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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
laryngeal paralysis - diagnosis - stable patient
careful physical exam Hematology & biochemistry: concurrent/intercurrent disease) Thoracic radiographs careful evaluation of laryngeal function under a light plane of anaesthesia.
26
laryngeal paralysis - treatment
left arytenoid lateralisation - Suturing of the arytenoid to the thyroid (lateralisation) or cricoid post-op care - animal at risk of aspiration pneumonia
27
laryngeal neoplasia - clinical signs
Dysphonia Sonorous respiration, Exercise intolerance, Respiratory distress.
28
types of laryngeal neoplasia
congenital rhabdomyosarcoma (oncocytoma), squamous cell carcinoma adenocarcinoma, chondrosarcoma, fibrosarcoma and lymphoma
29
laryngeal paralysis - treatment outcome
Overall 85 - 90% improved long-term Short term complication rate of 30% All postoperative deaths involved concurrent disease processes
30
laryngeal paralysis - treatment complications
poor arytenoid abduction hematoma formation laryngeal penetration aspiration pneumonia
31
granulomatous laryngitis
in the dog and the cat sign similat to laryngeal paralysis and laryngeal tumours biopsy diagnosis of all laryngeal neoplasms prior to definitive treatment.
32
tube tracheostomy - Indications
Temporary airway diversion to permit surgery of oral cavity Long-term ventilatory support Emergency provision of airway
33
tracheal collapse
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
tracheal collapse - Pathophysiology
Dynamic airway obstruction Reduced alveolar ventilation Chronic cough
35
tracheal collapse - clinical features
``` Exercise intolerance ins + expiratory noise Chronic “goose – honk” cough Cyanosis/Collapse dorsoventral flatening of trachea ```
36
tracheal collapse - diagnosis
``` Signalment PE – palpation of trachea Radiography Fluoroscopy Endoscopy ```
37
tracheal collapse - surgical therapy
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
tracheal collapse - intralumenal stents
older dogs with co-morbid disease | palliative measure
39
tracheal trauma
neck bite wounds, traumatic intubation. | In cats, blunt trauma to the chest may cause tracheal rupture/avulsion
40
tracheal trauma - clinical features
subcutaneous emphysema can be over whole body. Pneumomediastinum + pneumothorax may result causing respiratory distress. Respiratory distress - can vary with head position.
41
tracheal trauma - diagnosis
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
tracheal trauma - treatment
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
Lung lobectomy - indications
``` Primary lung tumour ( + LN) Metastatic pulmonary mass Lung lobe torsion Pulmonary abscess/infection Bullous disease Trauma ```
44
primary lung tumour
Majority are malignant | Adenocarcinoma
45
primary lung tumour - Clinical features
``` Cough (productive-haemoptysis) - 52% Dyspnoea - 23% Lethargy - 18% Weight loss - 12% none - 25% ```
46
primary lung tumour - diagnosis
Thoracic radiographs and/or CT | check for other masses if one found
47
primary lung tumour - treament
Exploratory thoracotomy and lung lobectomy with differentiated adenocarcinomas without local LN involvement have longest postoperative survival times. recheck every 3-6 months
48
spontaneous pneumothorax
when atmospheric air enters the pleural space "closed" pneumothorax - lung is source of the leakage animal has no history of trauma
49
spontaneous pneumothorax - causes
``` Ruptured pulmonary bullae or blebs. Migrating inhaled plant material. Bacterial pneumonia, Chronic obstructive lung diseases Asthma, tuberculosis, pulmonary neoplasia airway parasites (filaroides). ```
50
spontaneous pneumothorax - clinical features
Tachypnoea Dyspnoea Exercise intolerance Absence of lung sounds on auscultation and “thoracic resonance on percussion” Radiography/CT – care in dyspnoeic animal
51
spontaneous pneumothorax - treatment
thoracocentesis or a chest tube exploratory thoracotomy via median sternotomy and removal of diseased lobe Prolonged pleural evacuation using chest drain.
52
lung lobe torsion
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
lung lobe torsion - Clinical features
accumulation of pleural fluid + necrotic lung lobe. depressed, inappetent febrile. dyspnoea and a cough. muffled lung sounds (consolidated lung lobe/pleural effusion)
54
lung lobe torsion - treatment
lobectomy of the affected lobe.
55
lung lobe torsion - diagnosis
Thoracocentesis, thoracic ultrasound, radiography and CT aid definitive diagnosis. Repeat imaging once chest is drained.
56
diaphramatic rupture (DR) - pathogenesis + pathophysiology
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
diaphramatic rupture (DR) - pathogenesis + pathophysiology - acute
post trauma | pulmonary contusions, rib fractures, pneumothorax, hemothorax and pain can all exacerbate poor pulmonary function.
58
diaphramatic rupture (DR) - pathogenesis + pathophysiology - chronic
effusion from surface of entrapped or strangulated organ(s) - hydrothorax - compromises lung volume
59
diaphramatic rupture (DR) - diagnosis
PE radiography (can be obscured by pleural effusion) GI contrast radiography
60
diaphramatic rupture (DR) - treament - emergency
24-48hrs of medical stabilization prior to surgical repair | If dilated stomach within the thoracic cavity, immediate action - trans-thoracic gastrocentesis
61
diaphramatic rupture (DR) - treament - stable
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
diaphramatic rupture (DR) - treament - ongoing pleural effusion anticipated
thoracostomy tube placed prior to closure of the dipahragmatic defect
63
diaphramatic rupture (DR) - treament - chronic defect healing
enhanced by debridement of the edges of the diaphragmatic rupture, not necessary for acute ruptures
64
Peritoneopericardial diaphragmatic hernia (PPDH) - pathogenesis + pathophysiology
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
Peritoneopericardial diaphragmatic hernia (PPDH) - diagnosis
As for acquired DR.
66
Peritoneopericardial diaphragmatic hernia (PPDH) - treatment
young - asap to reduce the risk of adhesion formation older - can be managed conservatively surgery abdominal organs returned to peritoneal cavity
67
Peritoneopericardial diaphragmatic hernia (PPDH) - pathophysiology
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
Esophageal hiatial hernia (EHH) - pathogenesis
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
Esophageal hiatial hernia (EHH) - pathophysiology
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
Esophageal hiatial hernia (EHH) - diagnosis
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
Esophageal hiatial hernia (EHH) - treament
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
Non-penetrating thoracic trauma - treatment
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
Penetrating thoracic trauma - treatment
exploratory thoracotomy based around the traumatic thoracic opening removal of injured or devitalized tissue pleural drainage and closure of the thoracic wall
74
Multiple rib fractures and flail chest - treatment
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
thoracic wall tumours - most common
Osteosarcoma + chondrosarcoma from costochondral junction
76
thoracic wall tumours - less common
hemangiosarcoma, fibrosarcoma, mast cell tumors and infiltrative lipomas
77
thoracic wall tumours - clinical signs
palpable mass | lameness - pulmonary osteoarthropathy.
78
thoracic wall tumours - diagnosis
radiography thoracic CT and MRI incisional biopsy
79
thoracic wall tumours - treatment
full thickness thoracic wall resection followed by reconstruction

Respiratory (21 decks)

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