Surgical diseases of small animals Flashcards
Diseases of eyelid, conjunctiva and third eyelid
Entropion Congenital -inward folding of the eyelid often seen in chow chow Acquired -Trauma, muscle spasm Irritation of cornea T: eye drops, tacking suture
Ectropion Congenital -Outward folding of eyelid, often seen in bulldogs, great danes Acquired -paralysis of CN VII (facial) Exposure to environment T: Y-U suture, modified Khunt
Trichiasis
Ectopic hair growth on conjunctiva –> irritation of cornea
Blepharitis
- B: Chlamydia, mycoplasma
- V: Calici, distemper
- P: thelaria
- Non-Inf: Photosensitivity, allergies, vitiligo
Hordeolum
Inflammation of harderian glands, meibomian glands
Cherry eye
Prolapse of third eyelid + hypertrophy
Spaniels
T: Tacking suture
Conjunctivitis
Inf: distemper, herpes, chlamydia, thelaria, dermatophytosis
Allergic
Mechanical - Chemical, entropion, trichiasis,
KCS - lack of tear quality or quantity
Infectious Conjunctivitis
Diseases of the cornea - keratitis, ulceration, perforation
Ulcerative keratitis
Loss of stroma
-superficial, deep, perforating
-Mechanical: trichiasis, entropion, FB, Tear film deficiency
-Infectious: produce proteases that melt the cornea (malacia)
T: conjunctival flap NO STEROIDS
Boxer ulcer
-Spontaneous superficial ulcer of cornea
Deep keratitis
CAV-1 (inf. hepatitis)
-Corneal opacity “blue eye”
KCS -lack of tear film quant and qual -hormonal (hypothyroidism, DM, cushings) -infectious -congenital (MUC5A) -Nervous - loss of parasympathetic innervation Dx: STT-2. TFBUT T: artifical tears (pilocarpine) and parasympathomimetics
Pannus (chronic superficial keratitis)
-Grey opacity of cornea
-Auto-immune (german shepherds) triggered by viral Ag’s or UV light
T:Keratectomy
Lacerations/Trauma
Penetrating - enters cornea but does not even anterior chamber
Perforating - Through and through
T: sutures
Cs: Epiphora, keratitis, blepharospasm
Dx: STT, slit lamp, TFBUT, rose-bengal
T:
Superficial keratectomy
Keratoplasty
Conjunctival flap
Diseases of the iris and retina
Uvea (Iris, chroid, cilliary body)
Congenital defects Heterochromia Persistent pupillary membrane - should regress after birth Uveal cyst Collie eye -aplasia of retina
Anterior uveitis
Inflammation of uveal tract - iritis, iridocyclitis
Ant, Post, Int, Pan
Hyphema
Blood in AC
Trauma, clotting issues, glaucoma
Retinal dysplasia
Congenital (collie eye)
Acquired - herpes, toxoplasma, CAV-1, Calici, Distemper
Progressive retinal atrophy
-Breed disposition - setters, poodles
cGMP –> toxic to retina
Cs: Night –> full blindness, slow pupillary reflex, bumping obstacles
Dx: Maze or tracking test
OCT, ophthalmoscopy
T:Mydriatics (uvetits), CCS, ATB
Diseases of the lacrimal glands and ducts and KCS
Lacrimal gland (CN VII) Harderian glands Meibomian glands (zeis)
KCS
Deficiency of tear film quality or quantity
Acquired - hypothyroidism, DM, CNVII damage (parasympathetic), infectious
Congenital - brachycephalic ocular syndrome
Acute - conjunctivitis, ulceration
Chronic - hyperkeratisation
Dx: STT <15-25mm, rose-Bengal (stains epithelium)
T:pilocarpine
Mucin deficiency
- Shi-tzu’s
- Normal STT
- TFBUT
Imperforate puncta lacrimalia -medial canthus location -rains tears as well as the ICA -Congenital - spaniel -Acquired - inflammation (pus) Dx: cannulate + flush T: Excise --> Cannulate
Obstruction of nasolacrimal duct
Lacrimal puncta –> nasolacrimal duct –> nose and throat
Acquired: inflammation
Dx: Jones test
Dacryocystitis Inflammation of lacrimal duct 2nd to obstruction of NLD Dx: X-Ray T: conjunctivorhinostomy
Cs: epiphora, tear staining, fisulation
Glaucoma
Increased IOP –> visual defects –> blindness
AH drainage is blocked (ICA + puncta lacrimalia)
Excess production
Results in buphthalmos, exophthalmos –> rupture of descemet’s membrane (corneal striations)
