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MOD (year 3) > Soft tissue surgery > Flashcards

Soft tissue surgery Flashcards

1
Q

what are Halsteds principles of surgery?

A 
gentle tissue handling
meticulous haemostasis
preservation of blood supply
strict asepsis
minimal tension
accurate tissue apposition
obliteration of dead space
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2
Q

what is the least traumatic cutting instrument?

A

scalpel

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3
Q

what are the three different grips for holding a scalpel?

A

pencil grip
fingertip grip
palm grip

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4
Q

what’s the pencil grip used for?

A

short precise incisions

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5
Q

what is the disadvantage of the pencil grip?

A

not much contact of the blade with the surface so not suitable for making longer incisions

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6
Q

what is the fingertip grip used for?

A

long incisions (smooth cut as large contact between blade and surface)

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7
Q

what is a disadvantage of using the fingertip grip?

A

not as precise as the pencil

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8
Q

what is the palm grip used for?

A

cutting thick tissue (can apply force)

rarely used

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9
Q

what are the ways of cutting with a scalpel?

A

press cutting

slide cutting

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10
Q

what is press cutting?

A

(stab incision)

apply pressure to the tissue the same way in which you are cutting

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11
Q

what is slide cutting?

A

applying pressure to the tissue at 90° to the incision

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12
Q

what can be done to tissue to make slide cutting more efficient?

A

pull tissue apart with other hand so it is taut

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13
Q

what are straight tip scissors used for cutting?

A

tough tissue - connective tissue and fascia

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14
Q

what are curved tipped scissors used for cutting?

A

delicate fine tissue

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15
Q

what is the backhand thumb to third finger grip used for?

A

cutting towards you dominant hand (means you don’t have to awkwardly angle your arm)

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16
Q

what is the backhand thumb and index grip used for?

A

cutting backwards on the patient towards yourself

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17
Q

how do electrosurgical instruments work?

A

generating heat in the tissue by passing a high frequency electrical current through it

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18
Q

what are the two forms of electricosurgical instruments?

A

monopolar

bipolar

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19
Q

what are the differences between monopoly and bipolar electrosurgical instruments?

A

monopolar has a handpiece and ground plate

bipolar just has a handpiece

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20
Q

what can monopolar electrosurgical instruments be used for?

A

cutting and coagulation

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21
Q

what can bipolar electrosurgical instruments be used for?

A

just coagulation

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22
Q

what are the types of forceps used?

A

toothed forceps
dressing forceps
Alice tissue forceps
doyen forceps

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23
Q

what are toothed forceps used for?

A

tissue manipulation

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24
Q

what should Allis tissue forceps be used for?

A

only gripping things that won’t be left in the patients at the end of surgery such as tumours

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25
Q

what are doyen forceps used for?

A

occluding the lumen of bowels without crushing the tissue

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26
Q

what should be placed on tissue before putting retractors on? and why?

A

moist swabs

protect and keep tissue moist

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27
Q

what is lavage?

A

washing of a body cavity or tissue

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28
Q

what is lavage used for?

A

preserving tissues and keeping them moist
helps to remove bacteria
(don’t use antibacterials)

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29
Q

why is gentle tissue handling important?

A

reduce surgical trauma and improves outcome of surgery

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30
Q

why is meticulous haemostasis important?

A

haemorrhage obscures the surgical field, provides a medium for bacterial growth and can cause hypovolaemia

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31
Q

what is an example of curve tipped scissors?

A

Metzenbaum

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32
Q

what is an example of straight tipped scissors?

A

Mayo

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33
Q

what are the three forces a scissor depends on to cut?

A

closing force
shearing force
torque

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34
Q

what grip is used for routine scissor cutting?

A

wide-base tripod grip

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35
Q

what are the three ways of cutting with scissors?

A

scissor
push
blunt

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36
Q

what precautions must be taken when using electrosurgical instruments?

A

only used on anaesthetised patients
don’t use in the presence of flammable gas/liquid
ground plate must be in complete contact with the patient
don’t wrap power lead around towel clips etc
keep power as low as possible

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37
Q

what forceps are recommended for handling very delicate tissues?

A

DeBakey

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38
Q

what is a Balfour retractor used for?

A

abdominal wall retractions

working in the cranial abdomen (central blade lifts the diploid process)

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39
Q

what are finochietto rib extractors used for?

A

separate ribs for intercostal thoracotomy

divide halves of the sternum

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40
Q

what are the types of suction tip?

A

Frazier Ferguson
yankauer
poole

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41
Q

what is a frazier-ferguson suction tip used for?

A

fine work, removing haemorrhage during dissection

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42
Q

what is the yankauer suction tip good for?

A

removing large volumes of fluid

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43
Q

what is the poole suction tip good for?

A

removing fluid from body cavities

doesn’t block easily

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44
Q

what are some complication of improper tissue handling?

A 
tissue ischaemia
dead space formation (serum or abscess formation)
wound contamination
increased postoperative pain
poorer cosmetic results
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45
Q

what factors is suture material selection based on?

A 
tensile strength
structure of suture
chemical composition of suture
local wound conditions
wound healing rate
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46
Q

how should tensile strength of suture material be selected?

A

use the same strength as the tissue being sutured

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47
Q

what are the two structures of sutures?

A

monofilament

multifilament

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48
Q

describe a monofilament suture material

A

single strand of material that has little drag and can withstand contamination well

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49
Q

what are the disadvantages of monofilament sutures?

A

prone to damage when handling with instruments

have a high degree of memory which can make them harder to handle

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50
Q

describe multifilament suture material and their advantages

A

multiple strand of suture twisted together

they are easier to handle and more pliable, they also have better not security due to the higher surface friction

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51
Q

what are the disadvantages of multifilament suture material?

A

can labour bacteria and act as a wick which for bacteria to travel along

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52
Q

how are synthetic suture materials broken down?

