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
Surgical diseases of the small intestine and cecum. Enterotomy + enterectomy
Obstruction
Extraluminal, intraluminal, interluminal
-Mechanical: FB, intussusception, tumors
-Functional: Water loss, nervous, parasympatholytics
Simple obstruction
Causes:
-LI displacement, food impaction, nematode impaction, Neoplasia, Hypertrophy (mural)
-fluid cant pass to LI –> hypovolemia + cardiac failure
-Gas distention –> loss of peristalsis (ileus) + fluid (with protein and ions) leakage –> peritoneum –> hypovolemia + acid-base disbalance
- -Proximal: Alkalosis
- -Distal: Acidosis
Incarceration
-Through mesenteric defect
Strangulation
Causes:
-Intussusception, volvulus, Fibrous adhesions, herniation
-Acute abdomen. Vascular compromise –> hypoxia –> necrosis –> perforation
Ileus
- Arrest of peristalsis
- Mechanical: Gas distention
- Functional: electrolytes, myasthenia gravis
Infarct - mesenteric artery
Linear FB
-Partial obstruction
Intussusception
-Usually ileo-cecal junction
Enterotomy
- Opening of the bowel to remove FB’s
- Close horizontal to prevent stricture
Enterectomy
- Anastomosis of intestine for the removal of stenotic, necrotic or fibrous intestine
- Serosal patching can be used to promote healing
- Functional end-to-end anastomosis
Surgical diseases of the LI. prolapse recti. Colonpexy.
Megacolon Increase in diameter of colon Changes to function --> constipation + hypomotility Congenital or acquired -Mechanical: Obstruction -Neurological: Cauda equina
Constipation + obstipation
- C: Passage of dry hardened faeces
- O: Complete absence of faecal passage
Incontinence
Loss of voluntary control of defecation
Cauda equina, prolapse
Anal/Rectal prolapse
Complete - all layers
Incomplete - mucosa only
Often due to increased abdominal pressure (constipation, dystocia, respiratory disease)
Hypertonic (mannitol) solution can reduce size, lubricate, massage, replace, purse-string suture + colopexy
Diverticulosis
-Development of diverticula in LI –> diverticulitis
Diverticulitis
-Filling of diverticulum with faeces, blood or pus –> diverticulitis –> peritonitis, abdominal haemorrhage
Neoplasia
Polyps
Leiomyoma
Adenoma
Dx: colonoscopy, X-Ray, USG
T: Colectomy (resection)
Perineal hernia. Diseases of the perianal glands and perineal neoplasia.
Perineal hernias
Uni or bilateral
Often occurs in prostate disease, constipation, straining (tenesmus)
Dx: Palpation/imaging
T: Evacuate faeces, surgical herniorrhaphy + castration
Perianal fistula From diverticulitis Septic progressive infection of the perianal area (ulceration + abscessation) Cs: Moist foul smelling area near anus T: graft + anal sacculectomy
Anal sac neoplasia
Adenocarcinoma
T: excision
Anal sac disease Obstruction or infection of the gland Overproduction of gland Poor muscle tone in obese animals causes improper emptying of gland during defecation Cs: pain during defecation
Anal sacculectomy
Indicated in chronic anal sac impaction
2 types
-Open: incise gland and expose secretory lining
-Closed: Gland kept in tact and bluntly dissected
Hernias - general information. Inguino-scrotal hernias
Hernia
-Protrusion through a defect
Classification
- Ext. abdominal hernias - through the abdominal wall
- Int. abdominal hernias - peritoneal/inguinal
- True hernia - within peritoneal sac
- False hernia - non-enclosed
- Reducible - no adhesions
- Irreducible - adhesions
Can cause;
incarceration - fluid retention (obstipation)
Strangulation - obstructed blood flow (necrosis)
Inguinal (scrotal in male)
- Through inguinal canal
- Usually males after testicles descend
- rare in females associated with intersex
- Bladder, SI, uterus
Umbilical
- due to failure of closure of umbilicus at birth
- Pulling on umbilical cord during separation
Femoral / ectopic
-Defect in canalis femoralis
Surgical approach
- Linea alba approach
- Debride any fat or muscle
- hernial sac ligation
- tissue flap appositional suture
- Hernioraphy
Surgical diseases of the trachea. Collapse.
