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Year 4 Small Animal Studies > Soft Tissue Surgery: Surgery of the Respiratory Tract > Flashcards

Soft Tissue Surgery: Surgery of the Respiratory Tract Flashcards

1
Q

Label the missing layers of the trachea
1. What is the blood supply of the trachea?
2. What innervates the trachea?

A
  1. Segmental blood supply- thyroid and bronchoeosophageal artery
  2. Right vagus nerve
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2
Q

What different investigations can be done on the trachea?

A
  • Clinical examinations
  • Radiography
  • Computed tomography
  • Fluoroscopy
  • Trancheobronchoscopy
  • BAL
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3
Q

What is the surgical approach to the cervical trachea?

A
  • Dorsal recumbency and straight and neck extended over a sand bag
  • Ventral midline longitudinal incision from caudal to larynx
  • Seperate the sternohyoideus muscles- stay on midline
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4
Q

What is the surgical approach to the thoracic trachea?

A
  • First part: cervical approach and cranial retraction and cranial median sternotomy
  • Median sternotomy or right 3rd-5th thoracotomy
  • Refer
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5
Q

How is trachea closed?

A
  • Absorbable monofilament
  • Simple interupted
  • Knots placed extraluminally
  • Careful apposition of mucosa
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6
Q

When is a temporary tracheostomy indicated?

A
  • Life threatening upper airway obstruction- BOAS, laryngeal paralysis, laryngeal foreign bodies, neoplasia
  • GA when intra-oral surgery is performed
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7
Q

What equipment is needed for a temporary tracheostomy?

A
  • Surgical instruments
  • Tracheostomy tubes- uncuffed/cuffed
  • Large suture material
  • Umbilical tape
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8
Q

What managment is needed for a temporary tracheostomy?

A
  • ICU- 24hr monitoring- block or dislodge
  • Replace tube 2x daily
  • Suction
  • 0.2ml/kg sterile saline down or nebulise
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9
Q

What complications can occur with a temporary tracheostomy?

How should it be removed?

A
  • Plugging of tube
  • Tube removal
  • Gagging, coughing
  • Subcutaneous empysema, pneumomediastinum, pneumothorax
  • Infection
  • Stenosis
  • Occlude tube before removal
  • Second intention healing
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10
Q

When is a permanent tracheostomy indicated?

A

Salvage procedure- unresolvable URT obstruction

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11
Q

What are the indications, complications for tracheal resection?

What is the max number of rings removed?

A

Indications
* Trauma
* Stenosis
* Neoplasia
* Avulsion

Complications
* Air leakage
* Infection
* Stricture

No more then 6 rings

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12
Q
  1. What causes tracheal rupture, how is it treated?
  2. How is avulsion treated?
A
  1. Overinflation of ET tube (cats), medical managment?
  2. 1-4cm cranial to bifurcation, resection and anastomosis
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13
Q
  1. What causes tracheal collapse?
  2. What breeds are predisposed?
  3. What are the clinical signs?
A
  1. Laxity of trachealis muscle > weakness of rings
  2. Middle-aged small/toy breeds
  3. Goose-honk cough, dyspnoea, excercise intolerance, cyanosis
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14
Q

What are the different grades of tracheal collapse?

A
  • I laxity of dorsal tracheal membrane 25% luminal collapse
  • II- loss of cartilage rigidity and further laxity, 50% luminal collapse
  • III- flattening of the cartilages- 75% collapse
  • IV- 100% loss of integrity
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15
Q
  1. How is tracheal collapse medically managed?
  2. How is it treated in an emergency?
A
  1. Corticosteroids (anti-inflam), anti-tussives, bronchodilators, ABs, weight loss, harness
  2. Oxygen, sedatives, steroids
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16
Q

What are the complications of extraluminal prosthetic tracheal rings?

A
  • Necrosis
  • Collapse beyond rings
  • Migration of prosthesis
  • Tension pneumothorax
17
Q

What are the complications of intralumnal tracheal stenting?

A
  • Stent fracture
  • Stent migration
  • Inflammatory tissue
18
Q

What are the different surgical approaches to the thorax?

A
  • Intercostal thoracotomy
  • Median sternotomy
  • Transsternal thoracotomy
  • Rib resection thoracotomy
  • Transdiaphragmatic thoracotomy
  • Thoracoscopy
19
Q

What does an intercostal thoracotomy allow access too an not?

What special retractors are needed?

A

Access to R or L thorac
Cannot access structures away from the incision

Finochietto retractors

20
Q
  1. What is a median sternotomy used for?
  2. What ideally needs to be preserved?
  3. How is it closed?
A
  1. Bilateral exploration of the thoracic cavity
  2. Preserve the manubrium or xyphoid
  3. Peristernal orthopaedic wire in figure of 8
    Large non-absorbable suture material
    Crimped leaderline
21
Q

What are the indications for a lung lobectomy?

A
  • Lung lobe torsion
  • Localised pulmonary abscess, cyst, bulla, neoplasia
  • Severe lung trauma
  • Broncho-oesophageal fistula
22
Q
  1. What are the two techniques for a total lung lobectomy and partial?
A

Suture ligation or stapling technique

23
Q

How can lung lacerations be managed?

A
  • Conservative managment for at least 3 days
  • May require median sternotomy and suturing
24
Q

With thoracic trauma (RTA, bite wound etc), what is the priority?
How is this initially done?

A
  • Restore cardiopulmonary function
  • Maintain a patent airway- provide O2
  • Support circulation- IV access- fluids
  • Control obvious haemorrhage
25
Q

What are common injuries from thoracic trauma?

A
  • Pulmonary contusions
  • Pneumothorax
  • Rib fractures
  • Open thoracic wounds
  • Haemothorax
  • Diaphragmatic rupture
  • Shock
26
Q

What should be examined about a patient with thoracic trauma?

A
  • Respiration rate and pattern
  • Mucus membrane colour
  • CRT
  • Auscultation and percussion of thorax
  • Observation of thoracic outline
  • Check for evidence of wounds
  • Minimise patient stress
27
Q

What diagnostic tests could be considered for thoracic trauma?

A
  • Haematology
  • Serum biochemistry
  • Radiography
  • Thoracocentesis
28
Q

What needs to be considered for complications and treatment of rib fractures?

A
  • Often incidental findings
  • Suspect pulmonary contusion (hematoma)
  • Conservative managment usually adequate
  • Analgesia, rest, O2 supplementation
  • Internal rib fix may be required
  • Can cause lung lacerations
29
Q
  1. What is flail chest?
  2. Why does this compromise respiration?
  3. What may be required?
A
  1. segment of one or more ribs is fractured in two planes
  2. This segment can move independently from the chest wall- paradoxical movement compromises resp
  3. Possibly surgical stabilisation
30
Q

How is a diaphragmatic rupture managed?

A
  • Surgery when the patient is stable
  • Surgery straight away is the stomach is herniated- needle compression
  • If chronic consider no treatment

Midline coeliotomy- hernia reduction gently
Diaphragmatic closure: PDS in a simple continuous ± interrupted pattern

Year 4 Small Animal Studies (97 decks)

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