A

hydrolysis (causes minimal tissue reaction)

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53
Q

how are natural suture material broken down?

A

enzymatic degredation (causing inflammation and tissue reaction)

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54
Q

what are the two shapes of needles?

A

straight

curved

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55
Q

what are straight needles used for?

A

for near the body surface or suturing skin

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56
Q

what are curved needles used for?

A

most sutures

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57
Q

what are the types of point profiles of needles?

A

round bodies

cutting needles

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58
Q

what are round bodies needles used for?

A

suturing easily penetrated tissues such as fat, viscera and muscle

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59
Q

what are cutting needles used for?

A

difficult to penetrate tissue such as skin

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60
Q

what are the three shaped of cutting needle?

A

conventional - cutting edge on concave side of needle
reverse - cutting edge on convex side of needle
taper-cut - mix of the two above

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61
Q

what are taper-cut needles used for?

A

suturing dense/tough fibrous tissue (eg. tendons)

CV procedures

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62
Q

what are the three needle holders?

A

Mayo-Hegar
Olsen-Hegar
Gillies

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63
Q

what is the difference between Mayo-Hegar and Olsen-Hegar needle holders?

A

Olsen-Heger has a scissor blade built into the holders

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64
Q

describe the Gillies needle holders

A

no ratchet

arms are different lengths

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65
Q

what are the three suture types pertaining to tissue alignment?

A

appositional
inverting
everting

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66
Q

what are the two main groups of suture pattern?

A

interrupted

continuous

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67
Q

define interrupted sutures

A

each suture has its own knot
they are easily placed and removed and allow adjustment of tension across a wound
they are also more failure tolerant than continuous patterns

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68
Q

name the types of interrupted sutures

A

simple
cruciate mattress
vertical mattress
horizontal mattress

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69
Q

name the types of continuous sutures

A

simple
continuous horizontal mattress
ford interlocking

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70
Q

what are the three aims of arresting haemorrhage?

A

do as rapid as possible
do as completely as possible
do with as little trauma as possible

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71
Q

what are ways of haemostasis?

A 
pressure
haemostats
electrocautery
ligature
topical agents
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72
Q

how should pressure be applied to a site of haemorrhage?

A

with a moist swab for up to 5 minutes (time this)

don’t dab!

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73
Q

what type of haemorrhage is pressure used to apply haemostasis?

A

low pressure haemorrhage (bleeding from seal vessels - capillary ooze)

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74
Q

why should you always use the smallest haemostats possible?

A

create minimal tissue damage

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75
Q

what are the only vessels that haemostats should be used on?

A

blood vessels that will be sacrificed and don’t need to be patent after surgery
causes damage to lumen and closure of the vessel - permanently occludes the vessel

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76
Q

when putting two ligatures of large vessels for haemostasis, what type of ligature should be placed more distally (towards the cut end)?

A

transfixing

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77
Q

describe an encircling ligature

A

loop of suture passed around the vessel

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78
Q

describe a transfixing ligature

A

pass needle through wall of the vessel
tie a knot to hold it onto the vessel
pass suture around the vessel and tie

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79
Q

what vessels are transfixing ligaments used for? and why?

A 
high pressure (arteries)
they aren't pushed along the vessel by pressure - no risk of falling off
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80
Q

what are some examples of substances used as topical haemostasis agents?

A 
collagen
cellulose
gelatin
chitin
mineral based
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81
Q

how do topical haemostatic agents work?

A

act as a scaffold for fibrin deposition and clot formation

some also activate the clotting

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82
Q

what are topical haemostatic agents mainly used for?

A

control of capillary haemorrhage (low pressure)

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83
Q

what is a downside of topical haemostatic agents?

A

can potentiate infection as they are a foreign material

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84
Q

what is a surgical infection?

A

infection that occurs at the surgical site within 30 days of the procedure (extended to a year if there is an implant placed)

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85
Q

what is nosocomial infection?

A

infections that are acquired in hospital (usually multiple antibiotic resistant)

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86
Q

what is sterilisation?

A

getting rid of all of the microorganisms present on an object

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87
Q

what is disinfection?

A

using a germicidal substance on a non-animate object

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88
Q

what is antisepsis?

A

using a germicidal substance on an animate object

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89
Q

what are prophylactic antibiotics?

A

antibiotics used to prevent infection occurring

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90
Q

what are therapeutic antibiotics?

A

antibiotics used to treat an infection that is already present

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91
Q

what does whether a wound becomes infected or not depend on?

A 
number of bacteria present in the wound 
clipping the surgical site
anaesthesia and surgical time
use of propfol
endocrinopathies (immunosuppressed)
patients sex (males more likely)
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92
Q

what are the four categories of wound based on the number of bacteria likely to be present?

A

clean
clean-contaminated
contaminated
dirty

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93
Q

define a clean wound

A

elective surgical wounds not entering the respiratory, urogenital or GI tracts with no breaks in asepsis and primary closure

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94
Q

define a clean-contaminated wound

A

surgical wounds involving respiratory, urogenital or GI tracts without significant contamination or with a minor asepsis break

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95
Q

define a contaminated wound

A

fresh traumatic wound less than 4-6 hours old
surgical wounds involving respiratory, urogenital or GI tracts with significant contamination
surgery in the presence of inflammation
major breaks in asepsis

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96
Q

define a dirty wound

A

traumatic wounds greater than 4-6 hours old
traumatic wounds contaminated with foreign material
perforation of a hollow organ
surgery in the presence of abscessation

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97
Q

how does clipping of surgical sites effect wound infection?

A

clipping a long time before surgery increases risk - disturbance of skin leading to bacteria release

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98
Q

why does use of propofol increase the risk of wound infection?

A

has a lipid carrier in which bacteria can grow

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99
Q

what are some local wound environments and host defences that can effect whether a wound becomes infected?

