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Surgical Nursing And Analgesia Flashcards

1
Q

Features of laryngeal paralysis

A

Can be congenital - severe polyneuropathy and unable to work or feed
Acquired - degenerative disease of the recurrent laryngeal nerve resulting in crico-arythenoideus dorsalis muscle incompetence

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2
Q

Diagnosis of laryngeal paralysis

A

Cervical and chest X-rays to check for megaoesophagus or consolidation
Ultrasound
Direct visualisation
Laryngoscopy with light GA

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3
Q

Emergency treatment of laryngeal paralysis

A 
Oxygen
Anti inflammatories but not NSAIDS
ACP to sedate if necessary
Tracheostomy 
Cool down the animal with fan or wet towels
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4
Q

Surgical considerations of laryngeal paralysis

A

Laryngeal tie back
Clip with angle of mandible in centre, half of next to corner of eye
No intraoral sutures
Partial laryngectomy will cause stenosis from inflammation

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5
Q

Post op care and prognosis of laryngeal paralysis

A

Local blocks instead of pain and sedation post op to prevent regurg/aspiration pneumonia due to open glottis
Careful with anaesthesia protocol
20-30% complication rate
Short term prognosis is excellent
Long term risk of aspiration, megaoesophagus, neuro conditions

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6
Q

Features of tracheal collapse

A

Dynamic obstruction of the upper airway
Tracheomalacia
Common cause of cough
Can affect cervical region, intrathoracic segent or both

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7
Q

Diagnosis of tracheal collapse

A

Radiography
Fluoroscopy - best method
Endoscopy with BAL sample

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8
Q

Treatment of tracheal collapse

A

Medical tx first - anti tussives, antisecretory, bronchodilators, antibiotics

Extra luminal prosthesis - syringe round trachea in cervical region
Intre luminal prosthesis - stent which can be used anywhere. Less morbidity but anti tussives to start as Fb in throat until surrounded by mucosa

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9
Q

Indications for permanent tracheostomy

A

Permanent UAO - laryngeal collapse, laryngeal neoplasia

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10
Q

Surgery considerations for a permanent tracheostomy

A 
Ventral midline approach
Good apposition
Monofilament non absorbable
Large stoma as will reduce over time
Suture trachea to skin
Skin fold plasty
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11
Q

Aftercare for a permanent tracheostomy

A

Keep clean
No collar
Suction
Nebuliser to reduce swelling and discomfort

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12
Q

Complications of a permanent tracheostomy

A 
Mucous and secretions plug if not kept clean
Stenosis/ stricture
Obstruction
Dehiscence 
Granulation tissue formation
Skin fold obstruction 
Infection
Impacts quality of life - no swimming
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13
Q

What is cholesteatoma

A 
Epidermoid cyst with keratin debris
Expansive lesion of the middle ear
Locally destructive 
Non neoplastic 
Most commonly secondary to TECA-LBO
Erodes bone
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14
Q

Symptoms of cholesteaoma

A 
Head shaking
Discharge
Pain opening mouth
Head tilt
Facial palsy
Ataxia
Nystagmus
Neuro signs - poorer prognosis
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15
Q

How to diagnose cholesteatoma

A

Radiographs - oblique views
CT - osteolysis, sclerosis, expanded bulla
MRI - expanded bulla with varying intensity

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16
Q

Treatment for cholesteatoma

A

Surgical resection to remove all abnormal tissue

Medical tx of antibiotics long term

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17
Q

Prognosis of cholesteatoma

A

Frequent recurrence

Neuro signs make prognosis worse as well as inability to open mouth and temporal bone lysis

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18
Q

What is primary secretory otitis media

A

Poor venting of et orifice in naso pharynx
VBO/TECA don’t treat the cause
Place plastic hollow tube to connect middle ear and external ear - grommits

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19
Q

Features of a subtotal TECA

A

Preserves most proximal portion of ear canal
Less dissection so less post op pain
Dogs and cats can have it
Vertical part of the external ear canal is dissected and cut proximally
Cartilage is sutured proximally
Dissection follows as per normal TECA

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20
Q

Symptoms of a para-aural abscess or fistula

A 
Head pain
Pain when opens mouth 
Head tilt
Lethargy
Swelling or draining sinus over surgical site
Occurs 3-9months post op
Only in dogs
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21
Q

Pathophysiology of para-aural abscess or fistula

A 
Inadequate debridement of middle ear
Not all ear cartilage is removed
Osteomyelitis 
Parotid gland damage
Can occur with TECA and cholesteatoma
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22
Q

Diagnosis of para-aural abscess or fistula

A 
Can be FB or neoplasm
Plain X-rays 
Contrast fistulogram
CT and contrast
MRI if showing neuro signs
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23
Q

Treatment of para-aural fistula

A

Medical - antibiotics

Surgical - lateral approach, central if confined to bulla or ventral to it

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24
Q

Complications of para-aural abscess or fistula

A

Facial nerve paralysis
Otitis interna
Head tilt

Sx is more successful than medical tx

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25
Q

Features of a ventral bulla osteotomy

A

Performed in cats to treat nasopharyngeal polyps
Can be done on dogs with recurrence of cholesteatoma or diseases limited to bulla but need to incise a lot deeper in dogs than cats

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26
Q

Principle of the chest drain

A

Drain placed in pleural space to remove air and fluid

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27
Q

Indications for a chest drain

A 
Pneumothorax
Chylothorax
Haemothorax
Pleural effusion
Post thoracic sx
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28
Q

Equipment needed for chest drain placement

A 
Clippers
Prep
Chest drain - soft and fenestrated and radiopague
Sterile gloves and swabs
Basic surgical kit
Local blocks
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29
Q

How to place a chest drain

A

Lateral recumbancy
Clip 4th to 11th rib and prep
Local block 7-8th IC
Incision over rib 10 under skin and muscle to 7

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30
Q

How to care for a chest drain

A

Keep clean
Keep end covered if not continuous suction
Check stoma site for discharge and air leaks
Check drain for damage, leaks
Record output
Remove when production decreases
Cats tolerate poorly

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31
Q

What are the two types of chest drains

A

Intermittent

Continuous

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32
Q

Drainage of intermittent chest drains

A

Fluid and air
Every 2-4hours
Check for dyspnoea
Use a 3-way tap

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33
Q

Drainage of a continuous drain

A

Heimlich valve - valve closes on inspiration, passive system, dogs bigger than 10kg
Collecting bag and concertina
Different methods
Closed chest drainage system

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34
Q

Complications of a chest drain

A 
Internal trauma
Air leaks
Obstructions
Arrhythmias
Infection
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35
Q

What is pneumothorax

A

Air in chest
Common cause of non traumatic pneumothorax is pulmonary blebs and bullae which burst open
Medical tx of thoracocentesis or thoracostomy tube placement

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36
Q

Describe the use of a chest drain for pneumothorax

A 
Small lumen
Fenestrate
Soft
Flexible
Easily placed - no GA
Continuous suction
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37
Q

What is pyothorax

A

Accumulation of septic pleural effusion
Gram negative or anaerobic bacteria
Treated my surgical exploration and debridement
Drainage and antibiotics

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38
Q

Describe the use of a drain for pyothorax

A

Wide lumen
Can place at the same time as the surgery
Place one on each side incase one gets blocked
Central position as draining heavy liquid
Flush chest
Continuous

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39
Q

Patient prep for thoracic sx

A

Foreleg to last rib clip - needs to be large
Cover drape
Legs extended cranially
Sandbags

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40
Q

Instruments for thoracic sx

A

Right angle lahey forceps
Pledgeted sutures
Satinsky clamp for atraumatic clamping of hilar bronchus
Mechanical staplers - gold standard for lobectomies. Staple proximally to lesion

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41
Q

What should the trolley be stocked with for foal emergencies

A 
Syringes/ needles
Blood tubes
Glucose/ lactate reader
Hibiscrub 
Spirit
Catheter kit
Clippers
Fluids
Feeding tube
Oxygen
Foal resuscitator
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42
Q

What is normal behaviour off the foal post parturition

A 
Sternal - 2/3 minutes
Suckle reflex - 30 minutes
Standing - 60 minutes
Standing and suckling - 2 hours
Active/ playful - 6-7 hours

Healthy foal should avoid being caught and have a close affinity with the mare

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43
Q

What is a foals normal TPR

A

T 37.2-38.9
P 40-80bpm at birth which increases to 120-150 when trying to stand. First week 80-100bpm
R 60-80 at birth then 30-40

Rectal temp usually reflects that of environment so doesn’t indicate infection. Holosystolic murmers normal and disappear after 3 days

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44
Q

Clinical examination of a neonatal foal

A

Is there suck reflex
Look for entropion of eyelids and corneal ulceration
Look for colour changes in mm, coronary bands and ear pinnae which may indicate sepsis
Fungal plaques on tongue are a sign of ill thrift or systemic infection
Check for cleft palate and malocclusion of jaw
Milk at nostrils may show swallowing deficit - dummy foal
Palpate thorax for fractures
Check for abdo distension and hernias
Check umbilicus for swelling
Check genitalia - scrotal hernias, vulval petechiations
Monitor limbs closely for lameness from infection or contracted tendons
Extremities should be warm
Dilute urine should be passed frequently
Faeces should be pasty and toffee coloured once meconium passed

If born covered in meconium - stressful birth so monitor closely

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45
Q

How to tell if a foal is showing abnormal behaviour

A

Sick foals deteriorate rapidly
Low head carriage
Droopy ears
Appears to sleep standing up
Stand under the mare but will not latch or form a complete seal to nurse properly
Mares run milk which splashes onto foals face

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46
Q

What are the most common diseases in neonatal foals

A

Sepsis
Neonatal maladjustment syndrome - dummy foals deprived of o2
Prematurity

All 3 can occur together

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47
Q

How to nurse the recumbent foal

A 
Keep sternal to improve oxygenation
Well padded bed, lots of support
Keep clean and dry
Check eyes with fluoroscein for ulcers
Change recumbency every 2 hours
Blankets and hair huggers for warmth
Beware bedsores
Encourage to stand or walk with support
Physio if can't walk
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48
Q

