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Respiratory > Surgical conditions of the Airways > Flashcards

Surgical conditions of the Airways Flashcards

1
Q

rhinarium - congenital deformities

A

stenotic nares

cleft - harelip primary cleft palate

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2
Q

rhinarium - lacerations

A

haemorrhage - can heal by 2nd intention

primary closure can also be done

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3
Q

rhinarium - neoplasia

A

squamous cell carcinoma

wide local excision

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4
Q

nasal cavity - chronic hyperplastic rhinitis

A

infl in nasal cavity - stimulates hyperplasia of mucous membranes + incr mucous secretion

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5
Q

nasal cavity - chronic hyperplastic rhinitis - treatment

A

specific therapy for underlying predisposing factors

rhinotomy + turbinectomy

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6
Q

nasal cavity - trauma

A 
epistaxis, deformity
usually little need for orthapaedic fixation
decr maxillary fractures
possibility of acquired palatine clefts
occasional sequestrum formation
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7
Q

nasal cavity - dental disease

A

mucopurulent discharge
unilateral
radiography
lesions in oral cavity

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8
Q

nasal cavity - intranasal neoplasia

A

most are malignant - carcinoma, adenocarcinoma, chondro, fibro, osteo - sarcoma
benign polypoid rhinitis
exploratory rhinotomy

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9
Q

nasal cavity - mycotic rhinitis - treatment

A

if medicine fails - place irragation tubes via sinusotomy

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10
Q

nasal cavity - foreign bodies

A

sudden onset sneezing, serous discharge
may progress to mucoid/purulent in chronic
rhinotomy may be needed for confirmation

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11
Q

congenital defects of the secondary palate

A

unable to suckle properly + nasal return of milk
aspiration pneumonia
if mild - chronic nasal discharge

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12
Q

aquired defects of the secondary palate

A

trauma due to tooth extraction or other
aspiration pneumonia
chronic nasal discharge + sneezing due to impaction of food into nasal cavity

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13
Q

BrachycephalicAirwayObstructionSyndrome - Primarypathology

A

Stenotic nares

Long soft palate

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14
Q

BrachycephalicAirwayObstructionSyndrome - secondarypathology

A

Eversion of the mucosa of the lateral laryngeal venricles
Laryngeal collapse
many brachycephalic dogs have tracheal hypoplasia, redundant pharyngeal mucosa + scolling of epiglottis

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15
Q

BrachycephalicAirwayObstructionSyndrome - clinical features

A

mild - exercise intolerance/dyspnoea when stressed
worse in heat + stress
noise on inspiration + expiration
laryngeal + pharyngeal oedema

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16
Q

BrachycephalicAirwayObstructionSyndrome - diagnosis

A 
PE
hematology + serum chemistry
thoracic radiography
lateral radiography of larynx
pharynx + larynx exam
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17
Q

BrachycephalicAirwayObstructionSyndrome - clinical actions

A 
Oxygen supplementation
Cool intravenous fluids
Whole body cooling
Sedation
Emergency 
intubation/tracheostomy
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18
Q

BrachycephalicAirwayObstructionSyndrome - treatment

A

rhinoplasty
staphylectomy (removal of uvula)
resect everted mucosa of lateral laryngeal ventricles
post-op tracheostomy management

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19
Q

tracheal hypoplasia

A

in bulldogs - narrowed trachea.
no surgical treatment
live a normal life, providing their upper airway is in good condition
can be v.severe

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20
Q

post op care for tracheotomy

A 
Constant monitoring.
Insert sleeve removed and cleaned every 2hrs
Nebulization every 4hrs
Limit physical activity
Suction tube only if necessary.
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21
Q

causes of laryngeal collapse

A 
Orotracheal intubation
Emergency tracheostomy
Partial laryngectomy
Arytenoid lateralization
Permanent tracheostomy
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22
Q

laryngeal paralysis - Aetiopathogeneis

A

Congenital
Acquired - trauma, neoplasia, secondary to polyneuropathy/polymyopathy
Acquired (Idiopathic)

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23
Q

laryngeal paralysis - clinical features

A

chronic progressive exercise intolerance
dysphonia
incri respi noise (esp in inspiration stridor)
chronic cough.
cyanosis and collapse - heat stress and excitement, animals are often pyrexic.