A 
tissue trauma
foreign material
ischaemia
malnutrition
chemotherapy
systemic disease
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100
Q

what are the two categories of sites in which bacterial contamination can come from?

A

endogenous (inside the patient)

exogenous (outside the patient)

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101
Q

what are the main endogenous contamination sources?

A

skin
respiratory tract
GI tract

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102
Q

what are the main exogenous contamination sources?

A

room air
surgical team
instruments
drapes

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103
Q

why should waterproof drapes always be used?

A

if non-waterproof drapes get wet they can transfer bacteria from the underside of the drape

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104
Q

what are the two types of indicators that can be used to check the effectiveness of sterilisation?

A

biological

chemical

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105
Q

what is the advantage of advantage of biological indicators of sterilisation?

A

tell you if the autoclave has reach the correct temperature for the correct length of time to kill all the bacteria
(chemical just tell you if it reached the correct temperature)

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106
Q

when monitoring the wound post-operatively, what signs should be looked for that indicate infection?

A 
heat
pain
redness
swelling 
discharge
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107
Q

what types of wounds should prophylactic antibacterials be used in?

A

only clean wounds if the animals is immunosuppressed or surgery will last more than 90 minutes
in wounds that are going to be clean-contaminated or contaminated
(don’t use for dirt wounds - use therapeutic)

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108
Q

what are the three phases of normal wound healing?

A

lag/inflammatory
repair
remodelling

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109
Q

what happens during the repair phase of wound healing?

A

connective tissue repair - by fibrous and capillary growth
wound contraction
epithelialisation

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110
Q

what happens during the remodelling stage of wound healing?

A

increase in strength of the wound over many weeks

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111
Q

what are some local factors which will effect wound healing?

A 
wound perfusion
tissue viability
wound fluid accumulation
infection
mechanical factors
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112
Q

what factors will reduce wound perfusion?

A

hypovolaemia
hypotension
vessel injury
pain

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113
Q

what factors will reduce tissue viability?

A 
trauma
dehydration
osmotic injury
envenomation
chemical injury
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114
Q

what are mechanical factors which will reduce wound healing?

A

tension
motion
pressure

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115
Q

what are two systemic factors that may reduce wound healing?

A

immunosuppression (systemic disease and glucocorticoids)

neoplasia (radiotherapy and residual disease)

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116
Q

what ways can a wound be classified?

A

degree of contamination
aetiology
location

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117
Q

what are some classes of wounds based on aetiology?

A 
abrasion
avolsion 
surgical
lacerations 
puncture
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118
Q

what is an avulsion wound?

A

part of the tissue is torn away from its underlying attachments (can separate blood supply)

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119
Q

what is the first thing to do when a patient is presented with a traumatic wound?

A

prevent further contamination (cover wound)

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120
Q

if you suspect a wound to be dirty/contaminated, what should be done before treating?

A

take a swab for culturing (appropriate antibiotic treatment)

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121
Q

when clipping what should be done to the actual wound?

A

fill with lubricating gel or sterile swabs to prevent contamination from hair

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122
Q

what should be used to lavage wounds?

A

sterile solution

can you tap water for very contaminated wounds

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123
Q

what can be done after the initial lavage of a wound?

A

debriding the wound

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124
Q

what are the ways of debriding wounds?

A

hydromechanical

surgical

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125
Q

how do does hydromechanical debriding work?

A

gels work to hydrate necrotic tissue and aiding it to undergo autolysis

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126
Q

how can tissue be assessed to determine if it needs debriding?

A

colour - is it purple/black
is a pulse present in any large vessels in the area
does it bleed

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127
Q

how can you make it easier for yourself to decide if tissue around a wound is necrotic or not?

A

leave the wound open for 24-48 hours for a clear line of demarkation to form between necrotic and living tissue

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128
Q

when are the only times wound debridement needs to be done immediately and the wound needs to be closed?

A

if it is so contaminated there is risk of sepsis

if the wound enters a body cavity

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129
Q

what should be done after debridement of a wound?

A

lavage

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130
Q

what are the 3 ways of managing a wound?

A

primary closure
delayed primary closure
secondary

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131
Q

what is primary closure of a wound?

A

immediate suture closure

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132
Q

what wounds is primary closure used on?

A

clean or clean-contaminated wounds

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133
Q

what is delayed primary closure of a wound?

A

closure of the wound 1-5 days after initial debridement before there is a chance of a granulation tissue bed to form within the wound

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134
Q

what should be done to a wound during delayed primary closure?

A

lavage and dress the wound every day

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135
Q

what type of wounds is delayed primary closure used for?

A

contaminated

wounds with a lot of tension or oedema in surrounding skin

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136
Q

what is secondary closure of a wound?

A

closure of a wound more than 5 days after the injury once a complete granulomatous tissue bed has formed

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137
Q

what must be done to close a wound for secondary closure?

A

incise a small amount of skin around the edge of the wound to remove the granulation tissue

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138
Q

what wounds would secondary closure be used for?

A

contaminated or dirty wounds after initial debridement and lavage has been completed

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139
Q

how are open wounds managed?

A

continued debridement - lavage, surgical, hydromechanical, dressing
protect wound using dressings

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140
Q

what are the three layers of dressings?

A

primary (contact), secondary, tertiary

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141
Q

what is the primary layer of a dressing?

A

makes contact with the wound

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142
Q

what does the type of non-adherent primary layer chosen depend on?

A

amount of exudate produced

if the wound is infected or not

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143
Q

what are semiocclusive/occlusive non adherent dressings indicated for?

A

wounds in the repair phase

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144
Q

what are calcium alginate dressings used for?

A

wounds with moderate/heavy exudate being produced as they are very absorbent

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145
Q

what are polyethylene/polyurethane film dressings used for? and why?