Tracheal collapse Progressive collapse Acquired -Megaesophagus + laryngeal paralysis Congenital Inspiration - Cervical Expiration - Thoracic "Goose-honking" Grades 1 - 25% 2 - 50% 3 - 75% 4 - 100%
Dx:Endoscopy, palpation, x-ray
T: glycosaminoglycan, chondroitin, prosthesis (2+3),
Antitussive, bronchodilator
Tacking sutures (1)
Rupture
Bites, choke chains, overfilling of ET tube cuff
FB Cervical + thoracic Aspiration ET tube --> push past --> inflate --> remove with FB Tracheotomy
Tracheostomy
Critical care and UR obstruction
-Transverse flap (5-6th ring)
- Horizontal (3+4, 5+6th ring)
- Inverted ventral flap (as transverse but lifted upwards)
- Vertical (as horizontal)
Trauma of the chest wall and lungs. Neoplasia of the lung. Pneumothorax, Lobectomy. Thoracocentesis
Thoracic trauma
- Rib trauma –> “Flail chest”
- Paradoxical breathing (one piece of chest doesn’t move so looks depresed in inspiration and expanded in expiration)
Tumors of lung + thorax
-often 2nd tumors (Mx)
-Bronchoalveolar adenoma
T: Thoracotomy + lobectomy
Pneumothorax
-Spontaneous
-Traumatic
-Closed - Lung broken and air leaks into thorax
-Open - thoracic wall broken allowing air to enter that cannot escape
-Increased thoracic pressure can cause partial or complete lung collapse –> lung tidal volume reducation
Dx: Heart elevated from sternum
T: Thoracocentesis
Thoracocentesis 6-8ICS -Fluid: ventral portion position -Air: dorsal needle position -Needle at 45 degrees
Thoracotomy Access the cavity Method -Intercostal 3-4th ICS -Median - Sternum -Transcostal - Last rib
Lobectomy
Partial - Removal of part
Total - An entire lobe
Surgical therapy of the kidneys and surgical disease of ureters. Ectopic ureters
Kidneys
Trauma
causes rupture in vessels or rupture of parenchyma
Nephrolithiasis
Ca2+ and alkaline urine or UTI (haematogenous or ascending)
Hydronephrosis
Dilation of renal pelvis due to stones/inflammation/stenosis in kidneys or further down urinary tract
Cystic kidney disease Polycystic kidneys replace large portions of the parenchyma affecting function Genetic predisposition Hormonal - PTH + Vasopressin Dx: FNA + USG
Surgery
Nephrotomy - biopsy, cystic excision, stone removal
Nephrectomy
- Complete
- Partial
Nephrostomy
Cannulisation to create a permanent fistual - bypassing stones, damaged ureter
Pyelolithomy
Opening renal pelvis to remove stones
Ureter Ectopic ureters (opening of ureter anywhere but trigoneum of bladder) Most common cause of urinary incontinence in young dogs. Females at 8x higher risk Intra/extra-mural Cs: urine scalding Dx: contrast urography (iodine, air) T: Cystocentesis + ligate Nephrostomy
Ureter obturation/obstruction Hypomotility of muscle Urolithiasis, neoplasia, urethrospasm Post-renal azotemia + uremia Dx: contrast x-ray, neurology, myelography T: Muscle atony - metaclopromide + cisapride (prokinetic) Urethrostomy
Surgical diseases of the urinary bladder and ureters. Cystotomy, cystectomy, urethrotomy, urethrostomy
Bladder
Urolithiasis
Urinary stones (struvite, calcium, urate)
Higher concentration of salts + alkaline urine
Cystitis
Bacteiral, stones, neoplasia
Dx: Bladder becomes thickned
Feline lower UTI / FIC Congenital uroliths idiopathic/stress induced Primarily males Stages 1 - Inital disease 2 - No Cs but furtherment of 1 3 - PU/PD 4 - Uremic syndrome
