Thoracic Sx

Question 1

What is the most common thoracic sx approach?

Answer 1

Lateral thoracotomy

Question 2

What sutures are used for lateral thoracotomy closure?

Answer 2

Circumcostal sutures

Question 3

What surgical approach would you perform for bilateral thoracic exploration, cranial mediastinal masses, cranial thoracic trachea?

Answer 3

Median sternotomy

Question 4

What needs to be left intact when performing a median sternotomy?

Answer 4

Manubrium or xiphoid

Question 5

What sx is indicated with diffuse disease through multiple lung lobes?

Answer 5

Pneumonectomy- removal of all lobes of one lung

Question 6

How is a total lung lobectomy performed?

Answer 6

Lateral thoracotomy/thoracoscopy

Question 7

What suture pattern is used in a partial lobectomy?

Answer 7

Continuous suture pattern

Question 8

What suture is used for a complete lobectomy?

Answer 8

Triple ligation of vessels- horizontal mattress sutures in bronchus

Question 9

What can be done to the affected tissue to decrease risk of contamination?

Answer 9

Isolate affected tissue w/ moistened laparotomy sponges

Question 10

T/F: Traumatic pneumothorax is typically an emergency surgery situation

Answer 10

FALSE- sx is not typically necessary

Question 11

What are some examples of surgical disease of the pulmonary parenchyma?

Answer 11

Sponteaneous pneumothorax, traumatic pneumothorax, bronchoesophageal fistulas, lung lobe consolidation, bronchiectasis, lung lobe lacerations, lung lobe torsions and neoplasia

Question 12

What is the recommended tx for spontaneous pneumothorax?

Answer 12

Median sternotomy

Question 13

T/F: Lung lacerations are typically small and resolve spontaneously on their own

Answer 13

TRUE

Question 14

If you have an uncontrolled pneumothorax with ongoing hemorrhage of >2mL/kg/hr- what is recommended?

Answer 14

Sx treatment

Question 15

What are the surgical techniques used for lung lacerations

Answer 15

Continuous inverting suture pattern
Deep hemostatic mattress suture
Partial/Complete lobectomy

Question 16

What is another name for a continuous inverting suture pattern?

Answer 16

Lembert pattern

Question 17

Which breeds are predisposed to lung lobe torsion?

Answer 17

Afghan’s and pugs
Large dogs- right middle or left cranial lobe
Pugs- left cranial lobe

Question 18

What are the cs of lung lobe torsion?

Answer 18

Acute onset

Dyspnea, tachycardia, cough, exercise intolerance, hemoptysis

Question 19

What are the dx tests for lung lobe torsion?

Answer 19

Thoracocentesis
Rads
CT

Question 20

What is the treatment of choice for lung lobe torsion?

Answer 20

Lung lobectomy- DON’T UNTWIST LUNG LOBE

Question 21

Dx of idiopathic chylothorax is based on what?

Answer 21

Pleural effusion and rule outs

Question 22

what does chylous effusion result from?

Answer 22

Impaired drainage of disrupted lymphatic drainage

Question 23

What is an important history factor in idiopathic chylothorax patients?

Answer 23

History of cough due to pleural effusion

Question 24

What can be given to patient to visualize the lymphatic drainage route?

Answer 24

Oil or cream fed PO or methylene blue into ileocecal node

Question 25

What sx procedure MUST be performed and what are the optional procedures for idiopathic chylothorax?

Answer 25

Thoracic duct ligation or en bloc ligation=must be performed | Pericardectomy, cisterna chyli ablation and pleuroperitoneal shunt recommended

Question 26

What is occurring when there is loss of continuity of diaphragm resulting in movement of abdominal organs into thoracic cavity

Answer 26

Diaphragmatic hernia

Question 27

What is the most common cause of diaphragmatic hernia?

Answer 27

Traumatic | Radial and circumferential tears are most common

Question 28

What does an acute diaphragmatic hernia patient present like?

Answer 28

Acute: respiratory distress, shock and other injuries

Question 29

What does a chronic diaphragmatic hernia patient present like?

Answer 29

Respiratory and GI signs

Question 30

What is the name for when intestinal sounds are found in the thoracic cavity

Answer 30

Borborygmi

Question 31

What is the dx test for diaphragmatic hernia?

Answer 31

Thoracic and abdominal imaging

Question 32

What is a diagnostic sign of diaphragmatic hernia?

Answer 32

Abdominal contents in thoracic cavity

Question 33

What is the most accurate choice of dx test for diaphragmatic hernia?

Answer 33

U/S

Question 34

When would a diaphragmatic hernia be considered emergency sx?

Answer 34

Stomach is herniated

Question 35

What is the surgical procedure performed to fix a diaphragmatic hernia?

Answer 35

Diaphragmatic herniorraphy- ventral midline abdominal approach

Question 36

What suture pattern is used to close up the diaphragmatic herniorraphy?

Answer 36

Continuous suture pattern

Question 37

When is re-expansion pulmonary edema seen and what is it associated with?

Answer 37

Rapid expansion of previously atelectic lung associated with chronic hernia association

Question 38

What should your internal pressure be kept below?

Answer 38

PPV should be below 15 cmH20

Question 39

T/F: No tx for re-expansion pulmonary edema

Answer 39

TRUE

Question 40

What type of hernias are these considered- peritoneopericardial, pleuroperitoneal, hiatal, paraesophageal hernias

Answer 40

Congenital

Question 41

What is a sx commonly performed to correct congenital hernias?

Answer 41

Gastropexy- hold GE junction in abdominal cavity

Question 42

What breeds are high risk for congenital hernias?

Answer 42

Weimaraners, cocker spaniels. DLH and himalayans

Question 43

What are CS associated with congenital hernias?

Answer 43

Muffled heart sounds, ascites, murmur and concurrent ventral abdominal wall defect

Question 44

What is a common cause of thoracic wall trauma?

Answer 44

HBC

Question 45

T/F: most thoracic wall traumas don't require sx intervention

Answer 45

TRUE

Question 46

T/F: never remove objects penetrating the chest wall

Answer 46

TRUE

Question 47

What is the sx procedure for a flail chest?

Answer 47

Stabilization with external splint

Question 48

What is the term for inward concavity of sternum?

Answer 48

Pectus excavatum