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CPS > Surgery 3 > Flashcards

Surgery 3 Flashcards

1
Q

What affects the choice of suture material?

A
  • The wound
  • The body
  • The surgeon
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2
Q

What are the requirements of the wound regarding suture choice?

A
  • Maintain adequate strength until purpose is served (e.g. tendon needs support for longer vs mucosa)
  • Stimulate minimal tissue reaction
  • Must be absorbed at a dependable rate, or become encapsulated without complications
  • Must consider: tensile strength of wound, bacterial charge of wound, current or planned therapies for the wound
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3
Q

What are the requirements of the body regarding suture choice?

A
  • Must be non-electrolytic
  • Non-capillary
  • Non-allergenic
  • Non-carcinogenic
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4
Q

What are the requirements of the surgeon regarding suture choice?

A
  • Must be easy to use
  • Minimal tissue drag
  • Good knot security
  • Inexpensive
  • Easily available
  • Easily sterilised without alteration
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5
Q

What is tensile strength?

A

Breaking strength per unit area

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6
Q

What is suture memory?

A

The tendency to retain is original configuration, is not a good handling characteristic and will not tie good knots

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7
Q

What is tissue drag or chatter?

A

Lack of smoothness or friction whilst passing through tissue

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8
Q

What are the recommended and possible suture materials for skin?

A
  • Recommended: Monofilament non-absorbable materials e.g. Monosol, surgipro
  • Possible: absorbable, Polysorb (braided) or Biosyn (monofilament)
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9
Q

What are the recommended and possible suture materials for muscle?

A
  • Recommended: absorbable braided e.g. Polysorb

- Possible: absorbable monofilament Biosyn

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10
Q

What are the recommended, possible and contraindicated suture materials for bladder, uterus and digestive tract?

A
  • Recommended: absorbable monofilament Biosyn, PDS
  • Possible: absorbable braided (polysorb)
  • Contraindicated: non-absorbable monofilament monosol
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11
Q

What are the recommended and possible suture materials for kidney and liver?

A
  • Rec: absorbable mono Biosyn

- Poss: absorbable braided Polysorb

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12
Q

What are the possible suture materials for hernias?

A
  • Absorbable braided Polysorb
  • Non-absorbable braided (e.g. surgidac)
  • Non-absorbable mono e.g. Surgipro
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13
Q

What are the recommended and possible suture materials for tendons?

A
  • Non absorbable
  • Rec: Braided e.g. surgidac, mono e.g. surgipro
  • Poss: mono e.g. monosol
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14
Q

What are the recommended and possible suture materials for the articular capsule?

A
  • Rec: non-absorbable braided e.g. surgidac

- Poss: non-absorbable mono e.g. surgipro

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15
Q

What is the recommended suture material for vascular surgery?

A

Non-absorbable monofilament e.g. surgipro

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16
Q

What are the recommended, possible and contraindicated suture materials for contaminated tissue?

A
  • Rec: non-absorbable mono e.g. surgipro
  • Poss: non-absorbable mono e.g. monosol
  • Contra: non-absorbable braided e.g. surgidac
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17
Q

What suture material can be used with drains?

A

Non-absorbable monofilament e.g. surgipro

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18
Q

What suture material is recommended for surgery of the oral cavity and procedures where prolonged support is not needed?

A
  • Absorbable monofilament

- e.g. Caprosyn

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19
Q

How is ischaemia due to sutures avoided?

A
  • Sufficiently spaced suture bites
  • Tightened without excess
  • As little dead space as possible
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20
Q

When are surgeon’s knots required?

A
  • When the wound is under lateral tension
  • Prevents knot coming undone between the first and second throw due to increased friction
  • There is no difference in stability of the final knot, only the stability of the first throw is altered
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21
Q

What affects the number of throws required on a suture?

A
  • The material used
  • the tissue the sutures are being placed in
  • e.g. materials with higher memory typically need more throws than those with poor memory (except polypropylene)
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22
Q

What affects the knot security of a suture?