When to use enteral or parenteral nutritional support with a sick foal

A

Prematurity or diarrhoea will worsen if feed orally
Dummy foals can have NG tube placed and fed milk from mare as they’re not nursing properly
IV 5% glucose in isotonic fluids
Check for gastric reflux, GI sounds, abdo distension

45kcal/kg/day

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49
Q

What is failure of passive transfer and how to treat

A 
No absorption of antibodies from the mare in the colostrum
Check IgG levels
>8g/L is a pass
4-8g/L is a partial failure
< 4g/L is a fail

Boost with a plasma transfusion via NG tube if <6hrs old otherwise give IV

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50
Q

What is meconium impaction

A

Foal struggles to pass meconium
Obstructs rectum and colon
Common cause of colic
Commercial enema or homemade retention enema

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51
Q

When would you perform CPR on a neonatal foal

A

If born by assisted vaginal delivery following correction of dystocia or delivered by caesarean

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52
Q

What are the most common spinal disease categories in cats and dogs

A

Dogs - degenerative, traumatic, neoplasia, anomaolous

Cat - inflammatory/infectious, traumatic, neoplasia

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53
Q

What is a disc protrusion or extrusion

A

Disc extrusion - annulus tears and degenerate nucleus extrudes out to compress spinal cord

Disc protrusion - annulus bulges / protrudes which compresses the spinal cord - larger breeds

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54
Q

What colour should spinal discs be on MRI scans

A

White as they have water in them - become degenerate and turn black on imaging

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55
Q

What is cervical spondylomyelopathy

A 
Canal stenosis
Disc protrusion 
Facet hypertrophy
Flávio ligamentum hypertrophy
These all compress the cord

Facet joints not stable so disc degenerated - body makes more bone to stabilise but squishes cord in multiple directions

Poor prognosis

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56
Q

What is degenerative lumbosacral disease

A

Disc protrusion
Facet hyperplasia
Soft tissue proliferation
Subluxation

These impinge on caudal equina and directly or blood supply to it
Causes sciatic pain, affects urinary and fecal continence, v. Painful

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57
Q

What’s the most important thing to do when suspecting a spinal fracture or luxation

A

Radiograph two views

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58
Q

What are anomalous cysts

A

Sub arachnoid diverticula
Abnormal adhesion between layers of meninges
Causes a collection of CSF which compresses the spinal cord or causes inflammation in the cord

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59
Q

What is discospondylitis

A

Infection in the intervertebral disc and end plates of surrounding vertebrae
Compresses cord or causes instability with a compressive component

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60
Q

How do surgical diseases cause neuro signs

A 
Through pathology of
Laceration
Compression
Contusion
Ischaemia
Infiltration and dysfunction of cells directly or indirectly by affecting their environment
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61
Q

What spinal injuries can be medically managed

A

Laceration can be preventable
Ischaemia
Infiltration and dysfunction with drugs or radiations

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62
Q

How do you nurse a patient presenting with spinal laceration

A

Immobilise- spinal board

  • Bandages to form a neck brace
  • Spinal brace
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63
Q

How do you nurse a patient presenting with spinal ischaemia

A

Ensure ventilating appropriately - give o2 if necessary
Check cardiac output is sufficient
Ensure blood volume and blood pressure is appropriate - patient may be in shock

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64
Q

What are the 6 common surgical spinal procedures

A 
Dorsal laminectomy
Facetectomy 
Foraminotomy 
Hemilaminectomy 
Ventral slot
Stabilisation/ fusion
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65
Q

What is a dorsal laminectomy

A

Removal of the laminae of the dorsal vertebral arch and dorsal spinal process allowing access to the dorsal spine

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66
Q

What is a facetectomy

A

Removal of the articular facet

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67
Q

What is a foraminotomy

A

Enlargement of an intervertebral foramen to relieve pressure on a nerve or nerve root

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68
Q

What is a hemilaminectomy

A

Removal of one half of the lateral vertebral arch to allow access and partial access to the ventral or dorsal aspect of the spinal column

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69
Q

What is a corpectomy

A

Lateral approach with removal of part of the vertebral body and end plates either side of a intervertebral disc aswell as removal of part of the disc

For thoracic/lumbar cord without going through thorax or abdomen

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70
Q

What is a ventral slot

A

Ventral approach in endplates of the vertebral body and removal of part of the disc in the cervical spine

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71
Q

What is stabilisation of the spine

A

Removing motion between adjacent vertebrae using implants and bone grafts

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72
Q

What is useful surgical kit for spinal surgery

A 
Retractors - gelpi, odd leg gelpi, McKee 
Spinal burr and burrs
Rongeurs
Bone punch forceps
Microrongeurs
Periosteal elevator
Nerve hook
Curette
Scaler
Bone wax
Surgicell 
PVA
Duragen
Surgical patties
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73
Q

What is crucial for recovery of spinal surgery

A

Physiotherapy

Team effort

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74
Q

Why is physiotherapy important

A 
Prevents pressure sores
Reduces pain
Supports respiratory system
Forms bond between rehabilitation team
Promotes motor recovery
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75
Q

When do you start physio

A

24 hours post op
Nervous system needs to relearn by generating the movement

Only 10% spinal cord axons are needed to work

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76
Q

Where does physio act

A

Blood and lymph flow, relaxation, and promotes early ambulation
Maintains joint health, prevents muscle wastage, keeps tendons mobile
Improves core stability, retrains gait patterns, stimulates proprioceptive relearning

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77
Q

What physio actions are performed

A 
Massage
Passive
Active assisted
Active
Proprioceptive
Hot/cold therapy
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78
Q

Why is massage important

A 
Venous and lymphatic drainage
Analgesia
Dermal stimulation
Bonding
Warm up
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79
Q

Why is passive range of movement exercise important

A

Joint health
Flexibility and elasticity
Gait patterning

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80
Q

Why is active assisted exercise important

A

Provides assistance during muscular contraction

Helps train the gait

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81
Q

Why are proprioceptive exercises important

A

Challenges the body recognition of limb position in space

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82
Q

What should be considered when making a physio plan

A 
Expectation of the owner
Temperament of the dog
Previous activity 
Previous ailments
Clients involvement of time and expertise
Physical exam
Neuro exam
Disease process
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83
Q

Why can skin disease occur in spinal patients

A

Boredom
Sensory dysfunction - neuropathic pain causing self mutilation
Recumbancy - bed sores
Bladder / faecal dysfunction - leads to scalding

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84
Q

Why do skin sores develop

A

Lack of movement
Mechanical loading causing tissue compression
Ischaemia due to reduced pulsatile blood flow and venous blood return, repercussion injury and Bp anomalies following sx

Consequence of tissue break down - deep tissue first then skin - see wound after damage already caused

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85
Q

How do you prevent skin sores

A 
Turning every 2 hours
Good bedding - sling bed, porous mattress, non slip floors, inco sheets
Bandage doughnuts around bony prominences 
Physio
Inspect skin
Barrier creams
Relieve bladder often
Avoid unnecessary bandages
No tape on skin
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86
Q

How do you treat skin sores

A

Clean
Debridement
Antibiotics if needed
Bandage

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87
Q

How do you manage wounds from spinal surgery

A

Cryotherapy 15mins q4 48-72hrs
Dorsal approaches have skin movement and there is risk of layer separation and seroma formation

Care as may have loss of skin sensation

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88
Q

Why do many spinal patients have bladder impairment

A

Cells to bladder have nerves in s1-s3 to pons that cause contraction and relaxation of sphincter

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89
Q

What does lack of voluntary urination lead to

A

Uti from urine stasis
Bladder distension leading to atony where pacemaker fires but bladder cells can’t communicate with each other
Distension of ureters causing visceral damage
Skin sores

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90
Q

How to you manage the bladder and bowel of spinal patients

A

Manual expression x3 daily - only get 50% out but stops levels being dangerous
Catheter - indwelling or intermittent
Drug therapy to relax sphincter or contract bladder wall

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91
Q

What method of bladder management would be appropriate for a lower motor neurone bladder in a very aggressive dog that has urine scalding

A

Floppy bladder wall tone
Leaks urine constantly
Detrusor muscle stimulant

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92
Q

What is an upper motor neurone bladder

A

L1-L7
Increased tone to muscle wall but sphincter is tight
Difficult to express
Urine in lots of spurts as pressure is too great

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93
Q

What are the types of pain

A

Inflammatory - tissue damage
Neuropathic - dysfunction in transmission of nociception both peripherally or centrally
Acute
Chronic

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94
Q

Why do you need to monitor the respiratory system of spinal patients

A

Especially cervical lesions

Prone to hypoventilation, atelectasis, pneumonia

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95
Q

What are the 3 types of surgical site infections

A

Superficial incisional - skin and sub cut tissue
Deep incisional - deeper soft tissue involved
Organ / space infection - any other structures

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96
Q

What are th disadvantages of surgical infection

A 
Poor cosmesis
Delayed healing
Increased cost to practice and owner
Animal welfare
More surgery to correct
Client relationship may be damaged
Increased use of antibiotics - resistance
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97
Q

What is a biofilm

A

Bacteria attach to a surface in communities which allows them to intersect and adapt to changing environments
Resistance to hosts immunity and antibacterial agents
Quiescent so give negative cultures so hard to diagnose
Implants are high risk for biofilm formation

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98
Q

How do you manage a surgical site infection

A

Antibiotics once culture and sens is back - give antibiotics before for what it’s most likely to be
Barrier nurse
Cover wound and debride
Record the bacteria, surgery, treatment and if it was successful

