins. It may be necessary to gently retract the celiac artery caudally, the caudate lobe cranially, or the pancreas medially through the epiploic foramen to see the portocaval shunt termination. At that site the caudal vena cava may be dilated and contain turbulent blood flow” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.