A

protection for intact feeding wounds as they are nonabsorbent and do not allow fluid pass, except water vapour

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146
Q

how long can polyethylene/polyurethane film dressings be left in place?

A

up to 2 weeks

147
Q

what is an example of a hyperosmolar agent used for open wounds?

A

honey

148
Q

why is honey a good hyperosmolar agent?

A

it is bactericidal due to high osmolarity, low pH and hydrogen peroxide production

149
Q

why must honey used for wound be sterile hospital grade honey?

A

untreated honey can contain Clostridia

150
Q

what are the two uses of maggots for wounds?

A

debriding and stimulate healing

151
Q

how do maggots debride wounds?

A

enzymatic destruction of necrotic tissue

bacteria destroyed in their gut and by their secretions

152
Q

what do maggots secretions stimulate in wounds to aid healing?

A

fibroblast activity

153
Q

what are silver dressing used for?

A

wounds that have antibiotic resistant bacteria in them

154
Q

how do silver dressings work?

A

release silver ions into the wound bed which are bactericidal against a wide range of pathogens

155
Q

what is the function of the secondary layer of dressings?

A

absorb excess fluid from wound
secure primary layer
obliterate dead space
protect wound

156
Q

what is the tertiary layer of the dressing for?

A

securing the rest of the dressing
keeps the dressing clean and dry
(ensure it isn’t too tight)

157
Q

what can failure of good surgical technique or wound management result in?

A

delayed healing
prolonged discomfort
extra costs

158
Q

what are the three main components of skin?

A

collagen fibres
elastic fibres
ground substance (mainly proteoglycans)

159
Q

what are the layers of skin?

A

epidermis - stratum corneal, stratum grnaulosum, stratum spinosum, stratum basale
dermis - superficially papillary layer, deep reticular layer

160
Q

what is the aim of wound healing?

A

restore normal physical form, structure and function

161
Q

what are the types of cellular mediators involved in wound healing?

A

growth factors
cytokines
chemokines

162
Q

what are growth factors and their function in wound healing?

A

proteins that bind to cell surface receptors resulting in activation of cellular proliferation and differentiation

163
Q

what are cytokines and their function in wound healing?

A

small signalling proteins secreted by a variety of cells causing growth, differentiation and activation functions

164
Q

what are the 3 main phases of wound healing?

A

inflammatory/lag phase
proliferative phase
remodelling phase

165
Q

what % of the initial strength will a wound normally heal to?

A

80%

166
Q

what are the functions of the inflammatory stage of wound healing?

A

haemostasis
protects against infection
substrate and cellular signals for the next step

167
Q

what initially happens in the inflammatory stage after tissue disruption?

A

an initial transient vasoconstriction to occlude the injured vessels followed by vasodilation causing heat, redness and swelling

168
Q

what is the function of fibrin in the inflammatory stage of wound healing?

A

create a seal and act as meshwork for other cells

169
Q

what cells begin to aggregate during the inflammatory phase of wound healing?

A

platelets

170
Q

what do platelets release in the inflammatory stage of wound healing?

A

chemoattractants
growth factors
proteases

171
Q

what is the function of the substances released by platelets during the inflammatory phase of wound healing?

A

haemostasis
attracts other cells needed for wound healing
provide scaffold for migrating fibroblasts and epithelial cells

172
Q

what characteristics of the inflammatory phase aid the removal of wound contaminate and damaged/dead tissue?

A

erythema and oedema of wound edges

173
Q

what are the two key cells involved in the inflammatory stage of wound healing?

A

neutrophils

monocytes

174
Q

what are the functions of neutrophils in the inflammatory phase of wound healing?

A

kill bacteria after being stimulated by various factors

175
Q

what are the functions of monocytes in the inflammatory phase of wound healing?

A

mature to macrophages and decried wound

they are also essential for secretion of signalling molecules

176
Q

what begins in the proliferative phase of wound healing?

A

angiogenesis
fibroplasia and granulation tissue formation
epithelialisation
contraction

177
Q

what are the aims of the proliferative phase of wound healing?

A

permanent closure of the wound

replacement of lost tissue

178
Q

what are some factors that influence the duration of the proliferative stage of wound healing?

A

wound size
location
age of individual
health of individual

179
Q

what do fibroblasts synthesise during the proliferation phase of wound healing?

A

collagen
glycosaminoglycans
fibronectins

180
Q

what do fibroblasts transform into during the proliferation phase of wound healing? and what do these do?

A

myofibroblasts

start to cause wound contraction

181
Q

how is the proliferation phase clinically classified?

A

by the development of granulation tissue

182
Q

what is the main substance involved in the remodelling/maturation stage of wound healing?

A

collagen

183
Q

what are some local factors that will effect wound healing?

A 
wound perfusion
tissue viability
wound fluid accumulation
infection/foreign bodies
mechanical factors (movement)
184
Q

what are some systemic factors that will effect wound healing?

A 
immunology
oncology
systemic conditions
thermal injuries
external agents
excessive scarring
185
Q

what are the two main classifications of wounds?

A

open

closed

186
Q

what are some examples of open wounds?

A 
surgical incision
laceration
abrasion
degloving
shearing
puncture
brun 
pressure sore
187
Q

what are some examples of closed wounds?

A

contusion
haematoma
crush
hygroma

188
Q

what are abrasions/erosions?

A

superficial loss of surface epithelium without exposure of underlying dermis and submucosa

189
Q

how do abrasions/erosions primarily heal?

A

mitotic division (without inflammatory cells, capillaries, contractile elements)

190
Q

what are ulcers?

A

complete loss of surface epithelium with exposure and damage to underlying tissue

191
Q

what are contusions?

A

damage primarily to sub-epithelial tissues (bruise)

192
Q

what is laceration?

