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RUSVM Small Animal Surgery > Thoracic Surgery > Flashcards

Thoracic Surgery Flashcards

1
Q

most common surgical approach of thorax

A

lateral thoracotomy

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2
Q

what procedure is seen here

A

lateral/intercostal thoracotomy

less painful than median sternotomy

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3
Q

how is a lateral thoracotomy closed

A

circumcostal sutures

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4
Q

indications for median sternotomy

A

bilateral thoracic exploration

cranial mediastinal masses

cranial thoracic trachea

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5
Q

what should be left intact with median sternotomy

A

manubrium or xiphoid

can cut both if necessary - be extra careful when closing

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6
Q

minimally invasive approaches

A

used with lateral approach only

thoracoscopy

video assisted

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7
Q

special considerations for thoracic surgery

A

positive pressure ventilation

chest tube(s) commonly required post op

24 hour post op monitoring

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8
Q

what is a pneumonectomy

A

removal of all lobes of one lung

rarely performed, indicated for cases where disease is diffuse through multiple lung lobes (neoplasia, abcess, trauma, infiltrative inflammatory disease)

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9
Q

total lung lobectomy vs partial lobectomy

A

depends on disease process and location of lesion within the lobe

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10
Q

suture technique for partial lobectomy

A

suture proximal to clamps - 1-2 rows or continuous suture pattern

guillotine suture may be used for biopsies and very small peripheral masses

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11
Q

suture technique for complete lobectomy

A

triple ligation of vessels - cut between middle and distal ligatures

pre-place horzontal mattress sutures and tie prior to transection

oversew transected end of bronchus

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12
Q

advantages of stapling technique for partial/complete lobectomy

A

decreased anesthesia and surgery time

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13
Q

disadvantage to stapling technique for partial/complete lobectomy

A

standard devices too large for very small patients

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14
Q

prior to closure of pulmonary surgery

A

check for:

bleeding/hemorrhage

air leakage

chest tube placed vis separate intercostal incision

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15
Q

surgical diseases of pulmonary parenchyma

A

spontaneous pheumothorax

bronchoesophageal fistulas

lung lobe consolidation and abscessation

bronchiectasis

lung lobe lacerations

lung lobe torsions

neoplasia

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16
Q

bleb

A

localized collection of air between internal and external layer of visceral pleura

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17
Q

bullae

A

non epithelialized cavities produced by disruption of intra-alveolar septae

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18
Q

cyst

A

closed sacs lined by epithelium filled with fluid or air (often secondary to pulmonary contusions)

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19
Q

cysts, bullae, and blebs

A

can be secondary to blunt trauma (cysts) or traumatic rupture of alveoli secondary to underlying lung disease

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20
Q

complications or cysts, bullae and blebs

A

abscessation

rupture

spontaneous pneumothorax (atelectasis)

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21
Q

conservative treatment of cysts, bullae and bleds consists of

A

thoracostomy tubes for 48-72hrs

high recurrence rate

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22
Q

when is surgical intervention recommended for cysts, bullae, and blebs

A

when medical management has failed

pre-op CT may be helpful in ID-ing lesions; partial or complete lung lobectomy, pleurodesis?

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23
Q

what breed is the poster child for lung lobe torsion

A

afgans

  • large, deep chested dogs and pugs are most commonly affected*
  • large dogs: right middle or left cranial lung lobe*
  • pugs: left cranial lung lobes*
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24
Q

clinical signs of lung lobe torsion

A

acute onset

dsypnea, tachycardia, C+, exercise, intolerance, hemoptysis

pyrexia, pale mm, decreased lung sounds ventrally on PE

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25
Q

diagnostics for lung lobe torsion

A

thoracocentesis - serosanguinous or chylous effusion

imaging - rads or CT

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26
Q

T/F surgical treatment of lung lobe torsion includes untorsing the lobe

A

False

DO NOT untorse lung, avoid release of cytokines and endotoxins - REPERFUSION INJURY!

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27
Q

what is the initial treatment at patient stabilization

A

thoracocentesis

O2 supplementation

IV fluids

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28
Q

post op care for lung lobe torsion

A

thoracic drainage for 3-5 days

analgesia and antibiotics

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29
Q

T/F the prognosis for pugs with lung lobe torsion is fair to guarded while other breeds have a good prognosis

A

False

  • good prognosis for pugs, fair to guarded for other breeds*
  • 50-61% survival rate, second torsion can occur*
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30
Q

survival with primary pulmonary neoplasia is associated with

A

lack of LN involvement

location

size of mass

lack of clinical signs

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31
Q

most common type of primary pulmonary neoplasia

A

bronchiolar or alveolar carcinoma

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32
Q

what is the most common cause of thoracic wall trauma

A

hit by car

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33
Q

most thoracic wall truama requires surgical intervention

A

false

34
Q

what should be done before removing a penetrating chest wound

A

radiographs or CT

thoracotomy for removal of object

35
Q

what is flail chest

A

multiple segemental rib fractures

flail segment moves paradoxically with shest wall during respiration

36
Q

why do you see hypoxemia with flail chest

A

hypoventilation secondary to pain

V/Q mismatch secondary to pulminary contusions

37
Q

what is the most common cause of chylothorax

A

idiopathic

38
Q

what is a posible long term consequence of chylothorax

A

fibrosing pleuritis

39
Q
A
40
Q

what is the treatment for idiopathic chylothorax

A

surgical

  • thoracic duct ligation*
  • cysterna chyli ablation*
  • subtotal pericardectomy*
  • +/- omentalization, pleuralpport placement*
41
Q

