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ST Surgery > Thoracic And Resp Surgeries > Flashcards

Thoracic And Resp Surgeries Flashcards

1
Q

What part of the airway is the primary source of resistance to airflow?

A

The upper airway - nasal valve, rostrum nasopharynx, and larynx, oral cavity (tremendous resistance)

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2
Q

What occurs in the instance of upper airway dysfunction?

A

Incr resistance > decr ventilation > Poor performance; incr turbulence > incr noise

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3
Q

What are common presenting complaints for horses with upper airway issues?

A

Noise (inspirations vs. expiratory), poor performance, nasal discharge, cough, dysphagia, halitosis, anatomical distortions, fever, inappetence, weight loss

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4
Q

What are three tests for laryngeal function at rest?

A

Nasal occlusion, swallow reflex, and the slap test

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5
Q

What might you look at with laryngeal endoscopy when the patient is exercising?

A

Dynamic dysfunction; would do this on a high speed treadmill or overground exam

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6
Q

What are some indications for sinoscopy?

A

Old age, minor surgical procedures

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7
Q

What are you looking at with cranial radiographs? What is the biggest set back of this diagnostic method?

A

Paranasal sinuses and dental arcades primarily, but also at the guttural pouches, pharynx, larynx, and trachea; check for fluid lines, ST/fluid opacity; biggest set back = superimposition!

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8
Q

What body part are you limited to for ultrasonography in equines and why is this the case?

A

Larynx - bone limits most other locations; checking for abnormal anatomy (congenital, distortion d/t dz, muscular atrophy)

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9
Q

What are the benefits of CT scans?

A

No superimposition! - imaging method of choice, typically used for looking at dental arcades and paranasal sinuses

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10
Q

What are MRIs good for?

A

Soft tissue detail, +/- contrast

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11
Q

What are a couple other diagnostics for respiratory disease in equines?

A

Nuclear scintigrapy, clinical pathology (CBC/Chem), microbial culture and sensitivity, bronchoalveolar lavage, histopath

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12
Q

What are some potential diseases of the nasal passage?

A

Epidermal inclusion cysts (atheromas), redundant alar folds, nasal lacerations, nasal septal dz (cysts, neoplasia, trauma), engorgement of the nasal mucosa (Horner’s syndrome), wry nose

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13
Q

What are some diseases of the paranasal sinuses?

A

Sinusitis (primary, secondary), sinus cyst, ethmoid hematoma, neoplasia, trauma (fractures and wounds)

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14
Q

What are the causes of primary vs. secondary sinusitis?

A

Primary - usually Strep. Sp.; Secondary - dental dz, mass, trauma

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15
Q

How do you diagnose sinusitis?

A

Endoscopy (drainage from middle meatus), rads (fluid lines, space occupying lesion), CT, sinocentesis (culture and sensitivity), sinoscopy

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16
Q

What are your treatments for primary and secondary sinusitis?

A

Primary - lavage (trephine), abx, +/- sx debridement; Secondary - address the CAUSE!, tx as primary sinusitis

17
Q

What are your landmarks for trephination of the frontal sinus?

A

Draw a line from midline to medial canthus; 60% of distance from midline along this line and 0.5 cm causal to the line

18
Q

What are your landmarks for trephination of the caudal maxillary sinus?

A

2 cm ventral to medial canthus

19
Q

What are you landmarks for trephination of the rostrum maxillary sinus?

A

Draw a line from medial canthus to infraorbital foramen, 1 cm ventral to this line and midway b/t the medial canthus and the rostrum extent of the facial crest

20
Q

What is a paranasal sinus cyst?

A

Fluid filled mass, enlarge > facial deformation, sinusitis, +/- airway obstruction

21
Q

How do you diagnose and treat paranasal sinus cysts and what is the prognosis for these?

A

Dx: C/S, endoscopy, rads, sinocentesis, CT, histopath
Tx: Sx debridement
Px: Excellent

22
Q

What is the most common type of sinus neoplasia and what are some common clinical signs?

A

Sinus neoplasia is rare, but SCC is most common; C/S include facial deformation, +/- airway obstruction, often dx late in dz process

23
Q

How do you diagnose and treat sinus neoplasia and what is the prognosis?