A

The surface frictional characteristics of the material (mono vs multifilament)

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23
Q

When might slip knots be used?

A

When typing a ligature deep in a cavity, but must be locked properly into a square knot

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24
Q

Name the common interrupted patterns for skin closure

A
  • Simple interrupted
  • Cruciate mattress
  • Horizontal mattress
  • Vertical mattress
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25
Q

Name the common continuous suture patterns

A
  • Simple continuous
  • Subcuticular
  • Ford interlocking
  • Cushing
  • Connel
  • Lembert
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26
Q

Outline the use of a horizontal mattress suture

A
  • Common in large animal, rare in small animal
  • Produces everting suture, historical argument as wounds heal from dermis up so aim was to appose dermis
  • Produces messy wound
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27
Q

OUtline the use of Cushing, Connel and Lembert sutures

A
  • Inverting sutures
  • Commonly used for bowel surgery and cesareans when closing the uterus
  • Appose the serosal layers
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28
Q

What is the Aberdeen knot used for?

A

Typing off a simple continuous pattern

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29
Q

What are the principle causes of suture dehiscence?

A
  • Knot slippage
  • Knot breakage
  • Tissue laceration
  • Weakening of the suture during its handling e.g. crushing, shearing
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30
Q

Discuss the use of skin staples

A
  • Painful and irritating but quick to apply
  • Useful for long wounds
  • Useful where some interrupted sutures have been pulled out by animal and need to quickly top up sutures to hold wound together
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31
Q

What are the principles in cytological sample examination?

A
  • Low power first to find area of interest
  • Consider quality of preparation
  • Identify the background
  • Identify the predominant cell type
  • Examine other cells present at 40x magnification
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32
Q

What may be seen in the background of a cytological slide?

A
  • Haemorrhage
  • Granules
  • Protein
  • Matrix
  • Debris
  • Disrupted cells
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33
Q

What can be inferred from the predominant cell type on a cytological slide?

A

If neutrophils are the predominant cell type then the lesion is likely to be inflammatory rather than neoplastic

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34
Q

What are the potential causes of lumps?

A
  • Inflammation
  • Neoplasia
  • Cysts
35
Q

What are the different types of inflammatory lumps?

A
  • Can be neutrophilic, eosinophilic, lymphoplasmacytic, granulomatous
  • Acute or chronic
  • Septic or aseptic
36
Q

What are the different types of neoplastic lumps?

A
  • Benign or malignant

- Epithelial, round, sindle/mesenchymal cells

37
Q

What are the different types of cystic lumps?

A
  • Haematoma
  • Seroma
  • Sialocoele
  • Epithelial/follicular
38
Q

Describe the appearance of acute inflammation on cytology

A
  • > 70% of nucleated cells are neutrophils
  • Rest may be mononuclear cells
  • Can be septic or aseptic
39
Q

Describe the characteristics of aseptic acute inflammation on cytology

A
  • Neutrophils predominate but are well preserveed
  • In tact neutrophils with compact chromatin
  • A few macrophages and lymphocytes
  • No bacteria visible
40
Q

Describe the characteristics of septic acute inflammation on cytology

A
  • Neutrophils are degenerate (karyolysed)
  • Bacteria often present
  • Neutrophils appear swollen and pale
41
Q

Describe the characteristics of eosinophilic inflammation on cytology

A
  • Cell content may be mixed

- 50% or more are eosinophils

42
Q

Describe the characteristics of chronic inflammation on cytology

A
  • Number of mononuclear cells is increased and may be >50% of nucleated cells
  • Recruit other cell types, in particular macrophages
43
Q

Describe the characteristics of granulomatous inflammation on cytology

A
    • Chronic inflammation from persistent irritation/infection with particular organisms e.g. staphylococci and fungi
  • Characterised by presence of multinucleated giant cells (Langhans type cell)
44
Q

Describe the characteristics of cysts on cytology

A
  • Vary widely in aetiology and therefore contents of aspirate smear
  • May be aceullar and watery or filled with proteinaceous content, or with necrotic material or keratin debris
  • In hair follicles are likely to get keratin flakes building up and blocking gland
  • Keratin breakdown over time produces sharp edged cholesterol crystals
45
Q

Describe the characteristics of a sialocoele on cytology

A
  • Smears contain many RBCs, few WBC, clouds of pink amorphous mucin and many macrophages
  • Collections of epithelial cells, stick together
  • Cytoplasm filled with pink mucin to be released
46
Q

What are sialocoeles and how do they occur?

