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thorax Flashcards

1
Q

what should u avoid when trying to breath for an animal with respiratory dz

A
  • Do not use mask or chamber to induce a patient with respiratory disease
  • proceed to intubation without delay
  • do thoracoctomy if the mouth is damage
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2
Q

ultrasound in megaesophagus are good for which conditions

A

PDA

pulmonic stenosis

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3
Q

best method for tracheal collapse dx

A

endoscopy

also good for tracheal fb

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4
Q

discuss the primary tumor of the thorax

A
  • primary brochogenic carcinoma

metastatic

  • chest wall-osteosarcoma (slow growing tumor resemble the tip of the icebag require chest reconstruction)
  • remember that primary tumors are rare.most metastasesise from other areas
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5
Q

reason for doing lobectomy in dogs

A

do lobectomy to buy more time for the animal

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6
Q

pathophysiology for pneumothorax

A
  • air accumulates in pleural cavity leading to loss of normal negative pleural pressure
  • Lungs undergo elastic recoil and

collapse

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7
Q

differentiate open and closed pneumothorax

A

open means there is communication with the environment

closed means t means there is no opening to the thoracic rib cage
it means air is taken from the lungs and this causes -ve pressure eg. bronchi,trachea

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8
Q

dx for closed pneumothorax

A
  • muffled lung sounds are diagnostic in closed pneumothorax.
    • bronchovesicular will also be accepted
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9
Q

sources of air in closed pneumothorax

A
  • Respiratory tract (trachea, bronchi, lungs)
  • Esophageal(perforations in the esophagus–swalloed air)
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10
Q

what causes open pneumothorax

A

wounds

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11
Q

dx for mild pneumothorax

A

drum filled with air
drum sound when u precurse
auscultate the patient more often

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12
Q

characteristics of mild pneumothorax

A

Not progressive
No severe hyperventilation, hypoxemia,
or respiratory acidosis

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13
Q

tx for mild pneumothorax

A

Treat with cage rest and observation

dnt let owner take the dog home.it may get worse

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14
Q

characteristics of moderate pneumothorax

A
  • respiratory distress
  • one lung is ventilating while the other one iis not.
  • reinstate the negative pressure
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15
Q

how to tx moderate pneumothorax

A
  • Treat by thoracocentesis initially – if

pneumothorax recurs, insert
thoracostomy tube

  • reinstate the -ve pressure

expand the lung and let them work properly

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16
Q

characteristics of severe pneumothorax

A

progressive

marked respiratory distress

total lung collapse–aspirate

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17
Q

tx for severe pneumothorax

A
  • Tube thoracostomy with continuous suction drainage or Heimlich valve
  • Exploratory thoracotomy if leakage is significant or persists >5-7 days
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18
Q

causes of open pneumothorax

A

Penetration or rupture of chest wall
Bite wounds
Stab wounds
Gunshot wounds
Impalement
Inadequate thoracotomy closure

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19
Q

discuss tenstion(spontaneous) pneumothorax

A
  • occurs when a flap of of tissue acts as a one way valve so that there is a conntinuous influx of air into the pleural cavity on inspiration that doesnt return to the lung on expiration.
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20
Q

features of tension pneumothorax

A
  • univalve
  • air goes in but cant go out
  • will collapse the lung.
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21
Q

emergency tx for tension pneumothorax

A

thoracocentesis

thoractomy tube if intractable (hard to deal with)

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22
Q

discuss how pneumomediastinum occurs

A

air moves in2 the mediastenium and goes to the midline.it can extend to the neck .

this air is free and is not collapsing the lung.but depending on how much is occupying the mediastenium,it can collapse more or less

part of the air in the neck
dnt piece it trying to get the air out
its not a single ballon.let it be absorbed

what happens is as air decideds to saparate,it produces aryolar tissue

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23
Q

discuss paradoxial respiration

A

normally when the patient inhales the thorax expands but in paradoxial the thorax is collapsed

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24
Q

how to tx paradoxial respiration

A

do nerve blocking
the ribs must be broken in order to help with paradoxial respiration.ribs are broken at dorsal and venntral part
inject lidocaine caudal to the rib
clip very wide
place thoracoctomy tube