Primary - Breed (Brachy)
Secondary - Disease process
-Acute: corneal oedema, mydriasis
-Chronic: buphthalmos, luxated lens , corneal striations
Dx: Tonometry (15-25mm/Hg) >30mm/Hg = glaucoma
Gonioscopy, ophthalmoscopy
T:
AH outflow: Pilocarpine (parasympathomimetics), Adrenaline (sympathomimetics)
Decrease production - Acetazolamide (carbonic anhydrase inhibitors - sulfonamide derivatives)
YAG laser
Cryotherapy
Gonio-Implant (widens NLD)
Enucleation
Diseases of the lens. Neoplasia of the eye
Cataracts
Opacity of lens
Causes
- hereditary
- DM + hormonal
- Infectious
- Traumatic/iatrogenic
- Changes in IOP
Classification
- Onset: Juvenile, congenital, senior
- Location: capsular, subcapsular, cortical
Stage
- Incipient: focal opacity
- Immature: lens enlargement
- Mature: Total lens opacity
- Hypermature: liquefaction
Dx: ophthalmoscopy, USG
T: mydriatics, USG breakdown
Len sub/luxation
Luxation - total lack of attachment
Sub-Lux: partial loss of zonular attachment
Anterior or posterior
Causes:
-Changed by glaucoma and trauma
Cs: luxation - blocks ICA/PL --> glaucoma Posterior - assymptommatic Sub-lux: Aphatic cresent T: emulsification and removal
Neoplasia
Eyelid (common) - skin tumours
-Adeno, melano, histio, papillo
Orbital
-Osteosarcoma, fibrosarcoma
Corneal + limbal
Melanoma
Uveal
Melanoma + lymphosarcoma
Cs: exophthalmos, buphthalmos, strabismus, hyphema, glaucoma, iridocyclitis
Dx: Biopsy
Proptosis of the eyeball. Blindness
Proptosis
Protrusion of the eye (similar to exophthalmos)
Congenital - Mucocele
Acquired - Myositis, FB, Neoplasia
Proptosis causes inflammation + haemorrhage –> further displacement –> positive feedback
Can result in ulcers, optical nerve damage, KCS
T: Artificial tears, pilocarpine, canthotomy, tarsorrhaphy
Blindness
Partial or complete
Dx: lack of menace response, delayed pupillary response, Maze test, tracking test
Rods - Night vision
Cones - Day vision
Types
Central-cortical: Occipital damage
Acute: Retinal aplasia, optic nerve damage, lens luxation
Progressive vision loss (chronic lesions): corneal oedema, KCS, cataracts, retinal necrosis
Congenital vision loss: Collie eye, pannus, retinal dysplasia, anophthalmus
Cs: anisocoria, mydriasis, loss/delayed pupillary light reflex
Evaluation and therapeutic surgical methods for eye diseases. Diagnosis and Therapy.
Exam Discharge? Colour Pupil size Symettry Cloudiness?
Eliminate skin or dental disease
Ophthalmic exam Behaviour + vision -Tracking: cotton ball -Obstacle/Maze: navigation -Placing: pre-empt
Neuropathic exam
- Menace - 2 + 3
- Pupillary - 2,3,4,7
- Dazzle: should avoid
- Palpebral - CN 5, 6, 7
Tear film test
STT/STT-2 - 15-25mm/min
Phenol red - like STT (18-25mm/15 seconds)
TFBUT
Jones test - patency
Fluorescein - observe corneal defect
Rose-Bengal test: Degenerated cornea (herpes, corneal ulcers)
IOP - tonometry 15-25mm/Hg Lower - uveitis Higher - Glaucoma Manual (retropulsion) - assess with hands Schoitz - old school Tonometer - tonovet
Opthalmoscopy
Direct - fundus + behind eye
Indirect - Upside down
Fundus cam - iphone + lens
Gonioscopy
Goniolens to assess ICA
USG
Retrobulbar lesions, lens luxation or cataracts
Surgical procedures
- Eyelid laceration - figure 8
- Tacking eyelid issues
- Y-U repair: entropion
- Modified Khunt (similar to Y-U)
- Excision
- Enucleation
Surgical diseases of the pinnae and external ear canal. Methods of treatment. Lateral resection of the external ear canal. Partial and total ablation of the ear canal. Osteotomy of the bulla tympani
Otitis
Ext - Ear canal
Media - tympanic membrane + eustachian tube (Horner’s)
Int - semi-circular canals and ossicles (Vestibular)
–Cats: Ascending
–Dogs: Descending
Hyperplastica –> ossificans
Othaematoma auris Causes: -otitis externa -Trauma + fighting -Cushing's -Pendulous pinnae