A
  • Firm painless fluid swelling of acute onset in the submaxillary space
  • Caused by blocked salivary gland, continuous production of saliva but cannot be removed so end up with a collection of cells in large volume of fluid
47
Q

Describe the characteristics of a haematoma on cytology

A
  • Fluid blood-like, dark, does not clot
  • Cell counts/protein content similar to blood but no platelets unless still actively bleeding
  • Macrophages clearing red cells
  • Haemosiderophages may be seen
  • Breakdown products of haemoglobin may be seen, initially light blue then haematoid produced (yellow)
48
Q

What are the different types of epithelial neoplasia?

A
  • Surface: squamous, basal, transitional, hair follicle

- Glandular: apocrine, exocrine

49
Q

Describe the characteristics of epithelial neoplasia on cytology

A
  • High yield on FNA/FNCS
  • Cells associated with one another
  • Found in rafts/sheets/acini
  • Cuboidal or columnar shape of cells
  • Cobblestone street pattern
  • Can see white lines between cells
50
Q

What are benign epithelial tumours called?

A
  • Surface: papilloma

- Glandular: adenoma

51
Q

What are malignant epithelial tumours called?

A
  • Surface: carcinoma

- Glandular: adenocarcinoma

52
Q

What are the cell types of spindle/mesenchymal neoplasia?

A
  • Fibrocyte
  • Muscle cells
  • Osteoblasts
  • Endothelial cells
53
Q

What are malignant spindle/mesenchymal tumours called?

A
  • Suffixed with sarcoma

- e.g. fibrosarcoma, haemangiosarcoma

54
Q

What are benign spindle/mesenchymal tumours called?

A
  • E.g. fibroma

- Leiomyoma

55
Q

Describe the characteristics of spindle/mesenchymal neoplasias

A
  • Low cytological yield on FNA/FNCA
  • Spindle shaped cells seen
  • Usually single but may be in association/sheets
  • May be in matrix
  • Shape of cell difficult to make out, ends tail off
56
Q

What are the potential cell types for round cell neoplasia?

A
  • Lymphocytes
  • Mast cells
  • Histiocytes
  • Plasma cells
57
Q

What are benign round cell tumours called?

A
  • Histiocytoma

- PLasmacytoma

58
Q

What are malignant round cell tumours called?

A
  • Lymphoma
  • Mast cell tumour
  • Malignant myeloma
59
Q

Describe the characteristics of round cell neoplasia of cytology

A
  • High yield on FNA/FNCS
  • Discrete round cells with obvious border
  • Not adherent to each other
60
Q

Describe the general characteristics of a benign neoplasia on cytology

A
  • Cells all look similar to each other
  • Nuclear size within 1.25x of each other
  • Little variation in tissue where there should be, and lots of variation in tissues where there should be (e.g. lymph nodes should have variety of lymphocytes)
61
Q

Describe the cytological characteristics of benign epithelial neoplasias

A
  • Single population of uniform, large cells
  • Pale, mildly granular cytoplasm
  • Round to oval nuclei
  • Fine lines between cells and cobblestone pattern indicating epithelial cells
62
Q

Describe the cytological characteristics of benign round cell neoplasia

A
  • Single population of uniform cells
  • Moderate, pale cytoplasm
  • Round to oval nuclei
63
Q

Describe the cytological appearance of a lipoma

A
  • Soft, smooth, slow growing
  • Non-nodular, painless masses
  • Aspirate is clear and greasy, poor staining with Diff-Quick
  • Stains with Sudan III or oil red “O”
  • Low cellularity, few clumps of benign connective tissue cells and adipocytes
64
Q

What are the cytological criteria of malignancy?