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25
what do u do to confirm diaphramatic rupture
odine injected to comfirm diaphragm rupture inject within abdominal cavity if u have the contrast material then u can comfirm the d.rupture
26
where does diaphramatic rupture normally occure
ventral side
27
when are ultrasound most useful in thoracicsx
DETERMINING PDA AND TO MEASURE FLOW AND KNOW THE DIRECTION OF DILATION AND KNOW DEVELOPED PDA MAY BE
28
GOOD TOOL FOR DX TRACHEAL COLLAPSE
ENDOSCOPE
29
WHICH AREA OF THE THORAX IS MOSTLY AFFECTED BY PRIMARY BRONCHOGENIC CARCINOMA
* USUALLY MOST INVADE CAUDAL RIBS * CAN REMOVE THE CAUDAL RIBS AND MOVE THE DIAPHRAGM IN THE MORE CRANIAL DIRECTION TO CREATE NEW CHEST CAGE
30
DEFINE PNEUMOTHORAX
* all cavity is filled with air outside the lung so lung collapse * heart tends to float as it is separated from the sternum * there is no support bcoz of gravity and the heart will go down in lateral recumbency
31
discuss the first method you will use to tx moderate pneumothorax
* _thoracocentesis_ * ​place the needle parallele to the rib that will reduce the chance of perforating the lung * u can also use the iv catheter with a big bore(16G).it aspirate big volumes of air * **if pneumothorax results tx will thoracostomy tube**
32
tx for severe pneumothorax
put a thoracostomy tube
33
what should u do if severe pneumothorax persists for more than 5-7 days
do exploratory thoracotomy
34
which method can u explore to check for diaphramic rupture/ hernia
* peritoneography * it is done by injecting a media into the abdomen and do wheelbarrow position in the anima * if the media goes to the thorax then u are sure u hav diaphragmatic hernia/rupture
35
which PDA is hard to tx
right PDA wont ligate the ductus because will kill the patient the minute u ligate u creat hypertension into pulmonary field
36
why is that when the phrenic nn is ligated in animals they dnt die
the diaphragm is not the main respiratory mm. in animals like in humans the main respiratory mm are the intercostal mm.
37
where do u normally found PDA
4-5th ics be careful not to damage the recurent laryngeal n.when fixing pda
38
when auscaltating the thorax,whats a give away for pda
machinery mumur
39
preoperative tx for pda
Treat pulmonary edema, atrial fibrillation or congestive heart failure with diuretics and digitalis as necessary before surgery Occlusion of ductus
40
methods for occluding the pda
* surgical ligation * coil occlusion * ampratz occluder
41
explain how coil occlution works in pda
sits in between the aota and the pulmonary a. and acts as a scarfold for formation of a clot which will block the communication between pulmonary a and aorta.
42
explain how amplatz works in pda
it looks like an umbrella and it sits between the aota and pulmonary a and assist in clot formation
43
areas to do thoracotomy for treating pda in cats and dogs
dogs=4th ics cats=5th ics
44
advantages of sx ligation of pda
less expensive and higher success rate compared to coil occlution in hands of experienced suergons success rate =95%
45
discuss the suture to use when ligating pda
want braided coz it has the best coefficient of friction.silk is the best. * size is 2-0/3-0.go bigger coz if u too small when u tighten the little ligature,u may cut thru(like a guillotine)
46
when ligating pda,which side would u wanna ligate first,pulmonary a. or aorta
aorta
47
discuss sx ligation of pda
* The ligature on the aortic side is tied first, followed by the ligature on the pulmonary side * **Reflex bradycardia (Branham reflex)may occur** * Atropine should be available * Tightening the 1st ligature slowly may prevent severe bradycardia
48
complication that may arise with ligating pda
* reflex bradycardia * make sure atropine is available * tightning the 1st ligature slowly may prevent reflex bradycardia
49
**which recurent laryngeal nn should u be careful with when ligating pda**
left recurrent laryngeal nn not right
50
discuss the anatomy of the PRAA
the esophagus is encircled by the ligamentum arteriosus on the left creating a vascular ring the pulmonary a. and the base of the heart are ventral and the aotic arch on the right
51
clinical presentation of PRAA
stunted growth regurgitation aspiration pneumonia
52
**clinic signs of PRAA**
they are respiratory signs
53
signs of PRAA
* show clinical signs at weaning. * **may have concurrent respiratory signs.** * may have ventral tracheal displacement on survey radiographs
54
how to tx PRAA
* disect out ligamentum arteriosum.pass silk suture asround it * do two ligatures,one close to the aotic side and one close to the pulmonic side * do aotic first just in case u suspect pda as well but if u are sure its just ligamentum arteriosus then it doesnt matter which one u do first *
55
discuss post operative tx of persistent right aotic arch
tx pneumonia if necessary elevate feeding of moist solid food -may need to continue for life
56
discuss prognosis for PRAA as well as reversal chances for megaesophagus
* Use long-term follow-up esophagrams to assess recovery * Megaesophagus rarely completely reversed * With early surgery reversal more likely * If esophagus diameter \> twice normal, reversal very unlikely * 40 % of cases persistent left cranial vena cava * also there can be hemiazygos vein-=just displace with blunt disection
57
advantage of using turkel catheterin thoracocentesis
* stylet with both sharp an blunt endconnected to catheter with marks and the stylet goes into the catheter * when u insert catheter into thoracic wall and when it reaches a point of no more resistance the red marker turns green * so u dnt have to be afraid that u are about to piece the lung/heart
58
discuss the choosing the right tube for thoracostomy
* the tube diameter must be similar to the main bronchus * or 1/2 - 1/3 the width of the intercostal space * flexible, but not collapsible * number of holes: no more than 3 (each additional orifice only increments the flow by 5% ) * size of the hole: 1/4 the diameter of the tube (diameter \> 1/3 cause weakness and predispose for kinking)
59
when do u use stop cock
in patients less than 15 kg
60
which thoracostomy tube do u use in patients greater than 15 kg
heimlich valve
61
Subtotal Pericardectomy is performed to tx
chylothorax
62
discuss the sx approach for subtotal pericadioctomy
* **Median sternotomy preferred** * Lateral thoracotomy at 4th or 5th intercostal space - less of pericardium removed * Circumferential incision ventral to phrenic nerves * Chylothorax Tx?
63
prognosis Granulomatous pericarditis
fair
64
prognosis for idiopathic pericarditis
good 70-80% return to normal Remaining cases have recurrence of effusion, may require pleuroperitoneal shunt

small animal surgery (7 decks)

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