Neoplasia
TCC
Cs: stranguria, haematuria, imaging, palpation
Surgery
Cystotomy - removal of stones, biopsy, ectopic ureters (urethrostomy)
Two layer closure - schneiden + lambert
Cystectomy Removal of portion -Cut ventral or dorsal -suture submucosa NOT MUCOSA -Omentoplasty to help healing
Urethrotomy - stone
Urethrostomy - Premanent urinary diversion due to chronic processes
Head and spinal trauma. Critical and emergency care. Diseases of the peripheral nerves of the fore and hind limbs
Head traua RTA, fighting, falls Concussion - traumatised on impact Contussion - bleeding from blunt forse Coup-contrecoup - bilater contussion Diffuse axonal - shaking --> nerve tearing
Cs: eistaxis, coma, mydriasis
Dx: imagine, increased ICP
T: ABC, benzos
Spinal injury IVDD, trauma, ischemia Seen vental, dorsal or at ligaments Cs: ataxia, spastic, paralysis (depends on location) Dx: myelography T: ABC, Mannitol, benzos
Critical care
Indications; shock, poisons, burns, seizures, bleeding
ABC care
Airway - remove obstruction + place ET tube
Breathing - breathing patterns, Perform CPR, Thoracocentesis if fluid present
Circulation - HR, CRT, MM colour, pulse intensity
Head trauma Supply O2 IV catheter -60-90ml/kg/hr (dog) -45ml/kg/hr (cat) BP - Colloids, crystaloids Glucose - hypoglycaemia Seizures - Benzo's IC pressure - mannitol NO STEROIDS DO NOT MOVE SEDATE IF NEEDED
Peripheral nerve damage
Congenital/hereditary
Acquired
-Toxic, drug, chemical, heavy metals
- Neuropraxia: disruption in transmission but no muscle atrophy
- Anoxotmesis: damage and loss of function
Neurotmesis: complete severance of axon
Dancing doberman
- Flex and extend the hip
- develops to pariesis
Distal denerving disease
-Idiopathic in dogs –> muscle axons stripped of myelin
Distal polyneruropathy of rotweillers
Diseases of the cervical vertebrae and spinal cord. AAI, wobbler’s, Myelography
Atlantoaxial instability
Dens becomes displaced or ligaments fail
Developmental or acquired through trauma
Subluxation results in compression of the spinal cord –> UMN signs in FL and HL
X-Ray shows spinal process of axis over the atlas
T: Neck brace, fusion
Wobbler's syndrome Caudal cervical vertebrae (C4-7) Can result from; -Instability + subluxation -Articular process enlargement --> Ligament hypertrophy -IVDD (protrusion) -Malformed
Types
-Dynamic: when moving
-Static: due to spondylosis
Cs: HL ataxia (john wayne)
IVDD
Chondrodystrophic breeds (brachycephalics)
-Extrusion - through annulus fibrosis
-Protrusion - pushes annulus fibrosus (no rupture)
Schiff-sherrington syndrome
T3-L3
FL - Hyperreflexivity
HL - Paralysis
Surgical procedures
Ventral slot - drill to look
Facetectomy - remove cranial and caudal aspects
Foraminotomy - remove roof
Fenestration - Remove nucleus pulposus via annulus fibrosus
Laminectomy
Myelography
Injection of iodine into sub-arachnoid space
0.3-0.45ml
Cervical (cisterna magna)
-Middle ear line, Wings of atlas and occipital protuberance (triangulate)
Lumbar (L4-L6) - lumbosacral space
- extradural (IVD protrusion)
- intra-dural-extramedullary (neoplasia)
- intramedullary (oedema, ischemia myelopathy)
Intramedullary opacification = meningitis/myelomalacia
Diseases of IVD. Diseases of thoraco-lumbar vertebrae.
