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Year 3 respiratory > surgical conditions > Flashcards

surgical conditions Flashcards

1
Q

what would be a clinical sign of a congenital rhinarium deformity?

A

nasal discharge

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2
Q

what are 6 causes of nasal discharge?

A 
chronic hyperplastic rhinitis
trauma
dental disease
intranasal neoplasia
mycotic rhinitis
foreign body
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3
Q

what is chronic hyperplastic rhinitis?

A

prolonged inflammation in the nasal cavity stimulates hyperplasia of mucous memebranes and increased mucous secretion

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4
Q

how can you treat chronic hyperplastic rhinitis?

A

rhinotimy and turbinectomy if severe and intractable

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5
Q

when would you surgically intervene with nasal trauma?

A

if need to orthopaedically elevate depressed fragments

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6
Q

what nasal discharge can be seen with dental disease?

A

mucopurulent discharge, epistaxis

unilateral

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7
Q

what neoplasias are common intranasally?

A

carcinoma
adenocarcinoma
chondro/fibro/osteo-sarcoma

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8
Q

when would you surgically intervene with mycotic rhinitis?

A

if medical penicillin fails so place irrigation tubes to facilitate enilconazole therapy

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9
Q

what is seen with a congenital defect in the palate?

A

failure to thrive
cant suckle
nasal return of milk
resp signs of aspiration pneumonia

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10
Q

how can you get an acquired palate defect?

A

trauma
electrical burns
tooth extraction
forceful separation

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11
Q

what signs would you see with an acquired palate defect?

A

aspiration pneumonia
chronic nasal discharge
sneezing

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12
Q

what are the primary and secondary consequences of bracycephalic airway obstruction syndrome?

A

primary - stenotic nares, long soft palate

secondary - eversion of lateral laryngeal ventricles, laryngeal collapse, tracheal hypoplasia, redundant pharyngeal mucosa, scrolling of epiglottis

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13
Q

what are the signs seen with brachycephalic airway obstruction syndrome?

A

exercise intolerance
dyspnoea
noise on inspiration and expiration
acute cyanosis and collapse with stress/heat

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14
Q

how do you diagnose brachycephalic airway obstruction syndrome?

A
  • thoracic rads - often pulmonary oedema
  • lateral rad of larynx
  • pharyngeal and laryngeal examination
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15
Q

what are the surgical options for brachycephalic airway obstruction syndrome?

A

1) rhinoplasty - bigger nostrils
2) staphylectomy - trim soft palate to level of caudal pole of tonisl
3) resect everted mucosa of lateral laryngeal ventricles
- temporary tracheostomy?

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16
Q

what are the post-op recommendations for brachycephalic surgery?

A
  • monitor very closely
  • keep quiet for 7-10 d
  • no exercise for 2 w
  • soft food for 3-5 d
  • suture out and chest rads in 10-14 d
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17
Q

what breed is tracheal hypoplasia common in?

A

bulldogs

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18
Q

how do you manage tracheal hypoplasia?

A

nothing is have a good URT

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19
Q

when would you consider a tracheotomy?

A
  • before URT surgery

- emergency to bypass URT obstruction

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20
Q

how do you manage a tracheotomy tube?

A
  • remove and clean sleeve every 2 hrs
  • nebulise every 4 hrs to keep mucous loose so can come out of tube
  • limit physical activity
  • remove tube once have adequate upper airway movement
  • suction only if really necessary
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21
Q

how do you place a tracheotomy tube?

A

1) ventral midline skin incision 2-4 cm caudal to larynx
2) separate sternohyoid/sternothyroid muscles in midline to reveal trachea
3) place stay sutures around tracheal rings
4) incise between 4th and 5th tracheal rings between the stay sutures
5) place tube in lumen
6) close skin around tube and secure
7) leave stay sutures in so can reposition if needed

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22
Q

what are 4 surgical laryngeal conditions?

A

laryngeal collapse
laryngeal paralysis
laryngeal neoplasia
granulomatous laryngitis

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23
Q

what are 2 emergency obstructive crisis’s?

A

laryngeal collapse

laryngeal paralysis

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24
Q

what can you do for laryngeal collapse?

A

orotracheal intubation
salvage and place permenant tracheostomy
partial laryngectomy