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99
Q

What factors may predispose a patient to infection

A

Patient
Environmental
Treatment

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100
Q

What are patient factors predisposing to infection

A

Geriatric or young animals have a diminished immune response
Obese animals - more weight on surgical areas like joints and less oxygen able to get through fat
Malnourished patients - decreased albumin levels in blood
Immunosuppression - chemo, steroids, diabetes mellitus
Remote infection - skin disease
Recent surgery
Rerioperative temperature - vasoconstriction

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101
Q

What are the environmental factors predisposing to surgical infection

A

Patient prep - separate area, don’t pre clip
Cross contamination - hand washing
Aseptic technique
Proper theatre conduct
Cleaning methods - damp dusting, disinfectants
Inadequate ventilation

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102
Q

What are the treatment factors predisposing to surgical infection

A

Surgical time
Experience of surgeon
Antibiotic administration
Use of a drain - benefits have to outweigh the risks
Emergency procedure
Surgical implants
Suture material - multifilament vs monofilament. Triclosan coated

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103
Q

What are the Halsteads principles

A 
Gentle tissue handling
Adequate haemostasis
Preservation of blood supply
Strict aseptic technique
Minimum tension at wound closure
Good tissue approximation - maintain good blood supply
Obliteration of dead space
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104
Q

When to use antibiotics after surgery

A

Implants
When infection of wound would be catastrophic
Surgery more than 90 mins
Clean contaminated and contaminated procedures
Selection based on most likely contaminant
Start 30mins before sx IV
Likely to be no benefit continuing antibiotics post op other than already infected wounds, suspected infected wounds or bacteraemia

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105
Q

Post op care for surgical wounds

A

Cover for 24-48 hours and don’t change if strike through
Once fibrin seal has formed bandage no longer necessary
Avoid patient interference
Good drain management
Good nutrition - protein good for wound healing

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106
Q 
Troy 7y MN poodle
Retching post meal sudden onset
Lying down and unwilling to go out
HR 180, weak puls, pale mm
RR 48' increased effort bilaterally
Obtunded but appropriate 
Distended abdo
What does this mean and what to do?
A

Severe hypoperfusion
IV catheter
IVFT
Oxygen
Blood sample- PCV/TS, haem, biochem, clotting times
Opiates for analgesia- methadone, fentanyl, morphine - sedative effect
Radiographs

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107
Q

What are the risk factors of GDV

A 
Breed 
Body shape
Age
Anxious temperament
Diet composition
Number of meals
Speed of eating
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108
Q

What are the local and systemic effects of GDV

A 
Local effects on the gastric wall and spleen
Systemic effects - reduced venous return
- reduced cardiac output
- hypotension
- poor tissue perfusion
- acidosis/inflammatory indicators
- ischaemic reperfusion injury
Sepsis
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109
Q

How is percutaneous decompression done

A

14-16G catheter
Point of maximal gaseous distension
Removes gas only
Must have ex lap soon afterwards - examine site of needle penetration

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110
Q

How is Oro-gastric decompression done

A 
Can be done in conscious dog
Measure tube
Place bandage in mouth as gag
Pass tube
Fluid and gas
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111
Q

What is the aim of surgery to correct GDV

A

Gastric decompression and repositioning
Gastroplexy
Assessment of viability of abdo organs and resection of devitalised tissue

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112
Q

What anaesthetic plan would you have for a patient with GDV

A 
Opiates and maybe diazepam
Induction
Iso 
Avoid nitrous oxide
IVFT
Antibiotics
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113
Q

Apart from gastric necrosis what is also associated with GDV

A

Splenic torsion

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114
Q

Why perform a gastroplexy on GDV patients

A

No gastroplexy means 80% mortality
More chance of recurrence if don’t do
Use incisional, belt loop or tube technique

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115
Q

What is the post op care for a GDV patient

A 
Monitor parameters
PCV / TS
Urine output
ECG / Bp
IVFT
Opiates
NSAIDs when normotensive, normovolaemic and eating
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116
Q

Complications of GDV surgery

A

Arrhythmias- VPCs, caused by myocardial injury, electrolyte imbalance. Asses effect. Lidocaine 1-2mg/ bonus then CRI
Hypotension/ hypoperfusion
Aspiration pneumonia
Abnormal gastric motility - metoclopromide, gastroprotectants
Gastric necrosis
Sepsis

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117
Q

How can you prevent GDV and what advice to give to owners

A 
Breed predisposed - elective sx?
Laparoscopic gastroplexy
Prevention better than cure
Warm of risk of recurrence
Feed multiple times daily
Avoid stress
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118
Q

What do the thyroid glands do

A

Produce thyroxine which has metabolic effect on all organs

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119
Q

What are the clinical signs of hyperthyroidism

A 
Polyphagia
Weight loss
PUPD
increased activity
V+/D+
Goitre - swelling in neck
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120
Q

What other diseases are associated with feline hyperthyroidism

A

Heart disease - tachycardia

Kidney disease - often masked by hyperthyroidism

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121
Q

What are the treatment options for hyperthyroidism

A

Medical - methimazole to decrease thyroxine production
Surgical - thyroidectomy
Radioactive iodine treatment

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122
Q

What is the aim of a thyroidectomy

A

Removal of one or both thyroid glands
Preservation of parathyroid tissue to avoid post operative complications - dissect around it
Stabilise medically before sx

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123
Q

Post op care for thyroidectomy

A 
IVFT
Analgesia
Monitor renal function - avoid NSAIDs 
Watch out for laryngeal paralysis
Hypocalcaemia
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124
Q

Why is hypocalcaemia a risk for thyroidectomy patients

A

Inadvertent removal or damage of parathyroid glands
Monitor for 2-7 days
Check ionised calcium
Seizures, muscle twitching, facial pruritus

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125
Q

Treatment of hypocalcaemia

A

10% calcium gluconate 0.25-1.5ml/kg slow IV
Calcium drip 10ml calcium gluconate in 250 hartmanns 60ml/kg 24 hours
Oral vit D and calcium
Taper medication over 4 weeks and monitor ionised calcium

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126
Q

What is the anatomy and function of the parathyroid glands

A

Pair of parathyroid glands for each thyroid gland
Secrete parathyroid hormone
Cause increased calcium in the blood and decreased phosphorous

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127
Q

What are the features of parathyroid tumours

A

Older dogs
Adenoma
Increased secretion of parathyroid hormone and loss of normal inhibition
Increased ionised calcium

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128
Q

Diagnosis of a parathyroid tumour

A

Hypercalcaemia
PUPD
Parathyroid mass on ultrasound

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129
Q

Treatment of parathyroid tumours

A

Diuresis for high calcium - IVFT saline
Diuretic
Parathyroidectomy
Partial thyroidectomy

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130
Q

What is the pancreatic endocrine function

A

Beta cells produce insulin and glucagon
Regulates glucose metabolism
Insulin decreases blood glucose levels and causes storage of glucose

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131
Q

Features of an insulinoma

A 
Carcinoma of endocrine pancreas
Aggressive
Secretes insulin
Causes hypoglycaemia
Dogs
Weakness
Seizures
Ataxia
Muscle tremors
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132
Q

Diagnosis of hypoglycaemia

A 
Bloods
Wipples triad- clinical signs associated with hypoglycaemia 
- fasting glucose <2.2mmol/l
- improvement in signs following feeding or glucose administration
Increased serum insulin 
Imaging for metastasis 
Ultrasound
CT
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133
Q

Treatment of insulinoma

A

Emergency treatment - sugar solution, glucose IV 0.25g/kg
Medical management - frequent meals, glucocorticoid steroids, diazoxide
Surgery - partial pancreatectomy with 5% dextrose infusion to prevent hypoglycaemia

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134
Q

Post op care for insulinoma

A

Monitor BG
Complications - transient hyperglycaemia
- persistent hypoglycaemia
- pancreatitis
Prognosis of 785 days, over 1000 days of has medical management following relapse

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135
Q

Function of the adrenal glands

A

Adrenal cortex secretes aldosterone, cortisone, sex hormones
Adrenal medulla secretes noradrenaline and adrenaline

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136
Q

What diseases to adrenocortical tumours cause

A

Cushings - dogs

Conns syndrome - cat, hyperaldosteronism

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137
Q

Clinical signs of cushings

A 
PUPD
Polyphagia
Panting
Abdo enlargement 
Alopecia
Muscle weakness
Lethargy
Weight gain
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138
Q

How do you diagnose cushings disease

A

Low dose dexamethasone suppression test

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139
Q

What is phaeochromocytoma

A 
Tumour of adrenal medulla
Excess production of cathecholamines
Weakness and collapse
Panting
Tachycardia
Muscle wastage
Can cause intermittent hypertension
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140
Q

How are adrenal tumours diagnosed

A

Ultrasound

CTto show metastasis and involvement of vena cava

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141
Q

What is the pre operative surgical stabilisation for adrenal tumours

A

Cortical tumour - trilostane pre op
Pheaochromocytoma - phenoxybenzamine is an alpha-adrenergic blocker - give 2 weeks pre op
- propranolol if persistent tachycardia

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142
Q

Surgical considerations for adrenal cortical tumour

A

Delayed healing

Pulmonary thromboembolism

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143
Q

Surgical considerations for pheaochomocytoma

A

Surgical manipulation can cause surges in catecholamine release - hypertension, tachycardia, arrhythmias, cardiac arrest
Monitor anaesthetic carefully
Propranolol for tachycardia
Lidocaine for arrhythmias

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144
Q

Surgical approaches of adrenal tumours

A

Midline laparotomy to removal cabal thrombosis
Flank approach
Laparoscopy
Risk of haemorrhage so have donor blood available

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145
Q

Post op care of adrenal tumours

A

Adrenocortical tumours - hypocortisolism post op
Steroid supplementation - dexamethasone peri op, prednisolone post op
Mineralocorticoid supplementation - monitor electrolytes as can have decreased sodium and increased potassium. Fludrocortisone

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146
Q

Features of conns syndrome in cats

A 
Adrenocortical syndrome
Increased sodium and water retention
Hypertension
Hypokalaemia 
Episodic muscle weakness 
Collapse
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147
Q