Discospondylitis, DISH, Spondylosis deformans, fractures + luxation
C:7 T:13 L:7 S:3 Cau:6-23
Diseases of IVD
- Protrusion: mass impinging on SC
- Bulging: Nuc. Pulp pushes on AF
- Extrusion: NP breaks through AF
Hansen I - Dehydration –> mineralisation of NP and degeneration of AF –> Extrusion
Hansen II - Fibrosis of NP –> normal AF –> bulging (protrusion)
X-Ray: Narrowing and calcification
Diseases of T-L vert
Discospondylosis
-Bacterial infection of vertebrae (Prostate or bladder)
Dx: sclerosis
Spondylosis deformans
-Spinal Instability or luxation can result in osteophyte formation –> spurs can form
Diffuse idiopathic skeletal hyperostosis
-Boxers, calcification along SC assymptomatic until fusion
Fractures
- Vertebral body
- Compression fracture
Luxation
-Displacement of bone from jont
Neoplasia -Meningioma -Lymphoma -Osteosarcoma -Fibrosarcoma Dx: Scintigraphy
Syndrome cauda equina. Transitional lumbosacral vertebrae.
Cauda equina syndrome
-Instability, luxation, articular process enlargement and ligament hypertrophy, protrusion/extrusion
Compress the cauda equina, (nerves of the SC behind the lumbar vert)
T: laminectomy (removal of the doral lamina in the VC to make space for SC)
LS transitional vertebrae
Congenital malformation in which one vertebrae has the characteristics of another
German shepards
-Transitional LS segment: Vert w/ lumbar and sacral features (L7/S1)
-Sacralisation: Lumbar vert with sacral wings (no proc. trans.)
Causes;
-Hip dysplasia, CES, scoliosis
Fractures Luxation Neoplasia -Osteosarcoma -Chondrosarcoma
Dx of spinal cord diseases. spinal reflexes. imaging Dx, radiography, CT, MRI
Dx
Clinical signs
Cerical syndrome (1-5)
UMN signs on FL + HL
Cervico-thoracic syndrome (C6-T2)
UMN - HL, LMN - FL
“Root signature”
Thoraco-lumbar (T3-L3)
UMN - HL
Schiff-sherington (FL extension + HL paralysis)
Lumbosacral (L4-Ca5)
LMN - HL
Incontinance
Imaging
- X-Ray
- Myelography (iodine, 3ml - 4.5ml)
CT
-Creates a cross sectional imagine by taking multiple x-rays at different angles and building an image
MRI
-Uses protons and energy release from them to construct an image using magnetic coils that surround the patient to visualise the brain/SC in slices. Gold standard.
Spinal reflexes
Also diagnostic
Reflex testing
-Muscle tone > myotactic reflex > flexor reflexes
Mycotactic (patellar)
Flexor (withdrawl pedal reflex - pinch between digits)
Sensation (panniculus reflex)
C-Biceps reflex
T-Panniculus reflex
L-Patellar reflex
S-Perianal reflex
pediatric long bone diseases
Panostitis juvenilis
Inflammation of long bones with no lysis. Often large breeds with excess protein or calcium
Dx: increased bone opactiy
T: Pain relief
Hypertrophic osteodystrophy
Radius + ulna + tibia
Usually bilateral in the metaphysis –> necrosis + haemorrhage
X-Ray + histopathology (haemosiderin deposits)
Ricketts
Defective bone calcification in growing bones;
-persistant hypertrophic cartilage
-enlargement of epiphysis + costochondral junctions
Cs: bone curvature
T: Ca + P supplement
Osteochondromatsis
Benign bone nodules with cartilage caps
Often on growth plates during ossification of GP
Surgical removal of Exostosis
Avascular necrosis of the femoral head
- Traumatic: joint/hip trauma
- Non-traumatic: embolism, hypovolemia
Neoplasia Characterised -Lytic -Proliferative -Mixed
Primary
Benign: osteoma, osteochondroma, osteoblastoma
Malignant: Chondrosarcoma, Fibrosarcoma, osteosarcoma
Secondary
Often humeral or femoral
X-Ray of neoplasia
- Periosteal reactions
- -Solid
- -Lamellated
- -Sunburst
- -Codman’s triangle
Osteochondrosis dissecans. Osteoarthritis, osteoarthrosis, DJD. Arthrotomy.