T: puncture + drain –> Aspiration + CCS
S-Shaped incision –> ligate bleeders –> Ligate ear with horizontal mattress (not over incision) + buttons (to elivated pressure on the sutures)
Bandage with capistrum
Wounds/Trauma
Superficial, deep, perforating
Debridge edges, suture –> ATb
Bandage with capistrum
FB’s
Grass seeds
Otoscope + forceps
Neoplasia
Papiloma, fibroma, sarcoma
Surgical treatment
Lateral ear resection
-Vertical ear canal hyperplasia
-non-responsive otitis ext
Vertical ear ablation
-when vertical canal is diseased but horizontal is fine
Total ear canal ablation
- Vertical + medial ear canal
- Drain is affixed to prevent sebum build up
- Otitis hyperplastica (ossificans)
Lateral bulla osteotomy
- Done alongside TECA (TECA-BO)
- Removal of secretory epithelium
- Use rongeur (avoid retroauricular vein and ossicles) to express bulla
Vertical bulla osteotomy
-Mandible rami –> ventral midline (2cm from centre on affect side)
Avoid hypoglossal nerve and muscle + lingual artery
Cartilage (concha) or vertical ear canal graft
- Use in hard palate repair from celft palate
- Use cartilage from pinnae or 2/3 of vertical ear canal
Surgical diseases of the salivary glands and ducts.
Mucoceles
Inflammation of gland or duct cause leeching and accumulation of saliva
Location
Cervical - dysphagia and swelling
Sublingual ("Ranula")
Pharyngeal - coughing
Zygomatic - exophthalmos
T:Drain + marsupialised (cutting a slit and suturing the edges open)
Mandibular + subligual :
Incision at level of ear, removal of both glands must be done
Zygogatic:
Incise at dorsal zygomatic arch
Move globe dorsally
Parotid:
Incise between ramus and jugular bifurcation
Sialadentits
trauma or systemic infection
Swelling –> fistulation
T: drain and marsupialise
Sialoliths Calcified stone in salivary duct Formed from inflammatory cells or ascending FB Dx: imaging T: forceps
Fistula
Trauma to salivary glands finds it hard to heal due to constantly salivary drip
Ptylism
Primary - hypersialoism
Secondary - Infectious process, swallowing disorder, peridontal disease
DDx important in rabies
T:Anti-drool cheilioplasty
- cut at 2nd premolar (1/206)
- lower lip sutured into upper lip with mucosal fold suture
Diseases of the lip. Mouth diseases. Gingivitis. Tartar. Neoplasia of the soft and hard tissue of the mouth. Clef palate. Oronasal fistulation. Surgical diseases of the nose
LIPS
Lip fold dermatitis (intertrigo)
Spaniels + St.Bernards
Feline eosinophilic complex 3 Lesions -Plaque -Granuloma -Indolent ulcer
Allergic aetiology with localisation on hard palate
MOUTH
Stomatitis
Increased immune activity due to tartar build up on teeth
Contact ulcer on upper lip by carnacial
Gingivitis
Inflammation of gums –> first stage of peridontal disease
Bacteria –> plaque –> Ca2+ –> Tartar
T:Scale and polish
Cs: ptyalism, bruxism, dysphagia, chewing on one side
Peridontal disease
Inflammation of the structure holding the tooth due to excess tartar (plaque –> tartar 2 weeks)
Cs: Peridontal pockets, gingival rescession
Formation of peridontal pockets allows anaerobic bacteria (fuscobact) infiltration
T: Excision, gingivectomy
Cleft lip/palate
Failure of palatine fusion higher occurrence in brachycephalics
Primary - lip
Secondary - hard palate (oronasal fistula)
T: Palate guard. Surgery >12 weeks
Oronasal fistula
Congenital as a result of secondary hard palate clefting
Acquired - FB, chronic rhinitis, iatrogenic during canine tooth removal
Cs: milk leakage, aspiration pneumonia
T:
Debride and cover
-Advancing flap
-Rotational flap
-Double flap (hard palate and lip mucosa)
T:
HARD PALATE
Von Langenbeck technique (sliding pidical flaps)
Overlapping flap (tuck flap into pocket)
SOFT PALATE
Flap from nasal wall, tuck into lip mucosa
Z-cheilioplasty