What is the hepatic blood supply

A

Hepatic artery - 20% blood, 50% oxygen
Hepatic vein
Hepatic portal vein - 80% blood, 50% oxygen

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148
Q

What is the function of the liver

A 
Synthesis and clearance of albumin
Metabolises glucose
Production and activation of clotting factors
Clearance of toxins
Lipid metabolism
Reticuloendothelial function
Gastrointestinal function
Storage of vitamins, fats, glycogen, copper
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149
Q

Symptoms of hepatic insufficiency

A

Hypoproteinaemia
Hypoglycaemia
Coagulopathy
Hepatic encephalopathy

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150
Q

Assessment of the liver

A

Clotting times APTT and PT
Liver, bile and gall bladder samples for culture to determine if antibiotics peri op are necessary - normal for bacteria to be in liver - amoxycillin

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151
Q

How to do liver samples

A

Ultrasound guided FNA or tru cut

Surgical biopsies are more accurate and safer

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152
Q

What are the indications for liver lobectomy

A

Biopsy
Mass removal - benign or malignant
Abscess
Liver lobe torsion

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153
Q

Features of a liver lobectomy

A

Partial or complete
Can remove up to 70% liver
Blood type as risk of haemorrhage - DEA 1.1 dogs, AB cats

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154
Q

Indications for biliary tract sx

A

Extra hepatic biliary tract obstruction - cholelithiasis, gall bladder mucocele, pancreatitis, neoplasia
Biliary tract rupture and bile peritonitis

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155
Q

Clinical signs of a problem with biliary tract

A 
Non specific
Lethargy
Anorexia
V+
Abdo pain 
Icterus
Hypovolaemic shock in severe obstruction or bile peritonitis
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156
Q

What will haem and bio tell you if there’s a problem with the biliary tract

A

Decreased albumin
Increased bilirubin, cholesterol, ALP, ALT
Decrease vit k - 3 doses vit k at 0.5-1.5mg/kg sx
Coagulation abnormalities - fresh frozen plasma in emergencies 10ml/kg

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157
Q

Causes of bile peritonitis

A

Disease vs trauma
Therefore sterile or septic
Manage the peritonitis and treat the underlying cause

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158
Q

Surgical considerations for bile tract problems

A

Cholecystectomy
Cholecystoenterostomy
Better to preserve common bile duct rather than gall bladder

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159
Q

What is the outcome of extrahepatic biliary surgery

A

Often systemically unwell
Significant mortality
Poor prognosis in cats for neoplasia compared to inflammatory conditions

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160
Q

Post op care for extra hepatic biliary surgery

A 
Intensive nursing
Analgesia
Monitor - usual paramenters, Bp, leakage of bile, signs of haemorrhage
Haem and biochem
Antibiotics only if infection present
Monitor for sepsis or SIRS
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161
Q

What is a congentital portosystemic shunt

A

Vessel connecting the causal vena cava and hepatic portal vein
Can be extraheptatic - yorkies, westies
Can be intrahepatic - labradors, Irish wolf hounds

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162
Q

Clinical signs of Portosystemic shunt

A 
Failure to gain weight
Small
Neuro signs - hepatic encephalopathy 
Urinary tract signs
Gastrointestinal signs
Drug intolerance
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163
Q

What does haematology and biochem show for portosystemic shunts

A 
Microcytosis
Anaemia
Increased clotting times
Decreased urea, albumin, cholesterol, hypoglycaemia
Increased ALP and ALT
Decreased USG
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164
Q

How do you test the liver function

A

Ammonia tolerance - ammonia converted to urea in liver. Very labile. Abnormal in most portosystemic shunts
Dynamic bile acids - 100% sensitive

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165
Q

How do you diagnose portosystemic shunt using imaging

A

Ultrasound
Portovenography - fluoroscopy provides info on shunt configuration, confirms shunt and gives info on intrahepatic vasculature

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166
Q

How do you medically manage a portosystemic shunt

A 
Treat the clinical signs 
Manage hepatic encephalopathy
Restricted protein diet
Lactulose
Antibiotics
Seizure medication 
Manage for 2-3 weeks before sx
167
Q

What are the goals of portosystemic shunt sx

A

Attenuate shunt - complete of partial ligation or use a gradual attenuation device
Restore normal portal blood flow
Resolve hepatic insufficiency and clinical signs

168
Q

How is portovenography done

A

Catheter into jejunal vessel during surgery

Inject with contrast under fluoroscopy guidance

169
Q

Surgical complications of portosystemic shunt

A 
Portal hypertension
Haemorrhage
Neuro complications
Hypoglycaemia
Mortality 10%
Complications greater if intrahepatic shunt
Better outcome if complete attenuation
170
Q

What history do you need to know for an orthopaedic exam

A

Medication
Duration of lameness
Onset
Is it static, progressive, deteriorating, improving
Is the lameness continuous or intermittent
Alters with exercise or rest
Altered by the ground surface
Which limbs does the owner perceive to be the problem
Is the animal a working or pet dog
Any concurrent problems

171
Q

What does a lame animals gait look like

A 
Head bobs down on good leg
Shortened stride of good leg
Scuffed nails
Stifle pain limb is circumducted
Hip pain - spinal scoliosis. Lateral sway or bunny hopping
172
Q

What does ataxia mean

A

Pelvic limb in coordination

173
Q

What does paraplegia mean

A

Neurological deficits and no motor function

174
Q

What does paraperesis mean

A

Neurological deficits but motor function is present

175
Q

How will a lame animal stand

A

Paw of limb taking the most weight is flatter and will be difficult to lift
Inward or outward pointing of the paw
Weight may be shifted onto thoracic limbs
Scoliosis of spine
Frequent sitting - pelvic lameness
Frequent lying down - thoracic limb lameness

176
Q

How should you perform a physical exam for an orthopaedic patient

A

Examine the animal standing fully

Exam in lateral position working from the toes of each limb upwards

177
Q

How should you examine joints

A 
SPIRM
Swelling
Pain
Instability
Range of motion
Manipulation
178
Q

How do you examine limbs

A

SAP
Swelling
muscle Atrophy
Pain

179
Q

What are the specific tests for a stifle

A

Cranial draw
Tibial thrust
Patella luxation

180
Q

What are the tests for the hip

A

Ortolani test

181
Q

What equipment is needed for an arthrocentesis

A 
Spinal needle
5ml syringe
Clippers
Prep
Sterile gloves
Microscope slides
EDTA tube
Culture bottle
182
Q

When do dogs usually show signs of elbow dyslpasia

A

From 5 months of age and before 2 years

183
Q

What radiographs should be taken when elbow dysplasia is suspected

A

Craniocaudal
Mediolateral
Flexed lateral

184
Q

What is an ununited anconeal process

A

Anconeal process does not fuse
Elbow stability compromised
Osteoarthritis forms
Radius is longer than ulnar creating a shear which separates the anconeal process from the ulnar as it rubs against the humeral trochlear

185
Q

What is short radius syndrome

A

Short radius compared to ulnar
Incongruity of joint surfaces
Weight bearing on the medial aspect of the joint
Causes cartilage wear and fragmentation of the medial coronoid process and cartilage wear on medial humeral condyle

186
Q

What is osteochondritis dissecans

A

Affects medial humeral condyle

Thicken flap of cartilage on humeral trochlea overlying a deep subchondral bone defect

187
Q

Fragmented medial coronoid process

A

Most common pathology of elbow dysplasia
Craniolateral aspesct of medial coronoid
Appear dead and yellow in appearance compare to red well vascularised bone of the rest of the joint

188
Q

What is arthroscopic debridement

A

Used to treat elbow dysplasia
Remove fragments via arthroscopy
The underlying subchondral bone is then treated with abrasion arthroplasty or micro fracture to encourage fibrocartilagenous repair
Joint flushed with sterile saline

189
Q

What is abrasion arthroplasty

A

Hand burr or power shaver burr is spun to remove subchondral bone over the ware a of the lesion
Bleeding needs to be observed diffusely from the lesion bed
Lavage joint to remove debris

190
Q

What is microfracture technique

A

Micro pick inserted into joint and press tip against subchondral bone surface
Tap handle once or twice
Apply diffusely across diseased area and check for resulting bleeding
Lavage to remove debris

191
Q

What is a long bone osteotomy

A

Transfers weight bearing from medial aspect of the humerus to the lateral
Specific SHO plate used
Complications include humeral fracture, implant breakage

192
Q

What are the indications for arthroscopy

A

Exploration of joints for discharge agnostics through observation, biopsy and culture
Removal of loose bodies
Microfracture and abrasion arthroplasty can be performed to treat osteoarthritis
Joint debridement and lavage
Arthroscopic assisted joint stabilisation or fracture repair

193
Q

What are the advantages of arthroscopy

A 
Decreased morbidity 
Rapid recovery
Less complications
Improved outcomes
Decreased surgery, anaesthesia and hospitalisation times
194
Q

Disadvantages of arthroscopy

A

High level of skill needed
Equipment is expensive
Expensive for client

195
Q

What equipment is needed for arthroscopy

A 
Arthroscope
Camera mount
Light post
Cannula
Irrigation
Egress system - usually a needle in the joint
Instrument cannulas
Hand or power tools
Electrocautery
Patient prep
Waterproof drapes
196
Q

What are the causes of cruciate ligament disease

A

Traumatic due to a fall or stuck down rabbit hole
Degenerative is most common
Inflammation - rheumatoid arthritis

197
Q

How do you diagnose cruciate disease

A

Mediolateral and craniocaudal views of both stifles

198
Q

What is the first line of treatment for cruciate disease

A

Lead walk for 6 to 8 weeks

199
Q

What is the aim of cruciate surgery

A

Confirm diagnosis by arthrotomy
Debride the ruptured ligament
Check and remove torn pieces of menisci
Stabilise the stifle joint