Osteochondrosis
Disruption of endochondrial ossification –> angular deformities, valgus, OCD
OCD
-4-6mnths. Cartilage thickens and blood flow becomes impeded to deeper cartilage –> necrosis and fragmentation
Grading
1 - small defect in subchondral bone
4 - Vertical fracture + separation of the flap
T: remove flap (arthroscopy) + cauterise
Osteoarthritis
Inflammation of bone due to
-Septic: Bacteria –> toxins –> cartilage destruction –> osteomyelitis –> osteophytes + exostosis
-Aseptic: Ca2+
-Autoimmune: Rheumatoid arthritis (like lupus)
Results in osteoarthrosis (DJD)
Osteoarthrosis (DJD) Degeneration of cartilage remodelling of bone synovial membrane and peri-articular tissue damage Bone hypertrophy
Primary - aging, wear and tear
Secondary - OA, joint instability
Loss of cartilage causes bone on bone action (osteophytes) –> inflammation (destruction > production)
Arthrotomy
- Surgical exploration of the joint
- Drainage of inflammatory joint fluid
Diseases of the shoulder joint
Shoulder joint
Glenoid cavity + humeral head
Luxation (displacement of bone from joint)
Lack of collateral ligaments (glenohumeral ligs) –> instability
Subluxation - partial displacement
Categorised:
-Medial
-Lateral
-Cranial
Congenital - minitures
Acquired - RTA, Fighting
T: Manual reposition, velapeu sling
Surgical reconstruction of glenohumeral ligs (bicep tendons)
Instability
Abnormal movement of humeral head with destruction of periarticular tissues
Graded: Low –> High
Dx: ROM
T: NSAID’s physiotherapy, fusion, prosthesis, lig recon
Bicep tendon disease
Bicep brachii tendon affixes to spina scapulae. Instability of the joint can cause damage to the bicep tendon
T: Tendonotomy/tenodesis
OCD
-cartilage –> necrosis –> fragment
Diseases of the elbow joint. ED. Screening ED. Short radius + short ulna
Elbow dysplasia
Group of diseases found in growing dogs (esp. giants)
Developmental - nutritional (Ca + P)
Genetic - Lrg + giant breeds
Pathogenesis
Multiple primary lesions –> osteoarthritic process
Fragmented coronoid process
-Mild –> full fragmentation
OCD
-Medial humeral condyle
Ununitied anconial process -Ulnar metaphysis -Physiological fusion at 4-5 months -Short ulna and radius can exaserbate or prevent fusion T: Lag screw fixation
Incongruence of elbow
-Coronoid above radial head (asynchronus growth)
Begins at 4 months Cs at 6
Dx: Flex/Extension test Abducted stance (wide) X-Ray ML -110-120 - Neutral -45 - Flexed Cr-Cau -15 (OCD)
Grading - IEWG
0 - Normal
1 - Mild dysplasia + osteophytes (<2mm)
2 - Moderate osteoarthritis + osteophytes (2-5mm)
3 - severe OA + osteophyets (>5mm) + UAP
T:
Chondroprotectives (glycoasaminoglycan + chondroitin)
Lag screw - UAP
arthrostomy
Short ulna/radius syndrome Growth plates fuse prematurely Due to -Trauma -HyperVit A + D Other bone continues to grow Shortened bone pulls on the normal one --> bowing and luxation from the joint --> OA
Luxation/subluxation
Irritation + inflammation –> cartilage destruction –> bone irritation –> inflammation (OArthritis) –> bone remodelling (OArthrosis)
T: Arthrodesis + olecranon osteotomy
Diseases of the hip joint. Arthritis, Arthrosis (DJD).
Coxofemoral joint (acetabulum + femoral head + ligs + glutes)
Arthritis
Joint inflammation
-Septic: myocplasma, pasturella, staph
-Aseptic: AI (rheumatoid)
Arthrosis
Degeneration of cartilage + formation of osteophytes
2nd to luxation, osteochondrosis, osteoarthritis and hip dysplasia
Luxation of the femoral head
Part of HD
Avascular femoral head necrosis
Salter-harris fractures
OCD
Legg-calve perthes disease
-Thrombosis –> ischemia of subchondral bone –> necrosis + osteolysis
X-Ray: flattened femoral head
T: Physical therapy Arthrodesis Chondoprotectants (GAG, Ch) (open) Arthrotomy if osteophytes (closed) Myorelaxants + repositioning Prosthesis
Hip dysplasia. Screening program. Grading.