Neoplasia Odontoblastoma Ameloblastoma odontoblastic fibroma Epulis - boxers
Tonsilitis/adenoma
-Tonsilectomy
NOSE Stenotic nares Part of BS Mouth breathing T: Alar wing resection, punch resection
Diseases of the teeth - oligodontia, polyodontia, brachygnathia, pulpitis
Tooth anatomy Enamel Dentin Cementin pulp Periodontal ligament
Teething: 4 mnths –> 7mnths
Diphyodont
Dental formula:
Cats: 3/3 1/1 3/2 1/1
Dogs: 3/3 1/1 4/4 2/3
Tridan system:
1 - Upper R, 2 - Upper L
3 - Lower L, 4 - Lower R
Start at the incisor (X01)
Oligodontia - Brachycephalics have a higher incidence of this. (>6 teeth missing) 0 usually premolars
Polyodontia - “supernumery teeth” usually incisors –> crowding + malocclusion
Cs: Dysphagia, chewing on one side, bruxism, ptyalism
Brachygnathia Abnormally short jaw Maxilliary - results in crowding Mandibular T:Bite plates + correction
Pulipitis
Inflammation of pulp
-Trauma
-Infection from decay allowing bacterial infiltration
-periodontal disease
Pulp is enclosed so pressure can cause ischemia and further destroy the tooth
Cs: Dysphagia, swelling, halitosis, weight loss, ptyalism
Fracture of teeth. Extraction of teeth. Endodontia, exodontia. Local analgesia of the head
Fractures
Canine and carnacials (4th premolar)
Usually trauma from chewing FB’s
Classification Enamel Uncomplicated crown Complicated crown Root (bi/tri-furcation) Uncomplicated crown-root Complicated crown-root
Enamel hypoplasia (results in pulp exposure)
-Inf: distemper
-Non-Inf: fluoride excess
Pulp exposure –> infection (pulpitis)
Cs: dysphagia, unilateral chewing, ptyalism, facial oedema
T: ATb, replanting, extration, root canal
Exodontia Dental extraction Root abscess, fracture, FORL Elevate + levate Drill Perigingival flap (envelope tech) Canine = oronasal fistula risk
Endodontics Dentistry of the pulp -Pulp exposure + pulpitis -Abscess, cyst -Remove necrotic tissue -Prevent apical peridontitis -Fill canal with sealant
Partial maxilectomy/mandibulectomy -Oral neoplasia resection Localisations -Pre-maxilectomy (bilateral rostral) -Rostral - incisors + canines -Central - premolars -Caudal - molars -Hemi: entire side of skull
Anaesthesia in the head Rostral maxillary Caudal maxillary Rostral mandibular Caudal mandibular
Surgical diseases of the oesophagus. Hiatal hernia. oesophageal feeding tubes
Oesophagotomy - opening
Oesophagectomy - removal
Oesophagostomy - placing a tube
Adventisia, musc, sub, mucosa
-Lack of serosa means adhesions are common
Obstruction Intramural Foreign bodies 3 Sites -Ap. Thor. Cran. -Basis cordis -Hiatus oesophagi
Extramural
Neoplasia
Stricture - recurrent obstrcution
Diverticulum
- Traction
- Pulsion
Peristalsis –> necrosis –> perforation
Megaoesophagus
- Acquired: Addion’s, mechanical obstruction
- congenital: myasthena gravis
Oesophagitis
-FB, acid reflux, pancreatic enzymes
Hiatal hernia Cardia - slide hernia Fundus - rolling hernia Congenital Acquired: dyspnea (thoracic pressure), reflux
Gastroesophageal intussusception
-Similar to hernia but instead of fundus/cardia going into the hiatus the fundus folds into the oesophagus
Oesophageal aclasia
-Failure of sphincter to open at birth
Cs: Regurgitation (not vomiting), ptyalism, halitosis, dysphagia, dyspnea
Dx:
Fluroscopy (to observe size and motility)
Endoscopy
X-Ray
T: Omeprazole (PPI) Cimetidine (H2 blocker) Metoclopramide (peristalsis upregulator) Anastomosis
Oesophagostomy tubes -GA + feeding -7th ICS -forceps --> press to skin by ramus -Pull tube out mouth --> redirect into oesopagus Chinese finger trap suture
Acute abdomen. Types. Traumatic, hypovolemic and septic shock. Emergency and critical care
Acute abdomen
Sudden abdominal pain seen as distention, V+/D+, shock
Dilation - enlargement with gas without rotation (aerophagia, eating snow + delayed emptying = fermentation)