200
Q

What does TPLO stand for

A

Tibial plateau levelling osteotomy

Decrease tibial plateau angle to 7 degrees from 24

201
Q

Post op care for cruciate ligament surgery

A 
Lead walk for 6 weeks
Cage rest
Physio
Hydrotherapy
Gradual return to exercise after 6wk post op X-rays
202
Q

What types of surgery is there to correct cruciate ligament rupture

A

Lateral suture - extra articular stabilisation
Tibial plateau levelling osteotomy
TPLO using LCP plate
Cranial closing wedge ostectomy

203
Q

Features of meniscal injuries

A

Medial usually more damaged

Subsequent to cranial cruciate ligament disease

204
Q

Features of hip dysplasia

A

Presents 4-5months age
Laxity develops in joint capsule
Size of dog, rate of growth, diet and exercise
Thickening of joint capsule from inflammation
Erosion of acetabulum
Femoral head flattens
May see luxation

205
Q

Clinical signs of hip dysplasia

A 
Bunny hopping
Difficulty rising
Pelvic limb lameness or stiffness
Exercise intolerance
Clunking of hips
Lateral swaying of spine
Muscle atrophy of glutes
206
Q

Conservative management of hip dysplasia

A 
First line of treatment
Most dogs should become sound by 15months old
Lead walks
Hydrotherapy
Control food intake to slow growth
NSAIDs
207
Q

What is juvenile pubic symphysiodesis

A

Simple inexpensive procedure
Can be done when neutering
Fusion of pubic symphysis by electrocautery
Preventative measure
Less growth of ventral pelvis resulting in bilateral acetabular ventroversion allowing for increased femoral head coverage

208
Q

What is triple pelvic osteotomy

A

Preventative measure
Increases dorsal coverage of the femoral head
Corrects subluxation
Restores hips weight bearing surface area
4-8months of age
Painful hips with no osteoarthritis
Pelvis cut in 3 places to free acetabulum
Acetabulum rotated 20 degrees

209
Q

What is a femoral head and neck excision

A

Femoral head and neck removed
Fibrous pseudoarthritis form
Salvage procedure

210
Q

Post op care of femoral head and neck excision

A

Rapid return to exercise key to prevent muscle wastage

Physio 2 days post op

211
Q

What is a total hip replacement

A 
New femoral head and acetabulum
Chronically painful and arthritic hips
No concurrent problems
Conservative tx no longer effective
Luxation pre op increases risk of luxation post op
leave 6 weeks between contralateral hips

Cemented or non cemented systems in place

212
Q

Complications of total hip replacement

A 
Luxation
Osteomyelitis 
Aseptic loosening
Femoral fractures
Implant failure
Subsidence
Sciatic neuropraxia
Cement granuloma
Pulmonary embolism
213
Q

Post op care of total hip replacement

A

Lead walks for 6 weeks
Physio
Avoid slippery floors and jumping or playing
Gradual return to exercise after 6 week check

214
Q

What are the clinical effects of opioids

A

Analgesia
Sedation in unhealthy or young
Dysphoria if too high a dose given
Cough suppression
Bradycardia due to stimulation of vagal tone - fentanyl. Atropine to correct
Respiratory depression by Mu receptor - fentanyl but unlikely in awake animals
Vomiting - morphine
Reduced gut motility and GI sphincter closure
Pupillary constriction
Can cross placenta and cause resp depression in neonatal - naloxone under tongue to manage

215
Q

What receptor does butorphanol bind to

A

Kappa

216
Q

Name some full Mu agonists

A

Methadone
Morphine
Fentanyl

217
Q

Name a partial Mu agonist

A

Buprenorphine

218
Q

Name an opioid antagonist

A

Naloxone

Blocks Mu receptors but does not provoke a biological response

219
Q

What does potency mean

A

Concentration of a drug required to elicit half the maximum biological response of the agonist
Buprenorphine is the most potent

220
Q

What does efficacy mean

A

Maximum possible biological effect a drug can achieve following binding to the receptor. Maximum possible analgesia that can be achieved
Morphine, fentanyl and methadone are most efficacious

221
Q

Surgical considerations of nasopharyngeal atresia/ stenosis

A

Acquired or congenital
Sneezing, stertorous, URT obstruction
Diagnosis - rhinoscopy, CR, MRI
Open sx and resection of stenotic area through soft palate using endoscopy
Endoscopy guided stent placement works really well but is expensive

222
Q

Duration of opioids

A 
Fentanyl- 10 to 15 minutes. Given as CRI intraoperatively
Butorphanol - 90 mins
Methadone - 3-4 hours
Buprenorphine - 6 hours
Recuvyra - 96 hours
223
Q

Why use opioids as a pre med

A

Increase sedation of alpha 2 agonists, acepromazine or benzodiazepines
Lower doses of sedative agent to be used
Reduced cardiovascular and respiratory effects
Preventative analgesia in healthy animals

224
Q

How does methadone work as an analgesic

A

NMDA receptor antagonist so blocks up regulation of pain pathway

225
Q

What opioids should be used intraoperatively

A

Methadone can be given as a bolus
Fentanyl cri to decrease volatile agent
May need IPPV
Stop cri 15 mins before end of surgery to ensure spontaneous respiration

226
Q

Post operative administration of opioids

A

IV preferable

Pain score first

227
Q

What doses of opioids should be given

A

Bup 20microg/kg
Methadone 0.3-0.5mg/kg
Morphine cri 0.2-0.25mg/kg/hr diluted
Fentanyl cri 5microg/kg/hr

228
Q

Features of opioid CRIs

A

Constant plasma conc of the drug
Avoids peaks and troughs pain relief
Given via syringe driver
Label syringe with drug, dose, patient name, drug concentration
Give loading dose to ensure patient is comfy
Keep in separate bags

229
Q

Features of opioid epidural

A

Morphine and bupivicaine
12-18hours
Do not need to adjust the amount of opioid given systemically if epidural also given but usually means a lower dose needs to be given

230
Q

What drug should be given for chronic pain

A

NSAIDs

231
Q

What are the potential side effects of NSAIDs

A

Vomiting
Diarrhoea
Gastric ulcers
Reduced renal blood flow from dehydration or fluid loss
Elevation of liver enzymes
Prolong blood clotting depending on COX1:COX2 selectivity

232
Q

When are NSAIDs contraindicated

A

If hypertensive or dehydrated
If on corticosteroids
History of ulceration
Reduced renal function should be monitored as blockage of vasodilator prostaglandins may decrease the GFR in a GA
Liver disease - reduce dose
Cardiac disease
Hypoproteinaemia- NSAIDs protein bound so will increase free fraction and elevate side effect risk

233
Q

What should you monitor following nsaid therapy and how often

A

Body systems where effects are most likely - GI, renal, liver, cardiovascular
Underlying disease conditions or concurrent disease
Problems will occur 14-30days but depends on animal.
Educate owner to recognise nsaid toxicity early and know the side effects

234
Q

Assessment of NSAID efficacy

A

7-10days after starting therapy
Then 1 to 2 monthly periods
Owner keep diary about animals demeanour and activity level to determine QoL
If not tolerated or efficacious then change the nsaid used or give adjunctive therapy to increase analgesia

235
Q

How can the GI system be monitored when on nsaid therapy

A

Has owner seen vomiting o diarrhoea, nausea or inappetance
Examine for signs of GI pain
Monitor body weight, PCV, TS

236
Q

How do you monitor the renal system when on nsaid therapy

A

Urine sample
Any changes in drinking
Monitor plasma urea, creatinine, Bp
Monitor potassium is on pot supplements

237
Q

How to monitor the hepatic system if on nsaid therapy

A

Any signs of lethargy
Monitors liver enzyme levels
Monitor serum bile acid conc if has pre existing liver dx to see if there’s changes in liver function

238
Q

How to monitor cardiovascular system when on nsaid therapy

A

Ask about exercise tolerance
Monitor Bp
Monitor platelet count and function if going into sx

239
Q

Mechanism of action of local anaesthetic agents

A

Block conduction of action potentials in nerves by preventing depolarisation
Decrease sensory input to spinal cord and brain
Sodium ion channels blocked
Reversible and not asssociated with loss of consciousness

240
Q

Physio chemical characteristics of local anaesthetic drugs

A

Amide linkage - stable and can withstand heat sterilisation and pH changes
Metabolised in the liver
Lidocaine, bupivicaine, mepivicaine

241
Q

What determines the potency of a local anaesthetic

A

Lipid solubility. Higher the lipid/water partition coefficient the more potent the drug

242
Q

What determines the duration of effect of local anaesthetic

A

Protein binding. Highly bound drugs stay in the lipoprotein of nerve membranes longer

243
Q

What effects the speed of onset of local anaesthetic

A

pKa determines the ratio of ionised to unionised drug
The lower the pKa, the more unionised base is present
Only unionised drugs can enter nerve membranes so the lower pKa the faster the onset

244
Q

Features of lidocaine

A 
Relative potency 2
Relative lipid solubility 3.6
pKa 7.7
Protein binding % 65
Onset fast
90-200mins action
245
Q

Features of bupivicaine

A 
Relative potency 8
Relative lipid solubility 30 
pKa 8.1
Protein binding % 95 
Onset medium 
180-600 mins action
246
Q

Why are myelinated nerve fibres more resistant to local anaesthetic

A

Local anaesthetic must prevent depolarisation in 3 to 4 nodes of ranvier
Internodal distance increases with diameter so need higher conc of local anaesthetic
Motor nerves less sensitive than sensory nerves

247
Q

Wh are unmyelinated fibres more susceptible to local anaesthetic

A

Smaller length of the nerve fibre membrane must be blocked
Advantageous as a concurrent motor nerve block is usually undesirable
Sensory fibres blocked first - lower conc of drug needed

248
Q

Characteristics of lidocaine

A 
Stable in solution
Unlicensed 
Short duration and onset
Wide safety margin
Addition of adrenaline prolongs duration
249
Q