Laxity + arthritis of hip Multifactorial; -Genetic (German sheps) -Lifestyle (work load) -Nutritional (Ca + P) -Hormonal (oestrogen)
Cs: Bunny hopping, muscle atrophy, asymmetrical effusion
Laxity
- Subluxation (decreaed norberg angle)
- Femoral head should be 50% covered by craniolateral acetabulum
OA - “Morgan’s line”
Dx: ortolani signs - abduct + adduct femer = “click”
X-Ray
- VD - Rotate inwards
- Stress VD
- Frog legs (hip + stifle flex)
- Norberg = 105degrees (physiological)
T: Tripelvic osteotomy - bone plate that holds 3 parts of bone (ischi, ilii, pubis)
Pectinal myectomy - Remove m.pectinus = reduced pressure
Juvanile pubic symphsiodesis (>2 years)
Screen and grade
Minimum 2 views (VD + L)
FCI (>1 year age) A - normal 105 NA B - Asymptommatic but pathological C - Mild HD <100 NA D - Moderate HD <95 NA + Morgan's line + subluxation E - Severe HD <58 NA + ML + Luxation
OFA similar to FCI
-Excellent, good, fair, transitional, mild, moderate. severe
BVA 9 radiographic criteria 1-NA 2-Subluxation 3-Position in acetabulum (cranial) 4-Position in acetabulum (dorsal) 5-Position of acetabulum edge (cranial) 6-Acetabular fossa 7-Femoral head exostosis
58 per hip
116 total - high score = higher degree of HD
Diseases of the stifle joint. Patella luxation and fractures
Screening and radiological exam of DJD in the stifle
Stifle (femoropatellar + femorotibial Med + Lat)
Luxation of the patella Common cause of lameness Patella slipping from trochlear groove Medial, lateral, bidirectional Results in varus/valgus
Medial luxation
Quads hold the patella in place by inserting onto the tibial tuber
causes varus
Lateral luxation
often causing valgus
Grading
1 - No lesions
2 - Push patella easily returned
3 - Out of groove, medial movement, pushing limb laterally. Can be replaced
4 - Patella is STUCK medially, cannot be repositioned
X-Ray: patella is superimposed on condyles
T:
2-3 Soft tissue surgery
4 - Osteotomy of femer and tibia
Patella fracture
Trauma + extreme quadricep contraction
T: Kirschner wires
Radiographic exam
ML - Flexed 90
Cau-Cra
Lateral-oblique (dorsal recumbency)
Diseases of the stifle joint. Diseases of the ligaments of the stifle (LCC, LCCa, collateral ligaments)
Stifle stabilised by
Medial and lateral collateral ligs around the joint (prevents twisting of the joint)
Cruciate ligs inside the joint (prevents cranial and caudal movement.
Meniscus - c-shaped cartilages in the stifle
Cranial cruciate ligament rupture
-Partial or full
-Causes pinching on the medial meniscus
Dx
-Orthopedic exam (gait, palpation)
-Tibial compression test (Tibia will pop forward when pressed on)
-Cranial draw exam (instability side to side)
Caudal cruciate ligament rupture
-Less common
Dx: Caudal draw exam (place dorsally –> tibia parallel to ground –> if ruptured –> caudal aspect of tibia will depress)
Rupture of collateral ligaments
Prevent abduction/adduction
Varus - inward turning (medial)
Valgus - outward turning (lateral)
T: Hyaluron + NSAID's Muscular flap (fascia latae) Meniscotomy Stabilising sutures Prosthetic ligaments
Fractures. Biological, physical, clinical assessment. Cerclage. Intramedullar pinning. Bone plate. External fixation.