A
  • Cellular
  • Nuclear
  • Cytoplasmic
65
Q

Describe the cellular criteria of malignancy

A
  • Cells alien to position found in
  • Pleomorphism where there shouldnt be
  • Monomorphic cell population where there should be variation
  • High and/or variable nuclear to cytoplasm ratio
66
Q

Describe the nuclear criteria of malignancy

A
  • Variation in shape/size (ratio of smallest to largest diameter of >1.5x is bad news)
  • Multiple, fragmented or moulded nuclei
  • Clumped chromatin
  • Multiple/irregular nucleoli
  • Increased/abnormal mitotic figures
67
Q

What causes the flattening or moulding of nuclei in malignant neoplasia?

A

Rapid growth of adjacent cells

68
Q

Describe the cytoplasmic criteria of malignancy

A
  • Basophilia/hyperchromasia (more blue, higher RNA content of immature and active cells)
  • Vacuolation, granularity, phagocytosis of other cells
  • Pseudopod formation in some cases
69
Q

Describe the cytological appearance of epithelial carcinomas

A
  • High cellularity
  • Rounded or cells with distinct border, cluster/sheet/acini
  • Acini imply adenocarcinoma
  • Mitotic figures
70
Q

Describe the cytological appearance of mesenchymal sarcomas

A
  • Low cellularity
  • Single, elongated/spindle-shaped cells with indistinct cell boundaries
  • Difficult to identify specific cell of origin
71
Q

Describe the cytological appearance of round cell tumours

A
  • Cellularity high
  • Rounded or oval cells with distinct border, singly or in small clusters
  • Multiple nucleoli, little variation in cell type in lymphoma
  • In mast cell tumour, lots of cellular variation
72
Q

What may cause lymph node enlargement?

A
  • Reactive hyperplasia
  • Lymphadenitis
  • Lymphoma
  • Metastatic neoplasia
73
Q

Describe the appearance of a metastatic neoplasia in a lymph node

A
  • Presence of “alien” cells

- e.g. epithelial cells

74
Q

What cytological finding would indicate lymphadenitis?

A

Neutrophils (inflammation)

75
Q

Describe the cytological appearance of a liver FNA

A
  • Hepatocytes large, round or oval cells
  • Abundant, finely granular cytoplasm
  • Nuclei have coarse chromatin and prominent nucleolus
76
Q

What material and needle is used for subcuticular pattern sutures?

A
  • Absorbable monofilament

- Swaged to a sharp cutting needle

77
Q

Outline the procedure for a subcuticular suture pattern

A
  • Knot suture to subcutaneous tissues at the start of the wound commissure
  • Cut end
  • Start passage of needle from commissure through subcuticular tissue, then to the other side just back from where first stitch exited
  • Take alternating bites of tissues on opposite sides of wound, each time slightly back from where needle exited
  • Final passage of needle towards wound creates loop used for Aberdeen knot to tie off the suture
  • Pass needle back through wound, exit some distance from commissure to bury knot
  • Cut end and bury in the skin
78
Q

When can male rodents be castrated?

A

As soon as their testicles have descended

79
Q

What approaches can be used for castration of male rabbits?

A

Scrotal or prescrotal approach

80
Q

What approach is used for the castration of male guinea pigs?

A

Prescrotal

81
Q

What approaches can be used for the castration of male rats?

A

Abdominal, scrotal or prescrotal

82
Q

What is an important consideration when castrating male rodents and rabbits?

A
  • Open inguinal canal
  • May withdraw testes prior to surgery
  • Can be exteriorised by applying gentle pressure on the caudal abdomen
83
Q

Why is a subcuticular pattern commonly used in rodents and rabbits?

A

Are good at removing sutures

84
Q

What suture material should be used in the castration of rodents and rabbits?

A
  • Ideally synthetic materials
  • 3-0 absorbable for rabbits and larger rodents
  • 4-0 for smaller rodents

CPS (13 decks)

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