Characteristics of mepivicaine

A

Less toxic than lidocaine
Good for equine lameness diagnosis
Medium duration of action

250
Q

Characteristics of bupivicaine

A 
Stable
Slow onset and long duration
4 times more potent than lidocaine
Good motor and sensory separation 
Do not give IV
251
Q

How can systemic toxicity of local anaesthetics occur

A

Vascular sites cause rapid absorption so reduce dose if going into area with good blood supply
Drug dependent
Speed of injection when given IV
Adrenaline causes vasoconstriction causing slow absorption

252
Q

What effects do local anaesthetics have on the cardiovascular system

A 
Slowing of conduction of myocardium
Myocardial depression
Peripheral vasodilation
Hypotension
Bradycardia
Cardiac arrest

If adrenaline added - tachycardia and hypertension

253
Q

What are the effects of local anaesthetics on the central nervous system

A

Seizures
Convulsions
CNS depression
Coma

254
Q

How do you reduce the risk of toxicity following administration of a local anaesthetic

A

Small needle
Calculate the safe maximal dose depending on body weight
Draw up drug using appropriate sized syringe
Dilute with NaCl
Draw back and give slowly

255
Q

Why apply local anaesthetic to mucous membranes

A

Produces analgesia within 5 mins
Lidocaine
Ocular exam, intubation, nasogastric tube placement
EMLA cream takes nearly an hour to work and must be applied thickly

256
Q

What is infiltration analgesia

A

Local anaesthetic injected into skin at the edge of the previous weal
Only one needle prick felt
Used to close wounds, remove small growths and take biopsies

257
Q

Using local anaesthetic for thoracotomy

A 
First dose under GA
Q8hrs
Bupivicaine 1mg/kg in saline
Give each side
Stings so can give some lidocaine first
258
Q

Anatomy of the eye

A

Ciliary body and iris rich in vessels and pigments
Limbus has stem cells that allows the cornea to heal
Optic nerve goes into optic disc
Lens behind cornea
Fundus at the back

259
Q

What usually causes eye problems

A

Secondary to poor conformation of the eye

260
Q

What are bulging eyes at risk from

A

Corneal ulceration
Serous discharge
Sclera visible which has more pigmentation to make tissue tougher and more resistant to irritation
Often blood vessels extend to cornea - sign of irritation
Corneal dryness

261
Q

What should dogs eyes be tested for

A

Progressive retinal atrophy
As from 4years are night blind
From 8years can be day blind
Inherited condition

262
Q

What equipment is needed for an ophthalmic exam

A 
Pen torch
Ophthalmoscope 
Fluorescein 
Schirmer tear test strips
Tropicamide to dilate pupils
Tonometer
20D condensing lens to look at retina and fundus
263
Q

What are the different light filters for on a ophthalmoscope

A

White - direct illumination
Redfree light - differentiates vessels and pigments on the retina
Blue cobalt - to detect ulcers after fluorescein staining

264
Q

When doing an eye exam what history do you need to know

A

Previous ocular conditions and response to treatments
Concurrent dx
Current ocular complaint - characterisation, onset, progression, duration
Question how well the animal can see

265
Q

How is a distance ocular exam done

A

Body condition
Attitude
Face - symmetry, discharge
Eyelids - swelling, colour, size, palpebral fissure
Eyeballs - position in the orbit, size of the globe, direction, movements
Pupil - symmetry, size, shape, PLR
Use direct ophthalmoscope

266
Q

How do you test vision

A

Menace response
Tracking response
Visual placing response

267
Q

What are the clinical signs of neuro-ophthalmology

A

Strabismus - deviation of visual axis
Nystagmus
Aniscoria - different pupil sizes
Eyelid ptosis- drooping

268
Q

What is the schirmer tear test

A

Tests for dryness
Tests the quantity of tears produced
Normal 15-25mm in a minute

269
Q

What must be done before any diagnostic drops are used

A

Corneoconjunctival culture

270
Q

How do you test for the quality of the tears

A

Use fluorescein and blue filter
Maintain lids open and measure time for dark spots and lines to appear after last blink
Normal 20s
Quicker they appear the poorer the quality
Difficult to perform

271
Q

How do you perform an adnexa and anterior segment exam

A

Close exam with ophthalmoscope
To examine cornea, conjunctiva, eyelids and anterior segment
Use white light

272
Q

What can you use fluorescein for

A

Corneal ulceration detection
Permeability of the nasolacrymal duct system
Tear break up time - tear quality test

273
Q

What is the normal intraocular pressure measurement

A

10-20mmHg

274
Q

How do you examine the lens, vitreous and fundus of the eye

A

Tropicamide

Wait 30 mins

275
Q

How do you examine the posterior segment of the eye after pupil dilation

A

Monocular indirect ophthalmoscope to view fundus

Direct ophthalmoscope to visualise lesions in detail

276
Q

How do you increase the concentration of eye drops and what order do you give multiple tx

A

Increase the frequency not the number of drops

Give in order of viscosity- solution, suspension, lubricant

277
Q

Features of bandage contact lenses

A

Shields migrating epithelial cells

Complications not common

278
Q

What topical antibiotics can be used on the eye

A

1st intention - fucidic acid, chloramphenicol
2nd intention - gentamycin
3rd intention - ofloxacin acts against pseudomonas aeruginosa

279
Q

Topical corticosteroids that can be used on the eye

A

Reduce inflammation
Prednisolone 1%
Dexamethasone 0.1%

280
Q

Topical NSAIDs that can be used on the eye

A

Multimodal therapy with steroids to reduce frequency of admin
Ketorolac
Bromfenac

281
Q

Immunosuppressant drugs that can be used on the eye

A

Cyclosporine
Tacrolimus
To treat keratoconjunctivitis

282
Q

What antiproteolytic therapy can be used in case of ulcers

A

Serum
EDTA
Administer every hour if deep ulcer

283
Q

How do you treat glaucoma

A

Reduce the production and increase the drainage of aqueous humor in the eye
Carbonic anhydrase inhibitors
Prostaglandin analogues

284
Q

What can be used to treat intraocular inflammation

A

Atropine - mydriatic agent

285
Q

What are common eye complaints in consultation

A 
Red eye
Cloudy
Blind
Purulent
Painful
286
Q

What can cause an eye to look red

A

Inflammation - can be urgent
Haemorrhage - can be urgent
Vasodilation - can be urgent
Neovascularisation associated with corneal ulnar - urgent

Need to see that day if possible

287
Q

What is exophthalmos

A

Abnormal protrusion of the eye ball

E.g. Orbital foreign body

288
Q

What is globe proposes

A

Eye has come out of the socket
Try to save
Tell owner to keep moist and come quickly
Suture eyelid over eyeball until swelling goes down

289
Q

What is enophthalmos

A

Recession of the globe into the orbit

Horner syndrome

290
Q

What is a macropalpebral fissure

A

Eyelids not big enough to cover whole eye

Lubricant and sx

291
Q

What is ectropion

A

Exposed conjunctiva

Dryness and impaired eyelid function

292
Q

What is entropion

A

Eyelid is inverted
Can be primary or secondary
Sx to treat

293
Q

What does a normal conjunctiva look like

A

Pale in cats

Light pink in dogs

294
Q

What does blue cornea mean

A

Lesion of the superficial layer of the cornea
Causes water uptake in the cornea - corneal oedema
Urgent

295
Q

What does a red cornea mean

A

Corneal neovascularisation
Sign of a superficial ulcer
Fine vessels with no branching is a sign of a deep corneal lesion

296
Q

What does a white cornea mean

A

Corneal scar

Lipid keratopathy - lipid deposits associated with hyperlipidemia

297
Q

Stages of a corneal ulcer

A

Epithelial layer and involvement of stroma to give melting appearance
Deep ulcer is very vascular and has purulent discharge
Corneal perforation has fibrin surrounding it

298
Q

What are the clinical signs of cataract

A

Lens opacity

299
Q

What are the signs of ocular pain

A 
Increased blinking
Rubbing at eye
Redness
Photophobia
Increase lacrimation
300
Q

How do you treat third gland prolapse - cherry eye

A 
Sx
Buster collar
1st line antibiotics 
Lubrication
NSAIDs
301
Q

What is keratoconjunctivitis sicca

A 
Immune mediated
Dry eye - no tear production 
Ocular pain
Mucoid discharge 
Inflammation
Decreased vision and progressive corneal disease
Use schirmer tear test
302
Q

What is the treatment for keratoconjunctivitis sicca

A

Lubrication
Immunomodulating agent
Broad spectrum antibiotic
Topical anti inflammatory

303
Q

How do you treat an infected ulcer

A 
Antiobiotics hourly
Serum hourly
Lubrication
NSAIDs 
Reconstructive corneal sx
304
Q

History taking for animal presenting with a mass

A

When first noticed
Has it grown
Changed appearance
Any other masses visible

305
Q

What tests can be done to see what a mass is

A

FNA submit for cytology
Biopsy of FNA inconclusive - tru cut, incisional, excisional - bear in mind future sx
Biopsy can cause metastasis of mast cell tumours

306
Q

Tumour staging

A

TNM

307
Q

How do you stage the actual tumour

A 
Size
Growth rate
Location
Local invasion
Histological type and grade
308
Q

How do you tell if a tumour has spread to lymph nodes

A

Assess draining nodes
Palpation
FNA
Surgical biopsy

309
Q

How do you tell if a tumour has metastasised

A

Lung - inflated radiographs and CT

Look in the abdomen, brain, skin etc

310
Q

What are the considerations for tumour excision

A

Tumour type and grade
Tumour stage
Size and location

311
Q

What surgery can be performed on tumours

A 
Incisional biopsy
Debulking
Marginal excision
Wide excision
Radical excision e.g. Maxillaectomy
312
Q

Why do you need histopathology after tumour removal

A

Look at cells at the edge of the sample to see if tumour has been removed
Fill out forms comprehensively
Essential
Ink margins