Trauma
metabolic - Osteoporosis/chondrosis/malacia
Neoplasia
Classification
Types: Simple, complex, communicated, compound(open)
Salter-Harris
Localisation - Spiral, oblique, transverse, communicated, avulsion, greenstick, fissure
Fracture assessment score Evaluates Mechanical -Configuration (simple vs communicated) -Patient size (Large dogs are heavier)
Clinical
- Post-op co-op - active dogs (poor candidates)
- Comfort
- owner compliance
Biological
-Age, soft tissue injury, region on bone (distal heals slower)
1-10 (higher scores) = faster healing, lighter load on prosthesis and lowered rejection risk
Treatment
Incomplete fractures in young dogs can be splinted/cast
Anyting more will require fixation, a bone graft can be used to accelerate healing
Cerclage wire (kirschner wire)
- Full circlage: around the bone
- Hemi-circlage: through the bone and into medullary cavity
Intramedullary pinning
- Steinmann pin/kirschener wire
- Stops bending pressure but does not prevent rotation so often done with another form of fixation (6-8wks)
Bone plate
-Versatile and often left in place
External fixators
- Pinned both above and below the break, often with an intramedullary pin
- Often with ilizarov fixators
Primary and secondary bone healing. Complications of fracture therapy and arthrodesis
Primary (cortical) healing
Requires rigid fixation that inhibits callous formation
-Gap primary healing
-Contact primary healing
Gap
- Stage 1: bone fills the gap (not connective tissue)
- Stage 2: Haversian remodelling replaces necrotic bone
Contact
- Direct apposition allows cavity to form across the break by osteoclasts.
- These canals/cavities then become filled with new bone by osteoblasts
Secondary bone healing
Absence of fixation
3 stages
-Inflammation: immediately from break. oedema and pain stabilises movement of the break
- Reparative: first few days. Callus forms + chondrification begins –> invasion of osteoblasts and blood vessels –> CT replaced with woven (fibrous) bone
- Remodelling: Woven bone is replaced with lamellar bone
Assessment of fracture healing
2 weeks - Haematoma at site
3-4 weeks - Bridging callus with mineralised edge
8-12 weeks - remodelling + cortical repair
Complications
Delayed union - poor fixation, little blood supply, nutritional
Malunion - inadepqute fixation
Excessive callus - movement, periosteal stripping
Osteomyelitis - infection during malunion
Arthrodesis
Removal of cartilage, fusion of joint –> increases stability and strength + decreases pain
Use of bone grafts, pins/plates or synthetic bone can assist healing
Fractures of the pelvis
Often occur in multiple places due to shape
Types:
Stable - main joints in tact (symphesis pelvini, lumbosacral, hip, sacroilieac)
Unstable - break of any main joint of the pelvis
Cs: HL Paralysis (ensure there is no siatic n. damage)
T:
Conservative - rest and NSAID
-Stable
Surgical - Plates, screws, wires
- Non-stable:
- -Ileal - long oblique of the midline (plates required)
- -Acetabulum - usually with femoral head displacement
Surgical oncology. Amuptation of digits and limbs.
Type and grading
Benign - well divided cells
Malignant - mesenchymal (sarcoma), epithelial (carcinoma)
Aspects of tumours
- Structure (differentiation)
- Growth type (invasion (outside capsule with branches) or expansion (inside capsule))
- Growth speed (slow or fast)
- Growth extent (spontaneous or continual)
- Degree of Mx
Surgical types
Incision biopsy - histopath
excision biopsy - CI’ed as can cause PNPS + metastasis
Intracapsular resection - cannot be fully exsised due to location near a vital organ
Marginal resection - Removal of tumour with no margins (+ chemo and radio)
wide resection - Tumour and a wide section of healthy tissue around the tumour
Amputation FL -Scapula + humeral resection -Scapulectomy Humeral amputation
HL
- Coxo-femoral disarticulation
- Mid-femoral amputation
Limb-sparing technique
-<50% of bone, no joint or Mx
Digital amputation
- For neoplasia, fractures, toe deformities
- Disarticulation to ensure no adverse reaction to necrotising cartilage
Diagnostic and therapeutic arthroscopy. Rehabilitation & physical therapy.