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25
what are the 3 ways to get laryngeal paralysis?
congenital (bouvier des flandres, husky) acquired (trauma, neoplasia, secondary to polymyopathy) idiopathic (labrador, retriever, afghan, st.bernard, setter)
26
what are the signs associated with laryngeal paralysis?
``` progressive exercise intolerance dysphonia increased resp noise (man sawing wood) on insp cough cyanosis and collapse aspiration pneumonia ```
27
what do you do if faced with an obstructive crisis?
- sedate with low dose ACP - oxygen - cool IV fluids - external body cooling - rapid induction and orotracheal intubation if needed - tracheostomy
28
what are the surgical options for laryngeal paralysis?
- left arytenoid lateralisation (suture cartilage to thryoid) or laryngoplasty (suture to cricoid) - pallative but have aspiration risk - will cough for 2-3 wks post op
29
what are the common laryngeal neoplasia?
``` congenital rhabdomyosarcoma sq cell carcincoma adenocarinoma chrondrosarcoma fibrosarcoma lymphoma ```
30
what do you never do with a patient with laryngeal neoplasia?
place an ET tube
31
what signs are seen with laryngeal neoplasia?
dysphonia sonorous respiration exercise intolerance respiratory distress
32
how do you diagnose granulomatous larynitis?
biopsy
33
what are 3 tracheal conditions?
tracheal collapse tracheal trauma tracheal FB / obstruction
34
what can predispose to tracheal collapse?
- toy and small terriers - poor tracheal cartilage development - LRT inf - heart disease - laryngeal dysfunction
35
what are the signs of tracheal collapse?
- goose-honk cough - vibrant inspiratory and expiratory noise exacerbated by excitement and exercise - cyanosis and collapse - can occlude trachea on palpation
36
what are the 2 common presentations of tracheal collapse?
- primary collapse in the young | - middle aged collapse with concurrent disease
37
how do you diagnose tracheal collapse?
fluoroscopy and endoscopy to see dynamic collaspe
38
what are the surgical options for tracheal collapse?
- stent if old as a pallative measure as lasts 3-4 yrs - prosthetic rings around trachea to hold open if primary collapse - treat underlying disease
39
what signs may be seen with tracheal trauma?
subq emphysema - pneumomediastinum and pneumothorax - resp distress
40
how do you diagnose tracheal trauma?
peritracheal + intramuscular subq emphysema on rads | bronchoscopy to locate lesion
41
what is seen with primary lung tumours?
cough with haemoptysis dyspnoea lethargy wt loss
42
how can you surgically treat lung tumours?
lung lobectomy
43
what is a spontaneous pneumothorax?
when lung is source of leak and air is atmospheric - caused by: ruptures bullae/bleb, migrating inhaled plant material, bacterial pneumonia, chronic obstructive lung disease, asthma, TB, pulmonary neoplasia, parasites
44
what are signs of a spontanous pneumothorax?
tachypnoea dyspnoea exercise intolerant no lung sounds
45
how do you treat a spontaneous pneumthorax
- drain with thoracocentesis to stabilise - exploratory thoracotomy and fill thorax with saline to find holes and remove diseased lobe - chest drain for prolonged evacuation
46
what dogs are more common to get a lung lobe torsion?
narrow deep chested
47
what lung lobes are most commonly affected by torsion?
R middle and R cranial
48
what can lung lobe torsion be associated with?
``` pleural effusions trauma thoracic surgery neoplasia chronic resp distress ```
49
what signs are seen with lung lobe torsion?
depressed,, inappetant, febrile, dyspnoea, cough, muffled lung sounds - pleural fluid and necrotic lung lobe
50
how do you diagnose a lung lobe torsion?
thoracocentesis US CT
51
how do you surgically repair a lung lobe torsion?
lung lobectomy | DONT untwist as will release infl mediators and necotic toxins
52
how can you get an acquired diaphragmatic rupture?
- blunt trauma causing a sudden elevation in intra-abdominal pressure that results in rapid forced expiration when the glottis is open - get pleuroperitoneal pressure gradients which results in rupture of the weakest part of the diaphragm
53
what signs are seen with a acquired diaphragmatic rupture?
``` dyspnoea reduced lung volume effusion from trapped organs hydrothorax GI signs from trapped organs muffled heart sound loss of lung sounds 'empty' abdomen on palpation ```
54
how can you diagnose a diaphragmatic rupture
rad - contrast? | and repeat rads after removing effusion as may mask cause
55
how do you treat an acquired diaphragmatic rupture?
- if acute then can allow 24 hrs to stabilise before surgery - break down any adhesions between abd and thoracic organs - place a thoracostomy tube before closing defect
56
when must surgery become an emergency with diaphragmatic rupture?
if the stomach is in the thorax then need to deflate it so can breath and maintain a gastric tube until surgery
57
what is the process behind a congenital peritoneopericardial diaphragmatic hernia?
- failure of septum trasversum to advance leaving space between the two advancing lateral pleuroperitoneal folds - or failure of the lateral pleuroperitoneal folds to unite - or due to intrauterine trauma
58
when is surgery elective with a congenital hernia?
in older patients if stable
59
in young animals how is a congenital diaphragmatic hernia repaired?
-quickly surgically to prevent adhesions
60
what is a congenital oesophageal hiatal hernia?
- defect in formation of the hiatus - either the abdominal oesophagus and cardia slide into thoracic cavity or a portion of the stomach enters the thoracic cavity adjacent to abdominal oesophagus
61
what breed is an oesophageal hiatal hernia hereditary?
shar-pei
62
what signs are seen with a oesophageal hiatal hernia?
- chronic gastroesophageal reflux - regurg and vom - chronic oesophagitis - oesophageal hypomotility - aspiration pneumonia - ill thrift
63
how do you diagnose an oesophageal hiatal hernia?
- rads - gas filled viscus in dorsocaudal thorax | - alveolar pattern in cranioventral lung fields from asp pneumonia
64
how do you surgically repair a oesophageal hiatal hernia?
1) return stomach 2) close defect beginning dorsally 3) oesophagopexy between oesophagus and hiatus 4) gastric fundupexy
65
what is an example of a non-penetrating thoracic wall trauma?
- rib fractures | - superficial bite wounds
66
what is the difference in management between a penetrating and non-penetrating thoracic wall trauma?
-penetrating needs an exploratory thoractotomy to remove devitalised tissue, provide wound drainage and close wall
67
how do you manage a patient with multiple fib fractures?
- stabilisation is key as can relieve pain and improve ventilation - may need mechanically assisted ventilation until definitive repair
68
what tumours of the thoracic wall are common?
-osteosarcoma and chondrosarcoma from costochondral junction
69
what can cause pulmonary osteoarthropathy?
lameness - from a thoracic wall tumour
70
how can you surgically remove thoracic wall neoplasia?
full thickness wall resection and reconstruction

Year 3 respiratory (11 decks)

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