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24
Q

laryngeal paralysis - diagnosis - obstructive crisis

A

hyperthermic.
Sedation
oxygen supplementation,
cool intravenous fluids
external body cooling
Occasionally, rapid anesthetic induction and orotracheal intubation
tube tracheostomy will permit complete patient evaluation prior to definitive treatment.

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25
Q

laryngeal paralysis - diagnosis - stable patient

A

careful physical exam
Hematology & biochemistry: concurrent/intercurrent disease)
Thoracic radiographs
careful evaluation of laryngeal function under a light plane of anaesthesia.

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26
Q

laryngeal paralysis - treatment

A

left arytenoid lateralisation - Suturing of the arytenoid to the thyroid (lateralisation) or cricoid
post-op care - animal at risk of aspiration pneumonia

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27
Q

laryngeal neoplasia - clinical signs

A

Dysphonia
Sonorous respiration,
Exercise intolerance,
Respiratory distress.

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28
Q

types of laryngeal neoplasia

A

congenital rhabdomyosarcoma (oncocytoma), squamous cell carcinoma adenocarcinoma, chondrosarcoma, fibrosarcoma and lymphoma

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29
Q

laryngeal paralysis - treatment outcome

A

Overall 85 - 90% improved long-term
Short term complication rate of 30%
All postoperative deaths involved concurrent disease
processes

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30
Q

laryngeal paralysis - treatment complications

A

poor arytenoid abduction
hematoma formation
laryngeal penetration
aspiration pneumonia

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31
Q

granulomatous laryngitis

A

in the dog and the cat
sign similat to laryngeal paralysis and laryngeal tumours
biopsy diagnosis of all laryngeal neoplasms prior to definitive treatment.

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32
Q

tube tracheostomy - Indications

A

Temporary airway diversion to permit surgery of oral cavity
Long-term ventilatory support
Emergency provision of airway

33
Q

tracheal collapse

A

toy and small terrier breeds
poor tracheal cartilage development, poor tracheal conformation
exacerbated by LRT infections, heart disease and/or laryngeal dysfunction
disease usually causes a clinical problem in mid to late life
worsened by obesity.

34
Q

tracheal collapse - Pathophysiology

A

Dynamic airway obstruction
Reduced alveolar ventilation
Chronic cough

35
Q

tracheal collapse - clinical features

A 
Exercise intolerance
ins + expiratory noise
Chronic “goose – honk” cough
Cyanosis/Collapse
dorsoventral flatening of trachea
36
Q

tracheal collapse - diagnosis

A 
Signalment
PE – palpation of trachea
Radiography
Fluoroscopy
Endoscopy
37
Q

tracheal collapse - surgical therapy

A

in primary disease or where conservative management has failed
attempted salvage procedure
placement of prosthetic rings around the trachea
may need to be combined with arytenoid lateralization if laryngeal function is poor prior to or as a result of surgery.

38
Q

tracheal collapse - intralumenal stents

A

older dogs with co-morbid disease

palliative measure

39
Q

tracheal trauma

A

neck bite wounds, traumatic intubation.

In cats, blunt trauma to the chest may cause tracheal rupture/avulsion

40
Q

tracheal trauma - clinical features

A

subcutaneous emphysema can be over whole body.
Pneumomediastinum + pneumothorax may result causing respiratory distress.
Respiratory distress - can vary with head position.

41
Q

tracheal trauma - diagnosis

A

can be challenging.
cervical + thoracic radiographs - peritracheal, intermuscular, and subcutaneous emphysema.
+ve contrast studies using water soluble, organic iodide solutions if the diagnosis not obvious on radiography.
Bronchoscopy
Exploratory surgery

42
Q

tracheal trauma - treatment

A

Conservative therapy - cage rest + observation if stable + don’t have progressive lesions.
Surgical therapy if clinical signs are progressive and if respiratory distress is severe.