313
Q

Best way to close after tumour removal

A

Keep simple
Avoid tension
Place drain
Post op chemo or radiography

314
Q

Considerations for drain placement after tumour removal

A

Entry point as close to surgical incision as the tract is now part of the wound
If sx needs to be devises the tract also needs to be removed as can now contain cancer cells

315
Q

What are the reasons for wound breakdown post sx removal of a tumour

A 
Patient factors rare
Concurrent disease
Nutrition
Chemotherapy
Radiotherapy
Steroids
Neoplasia
Tension
Tissue handling
Motion
Sutures - wrong technique
Infection
Patient interference
316
Q

What areas are a problem for tumour removal

A

Distal limb
Axilla
Bony prominence

Consider axial flaps

317
Q

How do you treat wound breakdown post sx

A

Do not resuture

Heal by 2nd intention

318
Q

How do you prevent seroma formation

A 
Prevent dead space by placing drains
Halsteads principles - treat tissue with respect
Rest
Leave alone
Pressure bandage
Provide further drainage
319
Q

How do you treat infection after a tumour has been removed

A

Drainage
Heal by 2nd intention
Antibiotics after culture and sensitivity
Wound exploration if necessary

320
Q

Why might there be tumour recurrence

A

Dirty margins
First cut is the best as don’t want revision sx

May already be metastasis

321
Q

What types of sub dermal plexus flaps are there

A

Advancement flaps
Rotational flaps
Transposition flaps
Skin fold flaps

322
Q

What are the principles of sub dermal plexus flaps

A 
Wider base than body
Limit size
Avoid narrowing
Undermine panniculus
Atraumatic surgical technique
Take from area with ample skin
Avoid excessive stress or motion at donor site
323
Q

What is an advancement skin flap

A

Flap parallel to line of least tension
Stretched into defect
Loose skin adjacent to wound
Prone to dehiscence

324
Q

What is a rotational skin flap

A

Skin rotates to close triangular defect

Radius of rotation is the length of the wound

325
Q

What is a transposition flap

A

Flap parallel to tension
Rotated into the defect
Maximise width of base
Length equal to pivot arc

326
Q

What is a skin fold flap

A

Axillary or inguinal skin folds
Versatile and large
Sternal and groin wounds

327
Q

What are the complications of skin flaps

A

Seroma
Dehiscence due to too much tension
Flap necrosis from technical error or trauma

328
Q

What are axial pattern flaps

A

Involve a direct cutaneous artery
Superficial landmarks
Flap dimensions depend on conformation

329
Q

What are the indications for axial pattern flaps

A 
Large wounds on flank or proximal limb
Reconstruction post tumour excision
Chronic non healing wound
Avascular wound bed
Need to cover exposed bone
Provision of muscle bulk
330
Q

What are the advantages of axial pattern flaps

A 
Durable full thickness skin
Blood supply
Normal hair growth
Morbidity less likely
Can be larger than subdermal plexus flaps
331
Q

What are the four major axial pattern flaps

A

Caudal superficial epigastric
Thoracodorsal
Omocervical
Deep circumflex iliac

332
Q

Features of a thoracodorsal axial pattern flap

A

Thoracodorsal artery cutaneous branch
Shoulder, forelimb, elbow, axilla, thorax, carpus
Large, durable and robust

333
Q

Features of a caudal superficial epigastric axial pattern flap

A

External pudendal and caudal superficial epigastric artery
Caudal trunk, inguinal, perineum, pelvic limb to hock
Mammary tissue remains functional

334
Q

What are the post op care considerations for skin flap sx

A

Bandage to remove dead space and immobilisation of limb
Drain care
Analgesia
Antibiotics if needed

335
Q

What are the complications of axial pattern skin flaps

A 
Necrosis of flap
Seroma
Failure to adhere
Dehiscence
Infection
336
Q 
18mnth m(n) dlh cat
Missing 24hrs 
Large wound in inguinal region
Recumbent but responsive
How would you approach this case
A 
Major body system assessment
Place catheter
Pain relief no NSAIDs
IVFT if needed
Full body exam
Minimum database
Wound classified as dirty
337
Q

How would you manage a day old dirty wound

A 
Ga
Clip area around wound
Lavage with saline
Sx debridement
Swab
Broad spectrum antibiotics
Keep patient warm
338
Q

After cleaning a dirty inguinal wound what is the next step

A

Wet to dry dressing to provide debridement
Nappy style bandage
Tie over dressing
Urinary catheter
Feeding tube
Long stay catheter in saphenous vein or jugular line

339
Q

Once a wound has been suitably debrided what dressing would you use

A

Intrasite - osmotic effect causing gentle debridement
Alleyvn as very absorbable and is semi permeable so allows O2
Will give intrasite in and stop drying out

340
Q 
7yr m(n) cross breed
Wound over left hock
Possible bite
Previous partial tarsus arthrodesis
How would you manage this wound
A 
Clip
Lavage
Swab
Surgical debridement
Wet to dry dressing
Intrasite or homey with alleyvn
Antibiotics
Remove bone plate and drill holes in bone to encourage granulation tissue over exposed bone
341
Q

What are the indications for a free skin graft

A

Wounds on distal limb
Primary closure not possible
Healthy granulated wound

342
Q

What are the contraindications for a free skin graft

A

Wounds on head and trunk as rely on blood supply from local area so can’t have any movement, can immobilise limbs
Infection
Incomplete granulation bed
Debris

343
Q

How should you care for skin grafts

A 
Aseptic technique
Immobilisation of graft
Prevention of fluid accumulation
Sedation or ga for dressing changes as don't want movement
Keep bandages on for 2-3 days
344
Q

Pros and cons of skin grafts

A 
Cover distal limb deficits
Labour intensive and time consuming
Grafts take time to be fully functional
Variable cosmetic and functional outcome
Other reconstruction techniques preferred when possible
345
Q

What are the main concerns of dog bite wounds

A

Contaminated
Superficial skin wound but crushing injury to underlying muscle
Puncture wounds to deeper structures

346
Q

How should dog bite wounds be managed

A 
Ga 
Clip fur
Lavage
Explore
Swab
Antibiotics
347
Q

What are your concerns for a dog bite to the neck

A

Damage to jug vein, carotid artery, recurrent laryngeal nerve, trachea which could cause emphysema, crepitus or pneumonia
Always always explore

348
Q

What are the goals of wound management

A 
Prevent further conta,inaction
Remove debris and contamination
Debride dead and dying tissue
Promote a viable vascular bed
Patient considerations
Select appropriate method of closure
349
Q

What is the initial care for an equine fracture

A

Do not move horse until need for stabilisation is known
Sedate
Treat wound - clip, clean, sterile bandage
Stabilise fracture
Meds

350
Q

What clinical signs would you see with a suspected equine fracture

A 
Sweating 
Shock
Pain
Lameness
Palpable instability
Crepitus
Soft tissue swelling
351
Q

What are the goals of fracture stabilisation

A

Stabilise fracture
Reduce discomfort and distress
Minimise further trauma to bone, soft tissue and vasculature
Prevent further contamination if open wound
Include joint above and below fracture and splint to way above fracture line

352
Q

What are the options for a stabilising bandage

A

Robert jones
Splint using anything available
Cast

353
Q

What medication would you give a horse with a fracture

A

Antimicrobials
Analgesia - NSAIDs and opioids
Tetanus toxoid
IVFT to treat shock and haemorrhage

354
Q

What do you need to have ready for when an equine fracture comes in

A 
Drugs
Bandage material
Splints
Cast material
Catheter
Fluids
Turn radiography equipment on
355
Q

What surgical equipment do you need for an equine fracture repair

A 
Drapes
General kit
Fracture kit - 4.5mm set and screws
- 5.5mm set and screws
- locking plate and screws
Drill
Intraoperative imaging and gowns
Arthroscopy equipment
Bone reduction forceps
Plate bender
Hand held retractors
Self retaining retractors
Clippers and prep
Fluids
Bandage cart
Cast material
Suture material
Ropes
Support stands for legs
356
Q

Patient prep for equine surgery

A

Cover feet and tail
Clip hair 10-15cm radius from surgical incision
Clean skin
Disinfect skin

357
Q

What are the assisted recovery options post equine surgery

A

Head and tail rope
Sling recovery
Pool recovery

358
Q

What is the post op care for equine fractures

A

Analgesia and antimicrobials
Monitor vitals - HR should be less than 40
Monitor comfort, appetite, faecal output, catheter
Check cast for breakage, discharge, heat
Frog support on opposite limb
Rest 4 months

359
Q

What are the complications of equine orthopaedic surgery

A

Infection
Unstable fixation - pain and longer healing
Laminitis common in other foot

360
Q

Before an equine arthroscopy what should be done before

A

Radiographs
Catheter
Meds
Prepare theatre

361
Q

What are the components of arthroscopic equipment

A 
Arthroscope
Video camera
Tv screen
Light source and light cable
Fluid irrigation system
Motorised equipment
362
Q

What surgical instruments are needed in an arthroscopy

A 
Egress cannula
Forceps
Probes
Osteotome and elevators
Cutting instruments
Curettes
363
Q

What is the post op care for an equine arthroscopy

A 
Monitor lameness - stifle usually sore for 24hrs. Other joints should be sound walking
Temperature
Bandage
Appetite
Faecal output
364
Q

What are equine emergency surgeries

A

Colic
Lacerations
Dystocia

365
Q

What history do you need to know for colic

A 
How long
How severe
Response to meds
Had colic before
Had sx before
Had a foal
Age
Geography
Breed
366
Q

Clinical exam for equine colic

A 
Abdo discomfort
HR
Temp of ears and feet
Pulse quality
Mm
Rectal temp
Resp rate
Abdo distension
GI sounds
Rectal exam
Ultrasound abdo
Abdominocentesis
367
Q

