Thoracic Sx Flashcards
What is the most common thoracic sx approach?
Lateral thoracotomy
What sutures are used for lateral thoracotomy closure?
Circumcostal sutures
What surgical approach would you perform for bilateral thoracic exploration, cranial mediastinal masses, cranial thoracic trachea?
Median sternotomy
What needs to be left intact when performing a median sternotomy?
Manubrium or xiphoid
What sx is indicated with diffuse disease through multiple lung lobes?
Pneumonectomy- removal of all lobes of one lung
How is a total lung lobectomy performed?
Lateral thoracotomy/thoracoscopy
What suture pattern is used in a partial lobectomy?
Continuous suture pattern
What suture is used for a complete lobectomy?
Triple ligation of vessels- horizontal mattress sutures in bronchus
What can be done to the affected tissue to decrease risk of contamination?
Isolate affected tissue w/ moistened laparotomy sponges
T/F: Traumatic pneumothorax is typically an emergency surgery situation
FALSE- sx is not typically necessary
What are some examples of surgical disease of the pulmonary parenchyma?
Sponteaneous pneumothorax, traumatic pneumothorax, bronchoesophageal fistulas, lung lobe consolidation, bronchiectasis, lung lobe lacerations, lung lobe torsions and neoplasia
What is the recommended tx for spontaneous pneumothorax?
Median sternotomy
T/F: Lung lacerations are typically small and resolve spontaneously on their own
TRUE
If you have an uncontrolled pneumothorax with ongoing hemorrhage of >2mL/kg/hr- what is recommended?
Sx treatment
What are the surgical techniques used for lung lacerations
Continuous inverting suture pattern
Deep hemostatic mattress suture
Partial/Complete lobectomy
What is another name for a continuous inverting suture pattern?
Lembert pattern
Which breeds are predisposed to lung lobe torsion?
Afghan’s and pugs
Large dogs- right middle or left cranial lobe
Pugs- left cranial lobe
What are the cs of lung lobe torsion?
Acute onset
Dyspnea, tachycardia, cough, exercise intolerance, hemoptysis
What are the dx tests for lung lobe torsion?
Thoracocentesis
Rads
CT
What is the treatment of choice for lung lobe torsion?
Lung lobectomy- DON’T UNTWIST LUNG LOBE
Dx of idiopathic chylothorax is based on what?
Pleural effusion and rule outs
what does chylous effusion result from?
Impaired drainage of disrupted lymphatic drainage
What is an important history factor in idiopathic chylothorax patients?
History of cough due to pleural effusion
What can be given to patient to visualize the lymphatic drainage route?
Oil or cream fed PO or methylene blue into ileocecal node
What sx procedure MUST be performed and what are the optional procedures for idiopathic chylothorax?
Thoracic duct ligation or en bloc ligation=must be performed
Pericardectomy, cisterna chyli ablation and pleuroperitoneal shunt recommended
What is occurring when there is loss of continuity of diaphragm resulting in movement of abdominal organs into thoracic cavity
Diaphragmatic hernia
What is the most common cause of diaphragmatic hernia?
Traumatic
Radial and circumferential tears are most common
What does an acute diaphragmatic hernia patient present like?
Acute: respiratory distress, shock and other injuries
What does a chronic diaphragmatic hernia patient present like?
Respiratory and GI signs
What is the name for when intestinal sounds are found in the thoracic cavity
Borborygmi
What is the dx test for diaphragmatic hernia?
Thoracic and abdominal imaging
What is a diagnostic sign of diaphragmatic hernia?
Abdominal contents in thoracic cavity
What is the most accurate choice of dx test for diaphragmatic hernia?
U/S
When would a diaphragmatic hernia be considered emergency sx?
Stomach is herniated
What is the surgical procedure performed to fix a diaphragmatic hernia?
Diaphragmatic herniorraphy- ventral midline abdominal approach
What suture pattern is used to close up the diaphragmatic herniorraphy?
Continuous suture pattern
When is re-expansion pulmonary edema seen and what is it associated with?
Rapid expansion of previously atelectic lung associated with chronic hernia association
What should your internal pressure be kept below?
PPV should be below 15 cmH20
T/F: No tx for re-expansion pulmonary edema
TRUE
What type of hernias are these considered- peritoneopericardial, pleuroperitoneal, hiatal, paraesophageal hernias
Congenital
What is a sx commonly performed to correct congenital hernias?
Gastropexy- hold GE junction in abdominal cavity
What breeds are high risk for congenital hernias?
Weimaraners, cocker spaniels. DLH and himalayans
What are CS associated with congenital hernias?
Muffled heart sounds, ascites, murmur and concurrent ventral abdominal wall defect
What is a common cause of thoracic wall trauma?
HBC
T/F: most thoracic wall traumas don’t require sx intervention
TRUE
T/F: never remove objects penetrating the chest wall
TRUE
What is the sx procedure for a flail chest?
Stabilization with external splint
What is the term for inward concavity of sternum?
Pectus excavatum