Arthroscopy
Visualise joint with minimal risk compared to open arthrotomy
Indications
- Shoulder
- Elbow
- Stifle
- Tarsus
Procedure
-GA –> fluid egress + camera ingress. File down pathology or remove pathology
Osteoarthritis
-Aseptic: <4g of TP in synovial fluid
Synovia fluid types
- Non-inf - yellow, low TP
- Inf - Yellow, opaque, high TP
- Haemorrhagic - red
- Infectious - green/purulent
Rehabilitation and physiotherapy
Reduction of pain, increase in mobility and strength. Prevent necrosis or atrophy
Methods
Cryotherapy - lowered inflammation
Heat therapy - chronic joint stiffness (CI’ed in acute)
USG - increases blood and lymph flow
Massage - increases blood and lymph flow
ROM - prevents atrophy
Electrical stimulation - muscle contraction
Exercise - weight baring, wheelbarrow
Hydrotherapy - allows strengthrning without pain due to upper thrust
Principles of general anaesthesia. Perioperative pain management and perioperative monitoring. ASA system
Induction
Pre-med
-medetomidine + buprenorphine
-medetomidine + midozolam + acepromazine
Induce
- Propofol: 5mg/kg (0.5ml/kg)
- alfaxalone: 0.3ml - 0.6ml/kg
Peri-op care
Fluids
Fluids (10mk/kg/hr) and O2
-IV, IM, SubQ, IO, IP, PerOs
Crystalloids
-Water based
-Lactated ringers (0.9% glucose)
KCl - for acidosis from hypokalaemia (diabetes)
Hypertonic - oedema or shock (pulls fluid into vessels)
Colloids
- Large particals that stay in the blood (regulates oncotic pressure)
- Hexastarch, albumin, whole blood or plasma
Dosage
- Maintainence: 50-60ml/kg/day
- Shock crystalloids
- -80-90ml/kg (dog)
- -50-60 ml/kg (cat)
- 1/2 or 1/3 given over 10-20mins usually
- Shock colloids
- -3-5ml/kg/hr
Monitoring HR - 60-140 (110) Temp - 36-38 degrees Resp - 6-20 bpm O2 Saturation - >95% CRT - <2 Seconds BP - 60/90
General anaesthesia Requires: Analgesia, Anemnesis, Immobility, Unconciousness, Muscle relaxation
Barbituates - old but gold Non-barbituates (propofol) - lowered liver damage and clears faster Dissociatives - ketamine, zolazepam Inhalation - sevo and iso --Much safer and faster clearing
ASA system 1 - Minimal risk 2 - slight risk: young, old, obese 3 - moderate risk: fever, anaemia, murmur 4 - high risk: systemic disease 5 - extreme risk: Moribund E - Emergency
ASA score of >3 are 10x more likely to crash under GA
Pain management
NSAID’s - meloxicam, ketoprofen, carprofen, paracetamol (no cats)
Opioids - buprenorphine, butorphanol, tramdol, morphine
Behaviour is the idicator for pain, some vet associations have made questionaire sheets to assess pain using body positioning and behaviour (willingness to eat or drink)
Lameness in dogs and cats.
Lameness
Disharmony of swing and stand phase
Causes;
-Pain: usually soft tissue
-Neurological: ataxa / MG
-Mechanical: scarring or shortening of ligaments
-Orthopedic: Fracture, joint incongruency or osteomyelitis
-Metabolic: Ca/PTH/P/Vit D
-Circulatory: Ischemia/infarcts
-Infectious: Inflammation is painful (osteomyelitis)
Grading
0 - Normal weight baring
1 - weight bare at rest (stand), lame on trot
2 - partial weight baring at rest + walk
3 - no weight baring at walk
4 - can weight bare at rest or walk
5 - Reluctant to rise. walks <5 steps
Dx lameness History -When (walk, rest, run) -Onset -Which limb -Timing -BCS, Age and breed
Eliminating neurological, arthritis, muscular issues
Proprioception, spinal reflexes, pain responce (or lackthereof)
Observation Short stride (reduced ROM) Goose-stepping FL - Head bob HL - hip raising
Palpation
Standing - superficial
Laying - deep
Check for crepitus, pain, atrophy, malformed joints
Drawer test
- Cranial: thumb on patella and finger on tibial crest
- Looseness compared to femer = torn cranial cruciate
- Caudal: tibia parallel to ground, if caudal aspect drops = torn caudal cruciate
Tibial compression test
-Pressure on tibia –> popping forward = cruciate torn
Imaging X-Ray - breaks USG - arthritis Arthroscopy Muscle enzymes neurological exam and deficits