GDV Acute life threatening condition 90-360 degrees Duodenum between oesophagus and stomach Dx: Radiography (Lat + DV) -C-shape (stage 1 + 2) -Double bubble (stage 3)
Blood flow obstruction (VCCau)
- Portal hypotension
- GIT ischemia
- hypovolemic shock
Cs: ptyalism, bloating, tachycardia (hypovolemia), cyanosis
T: Fluids + critical care (dexamethasone) Omeprazole, cimetidine, metoclopramide Decompress - ETT, Large IV catheter gastrocentesis gastrectomy + gastropexy
Benign gastric outflow -Pyloric stenosis -Pyloric hypertrophy (Muscular, mucosal) Dx: Endoscopy > x-ray -Can DDx hyperplasia, stenosis, inflammation, FB
Shock
O2 requirement > delivery
Hypovolemic
-Lower blood flow, thready pulse, cold extremities
Due to:
-Haemorrhage
-Kidney failure: RAAS + ADH (vasoconstriction decreased GFR)
-Lungs: Vasoconstriction (oedema in lungs + impaired O2 exchange)
Traumatic shock
-Trauma + burns –> bleeding, vasodilation
Distributive shock (septic) Excessive vasodilation -septic: Endotoxemia or pancreatitis -anaphylactic: huge type I inflammatory response -No blood loss, but increased intravascular space and lowered filling
Surgery of the stomach. FB’s, Dilation and volvulus. Pericardioperitoneal hernia. Neoplasia of the stomach.
Surgery of the stomach Gastrectomy - resection -prefered between vessels Gastrotomy - opening Gastropexy - attach to abdominal wall -Circumcostal loop -Muscular flap
Arteria linealis + coeliaca
- Gastric
- splenic
- hepatic
Foreign bodies
Bones/stones
Linear FB’s are more serious (peritonitis if GIT ruptures)
Gastric ulceration
Zollinger-ellinson syndrome: overproduction of acid (gastroma of pancreas)
Erosion (muc + sub) –> ulcer (muc + sub + muscularis)
commonly iatrogenic (steroids + NSAID’s)
Dx: Relies on endoscopy (x-ray cant see erosions)
T: Omeprazole, metoclopramide, cimetidine, Sucralfate (mucous), bicarb
Dilation (pyloric stenosis) -aerophagia/snow eating Volvulous GDV C-Shape / double bubble 90-360 degrees Hypovolemic shock Oesophagus and duodenum entrap stomach and VCCau
Gastric neoplasia
Adenocarcinoma
Leiomyosarcoma
Pythium insidiosum (phycomycosis)
Laparotomy + celiotomy
- 3 layer suture
- -Skin
- -SubQ
- -Linea alba + m.rectus ab
Rectus abdominis Internal obliques Transversus obliques external obliques Linea alba
Diaphragmatic hernia. Pericardioperitoneal hernia. Abdominal organ trauma. Umbilical hernia, traumatic hernia.
Diaphragmatic hernia
Congenital or acquird
-Increased abdominal pressure –> diaphragmatic rupture
Abdomenal organs –> thorax
Pericardioperitoneal diaphragmatic hernia
-Birth defect of pericardium and diaphragm, often the liver herniates into the pericardial space
T: Repositioning and closure is usually easy as the motion of the heart stops adhesions
Abdominal trauma
- External Hernia through abdominal wall defect
- Umbilical hernia
- -associated with intersex in females and testicle descent in males
- Internal Hernia through abdominal structure (diaphragm or inguinal canal)
- May result in peritonitis
Surgical diseases of the pylorus and spleen. pyloroplasty + Splenectomy
Pylorus
-Stomach –> SI
Stenosis
Congenital or acquired
-True stenosis or muscular hypertrophy
Obstruction
FB, chronic hypertrophy (stenosis –> obstruction)
Causes ileus + gas dilation
T: Pyloroplasty
-UY-Pyloroplasty
- Fredet-Ramstead pyloromyotomy (cut through serosa and muscularis to allow muscoa to bulge)
- Heineke-mikulicz - horizontal
- Jaboulay pyloroplasty - attach duodenum to stomach (bypass pylorus)
Spleen Torsion -Torsion of splenic artery --> obstructs blood flow -Usually occurs with GDV T:Splenectomy, gastropexy
Rupture
Neoplasia - haemangiosarcoma
-Blood loss due to abdominal haemorrhage
-Anaemia + hypovolemia
T: Splenectomy
- Partial
- Total: ligate splenic arteries