43
Q

Lunglobectomy -indications

A 
Primary lung tumour ( + LN)
Metastatic pulmonary mass
Lung lobe torsion
Pulmonary abscess/infection
Bullous disease
Trauma
44
Q

primary lung tumour

A

Majority are malignant

Adenocarcinoma

45
Q

primary lung tumour - Clinical features

A 
Cough (productive-haemoptysis) - 52%
Dyspnoea - 23%
Lethargy - 18%
Weight loss - 12% 
none - 25%
46
Q

primary lung tumour - diagnosis

A

Thoracic radiographs and/or CT

check for other masses if one found

47
Q

primary lung tumour - treament

A

Exploratory thoracotomy and lung lobectomy
with differentiated adenocarcinomas without local LN involvement have longest postoperative survival times.
recheck every 3-6 months

48
Q

spontaneous pneumothorax

A

when atmospheric air enters the pleural space
“closed” pneumothorax - lung is source of the leakage
animal has no history of trauma

49
Q

spontaneous pneumothorax - causes

A 
Ruptured pulmonary bullae or blebs.
Migrating inhaled plant material.
Bacterial pneumonia, 
Chronic obstructive lung diseases
Asthma, tuberculosis, pulmonary neoplasia airway parasites (filaroides).
50
Q

spontaneous pneumothorax - clinical features

A

Tachypnoea
Dyspnoea
Exercise intolerance
Absence of lung sounds on auscultation and “thoracic resonance on percussion”
Radiography/CT – care in dyspnoeic animal

51
Q

spontaneous pneumothorax - treatment

A

thoracocentesis or a chest tube
exploratory thoracotomy via median sternotomy and removal of diseased lobe
Prolonged pleural evacuation using chest drain.

52
Q

lung lobe torsion

A

in both dogs and cats
right middle and right cranial lung lobes are most frequently involved
associated with pleural effusions (chylothorax), trauma, thoracic surgery, neoplasia, and chronic respiratory disease.

53
Q

lung lobe torsion - Clinical features

A

accumulation of pleural fluid + necrotic lung lobe.
depressed,
inappetent
febrile.
dyspnoea and a cough.
muffled lung sounds (consolidated lung lobe/pleural effusion)

54
Q

lung lobe torsion - treatment

A

lobectomy of the affected lobe.

55
Q

lung lobe torsion - diagnosis

A

Thoracocentesis, thoracic ultrasound, radiography and CT aid definitive diagnosis. Repeat imaging once chest is drained.

56
Q

diaphramatic rupture (DR) - pathogenesis + pathophysiology

A

acquired
Blunt abdominal trauma - elevation in intra-abdominal pressure - rupture at weakest point
loss of diaphragmatic contribution to pulmonary ventilation
migration of abdominal organs into the thoracic cavity - lung volume.

57
Q

diaphramatic rupture (DR) - pathogenesis + pathophysiology - acute

A

post trauma

pulmonary contusions, rib fractures, pneumothorax, hemothorax and pain can all exacerbate poor pulmonary function.

58
Q

diaphramatic rupture (DR) - pathogenesis + pathophysiology - chronic

A

effusion from surface of entrapped or strangulated organ(s) - hydrothorax - compromises lung volume

59
Q

diaphramatic rupture (DR) - diagnosis

A

PE
radiography (can be obscured by pleural effusion)
GI contrast radiography

60
Q

diaphramatic rupture (DR) - treament - emergency

A

24-48hrs of medical stabilization prior to surgical repair

If dilated stomach within the thoracic cavity, immediate action - trans-thoracic gastrocentesis

61
Q

diaphramatic rupture (DR) - treament - stable

A

If gastric decompression can be maintained via nasogastric tube, non-surgical therapy can continue; if this is not possible emergency surgery is indicated
chronic DR with pleural fluid accumulation - withdrawal of the fluid prior to surgical intervention

62
Q

diaphramatic rupture (DR) - treament - ongoing pleural effusion anticipated

A

thoracostomy tube placed prior to closure of the dipahragmatic defect

63
Q

diaphramatic rupture (DR) - treament - chronic defect healing

A

enhanced by debridement of the edges of the diaphragmatic rupture, not necessary for acute ruptures

64
Q

Peritoneopericardial diaphragmatic hernia (PPDH) - pathogenesis + pathophysiology

A

congenital
failure of septum transversum to advance - space between the 2 advancing lateral pleuroperitoneal folds
failure of the lateral pleuroperitoneal folds to unite or a result of intrauterine trauma
may be associated with other developmental abnormalities

65
Q

Peritoneopericardial diaphragmatic hernia (PPDH) - diagnosis

A

As for acquired DR.

