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Small animal (fourth year) > Soft tissue surgery (respiratory) > Flashcards

Soft tissue surgery (respiratory) Flashcards

1
Q

what are some possible effusions that can occur in the thorax?

A

pyothorax
chylothorax
haemothorax
serosanguinous effusions
neoplastic effusions

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2
Q

what are some contraindications for draining the thorax?

A

if patient isn’t stable
ongoing haemothorax (trauma/coagulopathy)
clinically insignificant volume

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3
Q

what are the features of a normal pleural cavity?

A

mesothelial lining
potential space in thoracic cavity
small volume of pleural fluid (lubrication)

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4
Q

what is lung collapse also known as?

A

atelectasis

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5
Q

what are the clinical signs of a pleural effusion?

A

restrictive/paradoxical breathing
tachypnoea, dyspnoea, cyanosis
orthopnoic posture
diminished cardiac sounds

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6
Q

what will happen if a pleural effusion if percussed?

A

lung sounds decrease dorsally due to fluid

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7
Q

what are the possible ways to drain the thoracic cavity?

A

needle thoracocentesis
trocar thoracostomy tube
wire guided multi-fenestrated thoracostomy

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8
Q

where is needle thoracocentesis carried out?

A

7th to 9th intercostal space (dorsal for air and ventral for fluid)
cranial aspect of rib

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9
Q

should the three tap be on or off when inserting for needle thoracocentesis?

A

off

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10
Q

what are some possible complications of needle thoracocentesis?

A

lung lacerations
pneumothorax
haemorrhage
iatrogenic infection

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11
Q

what angle should the needle be inserted for needle thoracocentesis?

A

parallel to chest wall once through it (reduce risk of lung laceration)

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12
Q

how can you test if blood from needle thoracocentesis is due to iatrogenic haemorrhage or haemothorax?

A

it will clot if its from iatrogenic haemorrhage

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13
Q

when are thoracostomy tubes placed?

A

if repeated thoracocentesis is required
following thoracic surgery
to medically manage pyothorax

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14
Q

what recumbency is best for inserting a thoracostomy tube?

A

lateral

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15
Q

where is a thoracostomy tube inserted?

A

through 7th/8th intercostal space on cranial border of rib

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16
Q

where is an incision madd when placing a trocar type chest drain?

A

over 10th/11th intercostal space and then inserted between the 7th or 8th intercostal space

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17
Q

what post-placement care is needed for thoracostomy tubes?

A

close monitoring (respiratory rate, effort, insertion site…)
hard elizabethan collar and body vest
analgesia

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18
Q

what are some possible complications associated with thoracostomy tubes?

A

discharge around tube site
damage/removal - pneumothorax
tube blocking/kinking
pain
intra-thoracic structure damage

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19
Q

when should a thoracostomy tube be removed?

A

when draining <2ml/kg/day of fluid
depending on patient status, disease and diagnostic imaging

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20
Q

how would the blood supply of the trachea be described?

A

segmental from thyroid and bronchoesophageal artery

21
Q

what nerve innervates the trachea?

A

right vagus nerve

22
Q

how is the cervical trachea approached for surgery?

A

patient in dorsal recumbency with the neck straight
ventral midline incision from caudal to the larynx
separate sternohyoideus muscle on the midline

23
Q

why may patients undergoing tracheal surgery have post-surgical laryngeal paralysis?

A

recurrent laryngeal nerves run very close to the trachea

24
Q

what suture material is used to close the trachea?

A

absorbable monofilament

25
Q

what suture pattern is used to close the trachea?

A

simple interrupted pattern with knots placed extraluminally

26
Q

what are the indications for a temporary tracheostomy tube?

A

life threatening upper airway obstruction - BOAS, laryngeal paralysis, laryngeal foreign bodies, neoplasia
GA for intra-oral surgery

27
Q

how do temporary tracheostomy tubes need to be managed?

A

ICU (24 hour monitoring)
replace tube twice daily
keep tubes clean (fill with mucous)

28
Q

what are the possible complications of temporary tracheostomy?

A

plugging of tube
accidental removal
gagging/coughing
infection
stenosis
pneumothorax/pneumomediastinum

29
Q

how do you determine if you can remove the temporary tracheostomy tube?

A

occlude before removal to see how they cope

30
Q

what ate the indications for tracheal resections and anastomosis?

A

trauma, stenosis, neoplasia, avulsion

31
Q

what is the maximum length you can remove for trachea resection/anastomosis?

A

5-6 rings

32
Q

what does tracheal collapse result from?

A

laxity of the trachealis muscle causing weakness of the trachea rings leading to collapse of the lumen

33
Q

what dogs are predisposed to tracheal collapse?

A

middle aged small/toy breeds

34
Q

what are the clinical signs of tracheal collapse?

A

goose-honk cough
dyspnoea
exercise intolerance
cyanosis

35
Q

what is a grade 1 tracheal collapse?

A

laxity of dorsal tracheal membrane leading to 25% luminal collapse

36
Q

what is a grade 2 tracheal collapse?

A

loss of cartilage rigidity and further laxity leading to 50% collapse

37
Q

what is a grade 3 tracheal collapse?

A

flattening of the carriage leading to 75% collapse

38
Q

what is a grade 4 tracheal collapse?

A

100% loss of luminal integrity

39
Q

what is used to medically manage tracheal collapse?

A

corticosteroids (anti-inflammatory)
anti-tussives
bronchodilators
antimicrobials (if infected)
weight loss
exercise control (use harness)

40
Q

how can tracheal collapse be treated surgically?

A

extraluminal prosthetic tracheal rings
intraluminal stenting (continue medically management)

41
Q

what is the disadvantage of an intercostal thoracostomy?

A

can only access one side of the trachea

42
Q

how is a median sternotomy carried out?

A

position in dorsal recumbency and approach through cutting through the sternum

43
Q

what are the indications for a lung lobectomy?

A

lung lobe torsion
localised pulmonary abscess, cyst, neoplasia…
severe lung trauma
broncho-oesophageal fistula

44
Q

how are rib fractures treated?

A

usually incidental - analgesia and oxygen

45
Q

what is flail chest?

A

segment of one or more ribs is fractured in two places so this segment moves independently from the chest 9causes paradoxical moving)

46
Q

how is flail chest treated?

A

stabilising surgically (external brace) - only if respiratory function is compromised

47
Q

where do tears of the diaphragm most commonly occur?

A

ventrolateral part of the diaphragm

48
Q

how are diaphragmatic hernias treated?

A

surgery when patient is stable (ASAP if stomach has herniated)
midline coeliotomy and close with absorbable monofilament

Small animal (fourth year) (26 decks)

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