A

Dx: C/S, endoscopy, rads, biopsy (sinoscopy), CT, MRI; Tx: sx debridement, radiation, chemo; Px: usually poor unless benign

24
Q

What are progressive ethmoid hematomas?

A

Masses arising from ethmoids or sinus, causing mild intermittent epistaxis (unilateral > bilateral), facial deformation and significant airway obstruction = RARE

25
Q

How do you diagnose and treat progressive ethmoid hematomas and what is the prognosis?

A

Dx: endoscopy, rads, +/- CT; Tx: intralesional 10% formalin, LASER photoablation, sx removal (sinus); Px: good but recurrence not uncommon

26
Q

What are common clinical signs of trauma to the paranasal sinuses?

A

Open vs. closed, depression fx, epistaxis, emphysema, dyspnea, CNS signs, check the eye!

27
Q

How do you diagnose and treat paranasal sinus trauma and what is the prognosis?

A

Dx: rads, CT, endoscopy; Tx: stabilize patient, abx, analgesia, wound tx, sinus lavage, surgical repair; Px: good for healing, dependent on concurrent problems

28
Q

What is lymphoid hyperplasia caused by, what are the clinical signs of it, and should you be worried about it?

A

Immune stimulation, C/S = typically none, often in young horses; rarely need treatment, just rest the horse and maybe give anti-inflammatories

29
Q

What are the clinical signs of cause of dorsal displacement of the soft palate?

A

C/S: noise during expiration; Intermittent > persistent

Cause? = persistent - CNS/PNS dz

30
Q

What are diagnostics and treatments for dorsal displacement of the soft palate? What is the prognosis of this?

A

Dx: resting endoscopy, exercising endoscopy, +/- rads, +/- U/S; Tx: conservative = tongue tie, figure 8 noseband, sx = laryngeal tie-forward, ST myectomy/tenectomy, palatoplasty?; Px: 60%, up to 80-90% for tie-forward in Standardbred racehorses

31
Q

Describe recurrent laryngeal neuropathy

A

Demyelination and axonopathy of the RLN, paresis > paralysis of intrinsic laryngeal mm (CAD - abductor), insp obstruction and noise at exercise, most often L side and in large horses (TB, draft)

32
Q

How do you diagnose and treat recurrent laryngeal neuropathy? What kind of prognosis does the patient have?

A

Dx: laryngeal palpation (prominent muscular process), resting endoscopy! (Grade I-IV), laryngeal U/S, +/- exercising endoscopy; Tx: prosthetic laryngoplasty (tie-back), partial arytenoidectomy, neuromuscular pedicle graft, ventriculecotomy, vocalcordectomy; Px: tie-back - racehorse (50-70%), performance horse (85-95%)

33
Q

What important vessels and nerve lie within the lateral compartment of guttural pouch? The medial compartment?

A

Lateral: External carotid > maxillary a. And facial n.; Medial: internal carotid a., cranial cervical ganglion, symp trunk, CN IX, X, XI, XII, pharyngeal branch of X

34
Q

Describe guttural pouch mycosis

A

Rare but life threatening, focal fungal infection with predilection for vital structures, often Aspergillus sp.

35
Q

What are the clinical signs for guttural pouch mycosis and how do you diagnose this?

A

C/S: epistaxis (DDx rupture of ventral straight mm), dysphagia, Horner’s syndrome, abn resp noise, nasal discharge; Dx: endoscopy!, +/- rads

36
Q

What are potential treatments for guttural pouch mycosis and what is the prognosis?

A

Tx: medical tx fungus - slow, poor efficacy, hemorrhagic shock - transfuse, fluids, vascular occlusion - epistaxis cases, NSAIDs, nutritional support; Px: guarded, 50% of horses that hemorrhage die

37
Q

What are some potential treatments for tracheal diseases?

A

Tracheotomy - provide airway for horses with life-threatening upper airway obstruction, emergency or pre-emotive, and permanent tracheostomy (good px)

38
Q

How do you perform a tracheotomy?

A

Longitudinal incisions at level of junction of prod and mid 1/3 of the neck
Transverse incision b/t rings, <50% circumference

39
Q

What are your indications for thoracic surgery?

A

Pleuritis, pleuropneumonia, pulm abscess, trauma, diaphragmatic hernia

ST Surgery (13 decks)

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