A

combination of tissue damage and loss extending to any depth beneath the epithelium

193
Q

what are the four types of burns?

A

thermal
chemical
electrical
radiation

194
Q

what does the 1st, 2nd, 3rd, 4th degree burn describe?

A

the depth of the burn

195
Q

what need to be done in the assessment of a wound?

A

initial history
initial first aid
initial wound assessment

196
Q

what should be collected in a history ops a wound case?

A

full medical history (concurrent disease and treatment)
when injury occurred
how the injury happened

197
Q

what should be done as initial first aid of a wound?

A

apply pressure if haemorrhaging
clinical exam to ensure no other injuries
check CV status (MM and HR)
sedate for safety

198
Q

what can be used to lavage wounds?

A

chlorhexidine
providone iodine solution
(diluted)

199
Q

what needs to be determined when initially assessing the wound?

A 
location
depth
direction
severity 
injury to other structures
200
Q

what must you be aware of when assessing a wound, especially in horses?

A

tetanus contamination (fatal but can be prevented)

201
Q

what three things are done to surgically manage a contaminated/infected wound?

A

lavage
debridement
wound closure?

202
Q

what are the types of wound healing?

A 
first intention (primary closure)
second intention
third intention (delayed primary closure)
203
Q

what is first intention (primary closure) wound healing?

A

wound closed immediately and completely using strict ascetic technique

204
Q

what conditions must be met for a wound to heal by first intention?

A

minimal bacterial contamination
revitalised tissue, foreign bodies, blood clots removed
no dead space/ischeamia/haematomas

205
Q

why may a wound need to heal by second intention?

A

if it is infected or there is severe soft tissue damage

206
Q

what is delayed primary closure?

A

treat wound as open initially to reduce bacteria and allow debridement then close it

207
Q

what is done for aftercare of wounds?

A 
antibiotics
NSAIDs
prevent self trauma 
rest animals if needed
remove sutures
208
Q

what is the trigone formed by?

A

the insertion of the urethra and ureters

209
Q

define haematuria

A

presence of blood in the urine

210
Q

when blood is seen at the end of urination, what part of the tract does this relate to?

A

upper urinary tract (kidney and ureters)

211
Q

when blood is seen at the start of urination, what part of the tract does this relate to?

A

lower urinary tract (bladder and urethra)

212
Q

what is polydipsia defined by?

A

water intake exceeding 100ml/kg/day

213
Q

what is polyuria defined by?

A

urine output exceeding 50ml/kg/day

214
Q

what is dysuria?

A

pain/difficulty to urinate

215
Q

define oliguria

A

decrease in urine production below normal

216
Q

define anuria

A

no urine production

217
Q

what does a urinalysis consist of?

A

refractometer
dipstick
sediment examination

218
Q

what are the three ways of collecting a urine sample?

A

free catch
catheterisation
cystocentesis

219
Q

when catheterising a male cat what is it important to do?

A

gentle stretch the penis to extend and straighten the sigmoid flexure

220
Q

what are the options of imaging for investigating patients with urinary tract issues?

A

radiography
contrast radiography
ultrasound
CT, MRI, cystoscopy

221
Q

what are the roentgen signs?

A 
size
shape
location
number
margination
opacity
222
Q

where are kidneys found on a radiograph?

A

retroperitoneal space
R - cranial pole of T13
L - L1 to L3

223
Q

what are the kidneys compared to to gage their size on a radiograph?

A

the second lumbar vertebrae

224
Q

what are the two types of contrast medium for contrast radiography?

A

positive and negative

225
Q

how are negative contrast mediums seen on a radiography?

A

have less radiopacity than soft tissue so appear darker on radiographs

226
Q

give some examples of negative contrast agents

A

room air
carbon dioxide
nitrous oxide

227
Q

how are positive contrast mediums seen on a radiography?

A

are more radiopaque than soft tissue so appear lighter on a radiograph

228
Q

give some examples of positive contrast agents

A

barium

iodine (main one for urinary studies)

229
Q

what are the types of contrast radiograph that can be performed?

A

intravenous urography (excretory urography)
cystography
retrograde urethrography

230
Q

what should be done before administering contrast mediums?

A

collect urine samples as some agents can inhibit bacterial growth

231
Q

what are some indications for intravenous urography?

A 
evaluation of kidneys/ureters
indirect assessment of renal function
investigation of uroabdomen
investigation of urinary incontinence
investigation of upper tract haematuria
232
Q

what are contraindications of intravenous urography?

A

renal failure
dehydration
hypotension
hypovolaemia

233
Q

why must patients be anaesthetised before administering contrast mediums?

A

some can cause anaphylaxis and vomiting so a secure airway is essential

234
Q

what are the steps of performing intravenous urography?

A

anaesthetise
take plain abdominal radiograph
inject contrast medium intravenously
abdominal radiographs taken at regular intervals

235
Q

what are the two techniques for intravenous urography?

A

bolus technique - low volume and high concentration, rapidly

infusion technique - high volume and low concentration, slowly

236
Q

what is the bolus technique of intravenous urography used to assess?

A

kidneys

237
Q

what is the infusion technique of intravenous urography used to assess?

A

ureters

238
Q

what are the three phases of intravenous urography?

A

angiogram
nephrogram
pyelogram

239
Q

what are the indications for cystography?

A

haematuria
dysuria
urine retention
incontinence

240
Q

what can be assessed using cystography?

A

bladder location and integrity
bladder wall and mucosa
presence of calculi

241
Q

what is the name of negative cystography using air?

A

pneumocystography

242
Q

what are the steps of performing pneumocystography?

A

place a urinary catheter
insert room air/carbon dioxide/nitrous oxide
gently palpate bladder whilst injecting and then radiograph when distended

243
Q

what are the contraindications of pneumocystography?

A

bladder rupture
mucosal trauma
haemorrhage

244
Q

what are the steps of double contrast cystography?