What do you need to have ready for when a colic comes in

A 
Sedation
Buscopan
NSAIDs
Stethoscope
Clippers and prep
Catheter
NG tube and bucket
Rectal sleeve and lubricant
Ultrasound machine
368
Q

What are the two types of colic

A

True colic - gastrointestinal

False colic - urofenital tract, resp system

369
Q

Preparation for colic surgery

A 
Catheter
Clip abdo
Meds
Pass NG tube
Prep patient
Prep theatre
370
Q

What equipment do you need for colic surgery

A 
Clippers
Urinary catheter
Prep
Fluids
CMC carboxymethylcellulose
General set
Drapes
371
Q

What instruments do you need for small intestinal colic

A 
Doyen clamps
Penrose drains
Separate drapes
Suture material
Fluids for lavage
Staples for anostomosis
Fresh clean table with new instruments to close
372
Q

What instruments do you need for large intestinal colic

A 
Colon tray
Drapes 
Separate table as contaminated
Hose with tap water for lavage
Sterile fluids for lavage
373
Q

How much care do colic patients need post op

A

If systemically healthy need minimal care
- pain meds and systemic antimicrobials
- gradual refeeding
Systemically compromised need intensive care
- endotoxemia
- ileau
- anostomosis not functional

374
Q

Monitoring of colic patients post op

A 
HR
Pulse quality
Mm
Hydration - PCV/TP/USG
GI sounds
Defecation
Check for nasogastric reflux - up to 5l/hr
Comfort - laminitis and colic
Appetite
Temp
Surgical wound
Abdo bandage
375
Q

What is the intensive care for a colic patient

A 
Meds
IVFT
PE every 4-6 hours
PCV/TP/USG every 4-6 hours
Gradual refeeding 
Walking helps to kickstart GI system
376
Q

What are the most common wounds for horses

A

Distal limb lacerations

60% of all wounds

377
Q

Why are distal limb wounds in horses so challenging

A

Extensive crushing or avulsion of soft tissue
Exposure of bone
Vascular compromise
Severe contamination
Less skin to mobilise
More likely to dehisce
Increased exuberant granulation tissue
Decreased contraction and epithelialisation
May include many critical synovial and supporting structures which can result in permanent loss of use or death

378
Q

How do you manage an equine wound

A

Cleansing
Exploration
Radiographs
Determine if synovial structures are involved
Debridement with lavage of synovial structures
Suture
Antimicrobials

379
Q

How do you cleanse an equine wound

A

Clip hair around wound but protect the wound whilst doing so
Irrigation - 18g needle and 60cc syringe
- saline or tap water and an antiseptic (povodine iodine or chlorhexidine)
Prep skin

380
Q

Why and how do you explore an equine wound

A

Determine extent of wound, if there’s a FB and if synovial structures are involved
Use a probe
Radiographs for Fb and to check for fracture, look for air around synovial structures
Contrast studies for synovial structures

381
Q

Why is it important to check for involvement of synovial structures in an equine wound

A

Less than 6-8hours before they are contaminated
If not recognised chronic injuries massively reduce prognosis - prognosis is good if treated aggressively from the start
Know the anatomy of the joint pouches and sites of injection

382
Q

What do you need to have ready for when an equine wound comes in

A 
Clippers and prep
Fluids for lavage
Probe
Gloves
Catheter
Radiography equipment turned on
Sedation
Antimicrobials
Pain med
Bandage cart
383
Q

What equipment do you need to close an equine wound

A 
Clippers and prep
Fluids for lavage
Standard kit
Arthroscopy equipment
Bandage cart
Drains
384
Q

What is the post op care for equine wounds

A

Systemically healthy
Bandaging
Meds
Monitor usual parameters

385
Q

What are the normal stages of equine labour

A

1 - relaxation cervix and uterine contractions
- restlessness, pacing, pawing, posture to urinate
2 - 10-15min up to 70min
- onset rupture chorioallantois and delivery of foal
3 - passing foetal membranes

386
Q

At what point does equine labour become dystocia

A

Stage 2 longer than 30 mins

Likelihood of dead foal increases by 16% every 10mins

387
Q

What history do you need to know for a mare with dystocia

A 
Signalment
Gestational age
Pertinent medical history
Time of stage 2 onset
Has assistance already been attempted
388
Q

What do you need to evaluate with a dystoic mare

A 
Physical exam - pale mm and low HR
Determine foetal orientation
Determine the viability of the foal - always assume alive unless proven otherwise
Ask if foal or mare is the priority
Cost
Distance to referral hospital
How healthy is the mare
389
Q

What are the methods for equine dystocia resolution

A

Assisted vaginal delivery
Controlled vaginal delivery
Csection
Fetotomy

390
Q

Features of equine assisted vaginal delivery

A 
Maintain hygiene
Lubricate
Manually reposition foal
Sedation
Clenbuterol to relax uterus
Epidural anaesthesia
391
Q

When is a fetotomy performed

A

Non viable foal
Cost
Need experience to do

392
Q

Features of equine controlled vaginal delivery

A

GA with mechanical ventilation
Hind limbs elevated
15mins max
Simultaneously prep for c-section

393
Q

Features of an equine c-section

A 
Ventral midline laparotomy
Localise uterine horn and exteriorise
Hysterotomy
Exteriorise foal
Control haemorrhage
Routine closure
Should be 20mins max until foal extraction
394
Q

Post op care for mare that had dystocia

A 
Antimicrobials and NSAIDs
Oxytocin every hour - if retained placenta for more than 6 hours then infuse 80IE over 30 mins
Hydrotherapy vulva
Stimulate GI system and adapt diet
Uterine lavage
395
Q

Why perform a terminal c-section

A

Mare with terminal illness - laminitis, cardiac failure, neuro
Full gestation and in parturition
Options for euthanasia- captive bolt, GA or sedation with local anaesthesia

396
Q

If neonatal foal not breathing

A

Intranasal O2 8-10l/min
Mouth to nose
Intubate and ventilate

397
Q

What should you do if a neonatal foal has bradycardia or no heartbeat

A 
Should be 80-120bpm
Thoracic compressions 100/min
After 40secs IV adrenaline 
Antagonise medication used on mare
Stop when heart rate is more than 60 Bp and spontaneously breathing more than 16/min
398
Q

What are the complications of dystocia

A 
Trauma of the reproductive tract - lacerations or rupture
Retained placenta
Delayed uterine involution
Bladder prolapse
Metritis
Peritonitis
Arterial haemorrhage 
Uterine prolapse
Neuropraxia
Pressure necrosis
399
Q

What are the stages of orthopaedic healing

A

Post op 24-48 hours - pain, oedema, healing tissues
Regeneration day 5- 3 weeks - new collagen fibres forming. Still fragile so relative rest
Remodelling and bone healing 6 weeks to 1 year - consolidation, maturation (10wk to 1 yr), bone regeneration (bridging and callous forms) and remodelling

400
Q

Treatment in post op stage of orthopaedic healing

A

Analgesia - need to know if sufficient or too much
Cryotherapy - 10 mins x3
Rest
Easy movement only - supported weight bearing

401
Q

What is the treatment for the regeneration phase of orthopaedic patients

A

Controlled lead exercise
Passive and active ROM exercises
Can help reduce swelling

402
Q

When considering non emergency orthopaedic surgery what can you do as prep beforehand

A

Weight loss especially if obese

Hydrotherapy but stop post op until sutures removed

403
Q

Immediate post op care for joint surgery

A

Cryotherapy
If haemorrhage then pressure dressing for 12-24hrs
PROM to maintain normal ROM, blood and lymphatic circulation. Stimulates sensory awareness
Massage can reduce oedema
Pain management

404
Q

Post op care for joint sx

A

Therapeutic exercises after a few days to encourage muscle strengthens and re-education
Weight bearing exercises and if not weight bearing then weight shifting exercises
Low impact initial exercises
Hydrotherapy
If in cast then PROM on adjacent joints
Hot therapy after 5 day inflammatory period can be done
If normal gait function not expected - sit to stand exercises to build glutes and prevent fibrosis and loss of motion
Luxation - Rehab as soon as sling removed. Weight bearing exercises limited. Don’t abduct or adduct limb

405
Q

How to treat animals who have a total hip replacement

A

Lead walk v slowly
Keep patient calm and settled - sedate if needed
Clear signage so people know how to handle them

406
Q

Anatomical types of fractures

A

Articular - joint
Physeal - growth plates
Condylar - long bone

407
Q

Commonly seen fractures

A

Humeral condylar fractures - Spanials, check other limb
Maxillary or mandibular - cats. Tube feeds
Radial/ulnar - RTA, horse kick, dropped
Femoral - sciatic nerve damage. Lots of physio
Tibial/fibular - RTA/ trauma
Pelvic - assess bowel/bladder care, care with ,offing and ensure stable. Can be completely recumbent or still able to walk

408
Q

Features of external fixations

A

Can be difficult to apply treatments
Can apply ice to parts of limb
PROM achievable with linear or ring fixators
May be reluctant to flex/extend limbs so active exercises useful
Work on extension of distal limb
Care for the pin tracts don’t excessively clean or cover too much and trap air
Ensure patient comfort

409
Q

Common tendon injuries

A

Lacerations
Seen in conjunction with wound
Supraspinatus tendon calcification common with agility dogs

410
Q

Rehabilitation for tendon injuries

A

PROM after 3 weeks rest
Limited exercise for 3-6 weeks
Tendon still not at full strength at 6 weeks

411
Q

When rehabilitating any patient what do you need to consider

A 
Client and you have the same goals
Communication is key with clinician
Have a plan
Know how progress will be assessed
How will you communicate progress with the client
Do you have access to a physiotherapist
412
Q

What are the primary goals of rehabilitation of the orthopaedic patient

A

Get patient weight bearing
Active range of movement
Muscle building

413
Q

What are the effects of atropine if dosed wrong

A

Too low dose - more bradycardia

Too high dose - tachycardia - wait it out

finals (3 decks)

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