66
Q

Peritoneopericardial diaphragmatic hernia (PPDH) - treatment

A

young - asap to reduce the risk of adhesion formation
older - can be managed conservatively
surgery
abdominal organs returned to peritoneal cavity

67
Q

Peritoneopericardial diaphragmatic hernia (PPDH) - pathophysiology

A

loss of intrapleural volume - reduction in lung volume
displaced gastrointestinal organs may become partially or completely obstructed
cardiac defects can result in primary signs of cardiac compromise and other vascular defects - CNS, urinary tract and GI tract signs.

68
Q

Esophageal hiatial hernia (EHH) - pathogenesis

A

congenital
defect in the formation of the esophageal hiatus,
laxity in esophageal hiatus - abdominal esophagus and cardia of the stomach move into the thoracic cavity or portion of stomach to enters thoracic cavity next to the abdominal esophagus

69
Q

Esophageal hiatial hernia (EHH) - pathophysiology

A

impairment of the “high pressure zone” of the caudal esophagus
chronic gastroesophageal reflux, regurgitation and/or vomiting
chronic esophagitis, esophageal hypomotility and aspiration pneumonia

70
Q

Esophageal hiatial hernia (EHH) - diagnosis

A

Hx
PE - may reflect secondary disease processes
radiography - gas-filled viscus in dorsocaudal thorax
alveolar pattern in the cranioventral lung fields
A barium paste esophagram + fluoroscopy

71
Q

Esophageal hiatial hernia (EHH) - treament

A

surgical therapy in three steps
1) stomach is returned to the abdomen + phrenoesophageal ligament dissected
2) defect closed beginning dorsal to the esophagus and proceeding ventrally
The hiatus should be closed so that the esophagus is in a normal position.
3) gastric fundupexy using a tube gastrostomy or belt-loop gastropexy.

72
Q

Non-penetrating thoracic trauma - treatment

A

single/small numbers of rib fractures and associated thoracic wall muscular contusions - managed conservatively
superficial bite wounds/skin avulsion wounds - surgical exploration and wound debridement

73
Q

Penetrating thoracic trauma - treatment

A

exploratory thoracotomy based around the traumatic thoracic opening
removal of injured or devitalized tissue
pleural drainage and closure of the thoracic wall

74
Q

Multiple rib fractures and flail chest - treatment

A

Stabilization of loose ribs + flail segments - relieve pain + improve ventilation
mechanically assisted ventilation (24 – 48 hrs) + medical therapy before definitive rib repair
Flail segments and unstable ribs may be successfully immobilized by percutaneously placed circumcostal sutures secured to an external splint
Open exploration of unstable ribs following massive bite wounds
Ribs may be stabilized by suturing to adjacent ribs, or may be resected if damage is severe
Closure of the wound with native tissues is ideal
massive trauma may necessitate reconstruction with synthetic implants.

75
Q

thoracic wall tumours - most common

A

Osteosarcoma + chondrosarcoma from costochondral junction

76
Q

thoracic wall tumours - less common

A

hemangiosarcoma, fibrosarcoma, mast cell tumors and infiltrative lipomas

77
Q

thoracic wall tumours - clinical signs

A

palpable mass

lameness - pulmonary osteoarthropathy.

78
Q

thoracic wall tumours - diagnosis

A

radiography
thoracic CT and MRI
incisional biopsy

79
Q

thoracic wall tumours - treatment

A

full thickness thoracic wall resection followed by reconstruction

Respiratory (21 decks)

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