A

place urinary catheter
empty bladder
inject air first
then inject positive contrast medium

245
Q

what are the indications for retrograde urethrography?

A 
haematuria
dysuria
lower urinary tract obstruction
urethral disease
prostatic disease
penile disease
246
Q

what are the steps of performing retrograde urethrography?

A

catheterise urethra and empty the bladder
perform a pneumocytogram
place the tip of the catheter at the distal urethra
inject the medium and take radiographs - need to take radiograph at the start of injection to check for urethral wall abnormalities

247
Q

what are the indications for a retrograde vaginourethrogram?

A

ectopic ureters
vaginal disease
mass lesions within the pelvis/vagina

248
Q

on ultrasound of the kidney what should be seen between the cortex and medulla?

A

clear demarcation

249
Q

what can be assessed about a kidney on an ultrasound?

A

size
shape
internal architecture
renal perfusion

250
Q

what can be assessed about the bladder on ultrasound?

A

wall thickness and layering
presence of mass lesions
lumen

251
Q

what are the clinical signs of nasal disease?

A 
sneezing
snoring/increased respiratory noise
nasal discharge
epistaxis
facila pain
252
Q

what are the differential diagnoses for acute nasal disease?

A

nasal foreign body
viral URT infection
allergic/irritant rhinitis
tooth root abscess

253
Q

what are the differential diagnoses for chronic nasal disease?

A 
unresolved acute disease
feline rhinotracheitis
neoplasia
fungal rhinitis
lymphocytic/plasmacytic rhinitis
254
Q

how can nasal disease be investigated on clinical examination?

A 
inspection of the head
palpation of the head
retropulsion of the globe
assessment of nasal airflow
oral examination
mandibular lymph node palpation
255
Q

what should there not be when retropulsing the globe of the eye?

A

shouldn’t take much pressure, be discomfort or any asymmetry

256
Q

how can nasal airflow be assessed?

A

putting fur/cloth infront of the nostrils

putting a mirror infront of the nostrils and see if it steams up

257
Q

what should be done before taking a biopsy from the nose?

A

take a clotting profile - taking a biopsy can cause haemorrhage

258
Q

how can nasal disease be investigated further after a clinical exam?

A

FNA of lymph nodes
nasal swabs - bacteriology and cytology
exploratory rhinotomy

259
Q

what is the fungus that causes fungal rhinosinusitis in dogs?

A

Aspergillus fumigatus

260
Q

what aged dogs is fungal rhinosinusitis normally seen in?

A

young/middle aged

rare in cats

261
Q

what are the clinical signs of fungal rhinosinusitis?

A

nasal discharge (with/without epistaxis)
facial pain
ulceration/depigmentation of nasal planum
dullness/depression

262
Q

how is fungal rhinosinusitis diagnosed?

A

history/clinical signs
serology (false negatives are common!!)
diagnostic imaging
histopathology (biopsy)

263
Q

what is used to treat fungal rhinosinusitis?

A

topical antifungals

264
Q

what are the two ways topical antifungals can be used to treat fungal rhinosinusitis?

A

trephination of frontal sinus and clotrimazole packing

noninvasive clotrimazole soaking

265
Q

what is the rough outline of how clotrimazole soaking is done?

A

anaesthetise the patient in dorsal recumbency and place a Foley catheter around the back of the soft palate and inflate the bulb to block off the nasal pharynx. Place two more Foley catheters in each nostril and inflate, then inject clotrimazole until the nasal cavity is filled, clamp of each catheter and leave to soak for an hour

266
Q

what dogs are nasal neoplasia usually seen in?

A

older medium/large breed dogs

267
Q

what are the clinical signs of nasal neoplasias?

A 
reduced airflow
nasal discharge (with/without epistaxis)
facial or palate swelling/distorsion
exopthalmos
neurological signs
268
Q

how can nasal neoplasias be diagnosed?

A

history/clinical signs
diagnostic imaging
rhinoscopy and biopsy

269
Q

how can nasal tumours be treated?

A

radiation therapy
chemotherapy
(surgery not normally an option due to access and haemorrhage)

270
Q

what specific nasal neoplasia is chemotherapy used for?

A

nasal lymphoma

271
Q

what is another name for non-infectious inflammatory rhinitis?

A

lymphocytic/plasmacytic rhinitis

272
Q

what are the clinical signs of non-infectious inflammatory rhinitis?

A

usually non-specific
serous/mucopurulent discharge that is usually bilateral
sneezing/snorting

273
Q

how is non-infectious inflammatory rhinitis diagnosed?

A

history/clinical signs
diagnostic imaging
rhinoscopy and biopsy

274
Q

what is seen on diagnostic imaging of animals with non-infectious inflammatory rhinitis?

A

mild loss of turbinate detail

increased soft tissue density due to discharge

275
Q

what are some treatment methods of lymphocytic/plasmacytic rhinitis?

A

environmental modification - cleaning, ventilating, humidifying
saline installation/nasal flushes
anti-inflammatories
antibacterials
mucolytics
allergen testing/elimination
(lots of options because nothing works very well)

276
Q

what are the clinical signs of nasal foreign bodies?

A

sudden onset of signs
paroysmal sneezing
facial discomfort (pawing)
purulent nasal discharge

277
Q

what can be done to diagnose nasal foreign bodies?

A

history/clinical signs
rhinoscopy
diagnostic imaging
exploratory rhinotomy

278
Q

how are nasal foreign bodies treated?

A

nasal flushing
endoscopic retrieval
rostral retraction of soft palate and forceps retrieval
rhinotomy

279
Q

how common is bacterial rhinitis in dogs/cats?

A

rare

280
Q

what should be done to treat bacterial rhinitis?

A

treat the underlying cause

281
Q

what are some other less common causes of nasal discharge?