what can be done to improve visualization of lymphatic structures

A

injection of methylene blue into mesenteric LN

42
Q

surgical correction of thoracic duct ligation

A

cats: L 10th ICS
dogs: R 10th ICS

transdiaphragmatic approach, dorsal to aorta ventral to sympathetic trunk, ligation/clip individual branches or perform en bloc ligation

ligate/ clip as close to diaphragm as possible

43
Q

what is performed with thoracic duct ligation to maximaize success of surgery

A

subtotal pericardectomy

44
Q

what can be done with a TD ligation or TD ligation + pericardectomy

A

cisterna chyli ablation

45
Q

cisterna chyli ablation results in

A

re-routing of abdominal lymphatic drainage to major abdominal vessles

46
Q

dogs have a ______outcome compares to cats

A

improved

~ 80-90% effusion free > 15 months post-op

47
Q

what is the most common cause of diaphragmatic hernia

A

trauma

48
Q

acute diaphragmatic hernia presentation

A

respiratory distress (tachypnea, dyspnea, cyanosis)

shock

other injusies may be present (fractures, wounds, etc)

49
Q

chronic presentation of diagraphmatic hernias

A

respiratory and GI signs most common

dyspnea, exercise intollerance, lethargy

V+, regurgitation, inappetance

pleural/peritoneal effusion

50
Q

what is the most accurate diagnostic imaging modality for diagnosing diaphragmatic hernias

A

Ultrasound (93% accurate)

rads - 66% accurate

51
Q

when is surgery emergent with diaphragmatic hernias

A

if the stomach is herniated

52
Q

complications with diaphragmatic herniorrhaphy

A

re-expansion pulmonary edema - close control of PPV during Sx is nesscesary! associated with rapid expansion of perviously atelectic lung

persistent pneumothorax

hemorrhage

failure of repair and re-herniation

loss of domain

53
Q

prognosis for diaphragmatic hernia

A

excellent if patient survive 24 hours post-op

54
Q

peritoneopericardial diaphragmatic hernia (PPDH)

A

congenital communication between pericardium and peritoneal cavity

commonly associated with other congenital defects

55
Q

presentation of PPDH

A

may be incidental finding

presentation at middle age

signs can be respiratory, GI, cardiac or neurologic system

56
Q

breeds predisposed to PPDH

A

weimaraners

cocker spaniels

DLHs

Himalayans

57
Q

pentology of defects: congential cranial abdominal wall and diaphragmatic defects

A

cranial abdominal wall defect

caudal sternal fusion defect

pericardial defect

diaphragmatic defect

intracardial defects (VSD most common)

58
Q

breeds predisposed to pentalogy of defects

A

cocker spaniels

weimeraners

dachshunds

collies

59
Q

exam findings with pentology defects

A

muffled heart sounds

ascites

murmur

+/- concurrent ventral abdominal wall defect

60
Q

radiographic findings with PPDH

A

enlarged cardiac silhouette

dorsal elevation of trachea

overlap of heart and diaphragmatic hernias

gas filled structures in pericardial sac

sternal defects

61
Q

when should surgery be performed with PPDH

A

ASAP - between 8-16 weeks ideally

62
Q

T/F the pericardial sac should be closed separately with PPDH repair

A

False

does not need to be closed separately - use simple continuous pattern

63
Q

what is the most common congenital cardiac defect in dogs

A

patent ductus arteriosus

64
Q

a patent ductus arteriosus is present when the ductus remains patent _______ after parturition

A

> 3 days

65
Q

PDA shunts bood from _____ to _____ side of the heart

A

PDA shunts bood from left to right side of the heart

severe volume overload of L heart that progresses to left sided failure

66
Q

what is a reverse PDA

A

Eisenmenger’s syndrome

right to left shunting, occurs in face of severe pulmonary hypertension

67
Q

what clinical signs can be seen with reverse PDA

A

differential cyanosis

exercise intollerance

pelvic limb collapse

polycythemia

68
Q

PE findings with PDA

A

continuous murmur

hyperkinetic pulses (BB shot, waterhammer)

+/- stunted growth

69
Q

T/F occluding of the defect is recommended in all PDA cases because most die before 1 year if not treated

A

False

occluding of R→L shunting is contraindicated

70
Q

complications with surgical ligation of PDA

A

severe hemorrhage secondary to PDA rupture

bradycardia (branham reflex)

residual ductal flow

long term: recanalization

71
Q

prognosis for PDA

A

excellant for animals < 6 months at time of surgery

poor to grave for reverse PDA

72
Q

what is the most common cardiac neoplasia in dogs

A

HSA of right auricle

73
Q

which course of treatment offers the best prognosis with right auricular HSA

A

excision of right auricular mass

followed by pericardiectomy followed by chemotherapy

74
Q

thickening of pericardium or rapid raise in pericardial pressure results in _______

A

cardiac tamponade

75
Q

pericardial diseases

A

pericardial rupture and secondary pericardial contraction and scarring

pericardial effusion

comstrictive pericarditis

76
Q

PE findings with pericardial disease

A

muffled heart sounds

weak femoral pulses +/- pulsus paridoxicus

+/- cardiogenic shock

77
Q

diagnostics for pericardial disease

A

thoracic imaging

complete database

electrocardiogram

pericardiocentesis

+/- abdominal imaging

78
Q

T/F pericardectomy can be curative or palliative depending on underlying disease process

A

True

79
Q

what is the most common type of PRAA

A

PRAA with left ligamentum arteriosum

80
Q

what is the most common breed with PRAA

A

german shepards

diagnosed via imaging between 2-6 months of age

81
Q

what do you have to be aware of when isolating ligamentum arteriosum

A

dont penetrate the esophagus!

82
Q
A

RUSVM Small Animal Surgery (41 decks)

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