A

cleft palate
ciliary dyskinesia
parasites
dysphagia and nasopahryngeal reflux

282
Q

what are the two approaches to a rhinotomy?

A

dorsal or ventral

283
Q

what would dorsal rhinotomy go through?

A

the maxilla and possibly more caudally through the frontal bone

284
Q

what is the main risk of rhinotomy?

A

severe life threatening haemorrhage due to the area being highly vascular

285
Q

breeds with short skulls can have brachycephalic obstructive syndrome, what are the consequences of this?

A 
overlong soft palate 
stenotic nares
tracheal/laryngeal hypoplasia 
pharyngeal collapse 
excessive turbinates
286
Q

what secondary changes can occur due to brachycephalic obstructive syndrome?

A

everted laryngeal saccules
tonsillar enlargement/protrusion
laryngeal collapse
tracheal collapse

287
Q

what are the clinical signs of braychephalic obstructive syndrome?

A 
inspiratory stertor
dyspnoea
snoring/sleep apnoea
exercise intolerance
cyanosis
fainting/collapse
gagging/dysphagia
regurgitation
cough, pyrexia, dullness
288
Q

define stertor

A

deep low pitch snoring type noise

289
Q

how is brachycephalic obstructive syndrome diagnosed?

A

signalment/clinical signs
examination of airway - tonsils, soft palate, larynx
radiography - pharynx, neck, thorax

290
Q

what is it important not to do when assessing the length of the soft palate?

A

don’t pull the tongue out as it will pull the larynx rostrally meaning length can be overestimated

291
Q

what can be done to treat brachycephalic obstructive syndrome?

A

surgical modification of the airway

292
Q

when should surgery of patients with brachycephalic obstructive syndrome be done?

A

as soon as possible but wait until animal is skeletally mature

293
Q

why should we wait until a patient is skeletally mature to perform surgery on animals with brachycephalic obstructive syndrome?

A

proportions of head changes as the animal grows
tissue will be more robust when older
mouth is physically larger - easier access

294
Q

what is the first part of the surgical treatment for brachycephalic obstructive syndrome?

A

widening the nares

295
Q

what are the grades of laryngeal collapse?

A

stage 1, 2 and 3

296
Q

what occurs on stage 1 of laryngeal collapse?

A

eversion of laryngeal saccules

297
Q

what occurs on stage 2 of laryngeal collapse?

A

eversion of laryngeal saccules medial deviation of the cuneiform process of the arytenoids

298
Q

what occurs on stage 3 of laryngeal collapse?

A

eversion of laryngeal saccules medial deviation of the cuneiform and corniculate process of the arytenoid cartilages

299
Q

how is stage 1 laryngeal collapse treated?

A

laryngeal sacculectomy

300
Q

how is stage 2 and 3 laryngeal collapse treated?

A

laryngeal sacculectomy with/without arytenoid caudolateralisation

301
Q

what is done for very severe laryngeal collapse?

A

permanent tracheostomy

302
Q

what is laryngeal paralysis?

A

the failure of dorsal cricoarytenoid muscle to abduct arytenoid cartilage on inspiration

303
Q

what does laryngeal paralysis cause?

A

reduced glottis size and increased airway resistance

304
Q

what are some causes of laryngeal collapse?

A

congenital dysfunction of recurrent laryngeal nerve
idiopathic dysfunction of recurrent laryngeal nerve (most cases)
metabolic neuropathy - hypothyroidism, myasthenia gravis
generalise myopathy
damage to recurrent laryngeal nerve - trauma /neoplasia

305
Q

what breeds of dog are predisposed to acquired laryngeal paralysis?

A

golden retrievers
labradors
irish setters
afghan hounds

306
Q

what are the clinical signs of laryngeal paralysis?

A 
inspiratory stridor
exercise intolerance
fainting/collapse
altered phonation
cough/gagging during swallowing
dysphagia
307
Q

define stidor

A

high pitch whistling sound

308
Q

what can exacerbate the clinical signs of laryngeal paralysis?

A

stress, excitement, heat

309
Q

what can be done to diagnose laryngeal paralysis?

A 
history/clinical signs
laryngoscopy to assess laryngeal function
thoracic/cervical radiographs
blood tests
electromyography/nerve and muscle biopsy
edrophonium response test
310
Q

what are the pitfalls of using laryngoscopy to assess laryngeal function for [patients with suspected laryngeal collapse?

A

if the patient is too deeply anaesthetised the larynx will become paralysed
can get paradoxical movement of larynx when animal inspired/expires

311
Q

what is the main treatment of laryngeal paralysis?

A

surgery - left arytenoid lateralisation

312
Q

why is only left arytenoid lateralisation done?

A

easier for right handed surgeon
unilateral gives adequate airway
bilateral increases the risk of postoperative aspiration pneumonia

313
Q

describe the process of left arytenoid lateralisation

A

incision made ventral to the jugular

place suture between caudal border of the cricoid cartilage and muscular process of the arytenoid cartilage

314
Q

what complication are associated with arytenoid lateralisation?

A

aspiration pneumonia
failure of tieback
seroma
development of other signs of neuropathy

315
Q

what are patients that have had arytenoid lateralisation more prone to aspiration pneumonia?

A

can’t close glottis when swallowing so more prone to inhaling food

316
Q

how can tracheal disease be investigated?

A 
clinical exam - auscultation, palpation
diagnostic imaging 
tracheobronchoscopy
biopsy
tracheal wash
317
Q

what can cause tears in the trachea?

A

sharp or blunt trauma - bite wounds or ET tubes in cats

318
Q

what are the clinical signs of tracheal tears?

A

can be asymptomatic or have subcutaneous emphysema/ pneumothorax/ pneumomediastinum

319
Q

what can be done to treat tracheal tears?

A

cage rest if not severe

surgical repair after tracheostomy

320
Q

where are tracheal avulsions usually found?

A

intrathoracically in cats

321
Q

what can initially form in tracheal avulsion cases?

A

pseudotrachea - the animal will be asymptomatic

322
Q

what is done to treat tracheal avulsion?

A

debridement and anastomosis - technically very difficult but with a good prognosis

323
Q

what causes tracheal collapse?

A

laxity of tracheal muscles and chondromalacia of tracheal rings leading to dorsoventral collapse of the lumen

324
Q

what is dynamic collapse of the trachea?

A

cervical trachea collapse during inspiration and the intrathoracic trachea collapses during expiration

325
Q

what dogs is tracheal collapse most seen in?

A

middle aged miniature/toy breeds

326
Q

what are the grades of tracheal collapse?

A

grade I, II, III, IV

327
Q

describe a grade I tracheal collapse

A

laxity of dorsal tracheal membrane and a 25% reduction in tracheal lumen

328
Q

describe a grade II tracheal collapse

A

laxity of dorsal tracheal membrane and widening of the cartilage leading to a 50% lumen reduction

329
Q

describe a grade III tracheal collapse

A

further laxity of dorsal tracheal membrane and widening of the cartilage leading to a 75% lumen reduction

330
Q

describe a grade IV tracheal collapse

A

w shaped tracheal cartilage rings so almost 100% occlusion of the trachea

331
Q

what are the clinical signs of tracheal collapse?

A 
goose honk cough
waxing/waning dyspnoea
exercise intolerance
cyanosis
flattening of cervical trachea on palpation
332
Q

how can tracheal collapse be diagnosed?

A 
signalment/history/clinical signs
examination of upper airway
fluoroscopy
radiography - trachea, heart, lungs
tracheoscopy
bronchioalveolar lavage
333
Q

what can be used to initially treat laryngeal collapse?

A 
medical management often initially successful - corticosteroids, antitussives, bronchodilators, antibacterials
weight loss
avoid stress/excitement/heat
harness instead of a collar 
treat concurrent disease
334
Q

what surgical techniques can be used to treat laryngeal collapse?

A

stents

place extraluminal tracheal rings

335
Q

what is tracheal stenosis?

A

abnormal narrowing of trachea due to granulation tissue formation after trauma

336
Q

what can be done to treat tracheal stenosis?

A

resection and anastomosis

337
Q

what can be done to treat tracheal neoplasias?

A

resection/anastomosis (if localised)
chemotherapy
radiotherapy

338
Q

what are the two ways of accessing the trachea for surgery?

A

ventral midline cervical approach (in neck)

right 3rd-5th intercostal space thoracotomy (in thorax)

339
Q

what type of suture is normally used for closing the trachea?

A

monofilament absorbable sutures (extraluminal knots)

340
Q

why is a temporary tracheostomy usually performed?

A

to bypass potentially life threatening upper respiratory obstruction

341
Q

how are temporary tracheostomy tubes maintained?

A

changed every 12 hours (or if blocked)
suction of air is required
moisturise airway every 1-4 hours

342
Q

what are possible complications with temporary tracheostomy tubes?

A 
tube obstruction
premature removal
gagging/coughing
SC emphysema, pneumomediatinum, pneumothorax
infection
stenosis
343
Q

what should be done when taking a tracheostomy tube out?

A

occlude it for 15-20 minutes to ensure patient can breath

344
Q

how should the wound of a tracheostomy heal?

A

by secondary intention with appropriate care

345
Q

where is permanent tracheostomy done?

A

at 4th to 6th tracheal ring

346
Q

how should a permanent tracheostomy be maintained?

A

clean skin/stoma
trim hair
maintain body condition
no swimming

347
Q

what is there maximum number of rings that can be removed in a tracheal resection?

A

5-6

348
Q

which kidney is found more cranially?

A

right

349
Q

which kidney is more mobile?

A

left

350
Q

what are some possible developmental abnormalities of the kidneys?

A 
(rare)
renal agenesis
renal dysplasia 
renal ectopia 
polycystic kidney disease
351
Q

what is renal agenesis?

A

when a kidney and ureter aren’t present

352
Q

what is renal dysplasia?

A

disorganised parenchyma of the kidney

353
Q

what breeds are usually effected by polycystic kidney disease?

A

Persians and bullterriers

354
Q

what are some indications of a renal biopsy?

A

renal mass (most common)
haematuria of upper urianry tract
renal corticoid disease
renal failure (may damage further by biopsying)

355
Q

what tests should be carried out before doing a renal biopsy?

A 
haematology 
biochemistry 
bacteriology 
diagnostic imaging
coagulation profile
356
Q

what are some contraindications for renal biopsy?

A 
anaemia/coagulopathy
oliguria/anuria
severe azotaemia
hypertension
urinary obstruction
hydronephrosis 
solitary kidney function
357
Q

what a some complications with renal biopsy?

A 
haematuria
renal infarction
infection
haemorrhage 
renal fibrosis
358
Q

what are the methods of renal biopsy?

A

FNA
tru-cut instrument
surgery

359
Q

how can the kidney be approached for biopsy?

A 
ultrasound guided
percutaneous (blind)
keyhole
laprascopy
ventral midline coeliotomy (most common)
360
Q

when would a nephrotomy be done?

A

wedge biopsy

removal of nephroliths

361
Q

what is nephrotomy?

A

cutting into the kidney

362
Q

when taking a biopsy using FNA or trucut from the kidney, where is sampled?

A

cortex

363
Q

how can the kidney be exposed after a ventral. midline coeliotomy?

A

drag the duodenum to the midline and this will expose the right kidney
drag the colon to the midline and this will expose the left kidney

364
Q

how is the kidney cut to remove calculi?

A

bisectional - pole to pole

MOD (year 3) (45 decks)

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