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small animal surgery > thorax > Flashcards

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
Q

what do u do to confirm diaphramatic rupture

A

odine injected to comfirm diaphragm rupture
inject within abdominal cavity
if u have the contrast material then u can comfirm the d.rupture

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26
Q

where does diaphramatic rupture normally occure

A

ventral side

27
Q

when are ultrasound most useful in thoracicsx

A

DETERMINING PDA AND TO MEASURE FLOW AND KNOW THE DIRECTION OF DILATION AND KNOW DEVELOPED PDA MAY BE

28
Q

GOOD TOOL FOR DX TRACHEAL COLLAPSE

A

ENDOSCOPE

29
Q

WHICH AREA OF THE THORAX IS MOSTLY AFFECTED BY PRIMARY BRONCHOGENIC CARCINOMA

A
  • 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
Q

DEFINE PNEUMOTHORAX

A
  • 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
Q

discuss the first method you will use to tx moderate pneumothorax

A
  • 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
Q

tx for severe pneumothorax

A

put a thoracostomy tube

33
Q

what should u do if severe pneumothorax persists for more than 5-7 days

A

do exploratory thoracotomy

34
Q

which method can u explore to check for diaphramic rupture/ hernia

A
  • 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
Q

which PDA is hard to tx

A

right PDA

wont ligate the ductus because will kill the patient

the minute u ligate u creat hypertension into pulmonary field

36
Q

why is that when the phrenic nn is ligated in animals they dnt die

A

the diaphragm is not the main respiratory mm. in animals like in humans

the main respiratory mm are the intercostal mm.

37
Q

where do u normally found PDA

A

4-5th ics

be careful not to damage the recurent laryngeal n.when fixing pda

38
Q

when auscaltating the thorax,whats a give away for pda

A

machinery mumur

39
Q

preoperative tx for pda

A

Treat pulmonary edema, atrial fibrillation
or congestive heart failure with diuretics
and digitalis as necessary before surgery
Occlusion of ductus

40
Q

methods for occluding the pda

A
  • surgical ligation
  • coil occlusion
  • ampratz occluder
41
Q

explain how coil occlution works in pda

A

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
Q

explain how amplatz works in pda

A

it looks like an umbrella and it sits between the aota and pulmonary a and assist in clot formation

43
Q

areas to do thoracotomy for treating pda in cats and dogs

A

dogs=4th ics

cats=5th ics

44
Q

advantages of sx ligation of pda

A

less expensive and higher success rate compared to coil occlution

in hands of experienced suergons success rate =95%

45
Q

discuss the suture to use when ligating pda

A

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
Q

when ligating pda,which side would u wanna ligate first,pulmonary a. or aorta

A

aorta

47
Q

discuss sx ligation of pda

A
  • 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
Q

complication that may arise with ligating pda

A
  • reflex bradycardia
    • make sure atropine is available
    • tightning the 1st ligature slowly may prevent reflex bradycardia
49
Q

which recurent laryngeal nn should u be careful with when ligating pda

A

left recurrent laryngeal nn not right

50
Q

discuss the anatomy of the PRAA

A

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
Q

clinical presentation of PRAA

A

stunted growth

regurgitation

aspiration pneumonia

52
Q

clinic signs of PRAA

A

they are respiratory signs

53
Q

signs of PRAA

A
  • show clinical signs at weaning.
  • may have concurrent respiratory signs.
  • may have ventral tracheal displacement on survey radiographs
54
Q

how to tx PRAA

A
  • 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
Q

discuss post operative tx of persistent right aotic arch

A

tx pneumonia if necessary

elevate feeding of moist solid food -may need to continue for life

56
Q

discuss prognosis for PRAA as well as reversal chances for megaesophagus

A
  • 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
Q

advantage of using turkel catheterin thoracocentesis

A
  • 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
Q

discuss the choosing the right tube for thoracostomy

A
  • 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 (eachadditional 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
Q

when do u use stop cock

A

in patients less than 15 kg

60
Q

which thoracostomy tube do u use in patients greater than 15 kg

A

heimlich valve

61
Q

Subtotal Pericardectomy is performed to tx

A

chylothorax

62
Q

discuss the sx approach for subtotal pericadioctomy

A
  • Median sternotomy preferred
  • Lateral thoracotomy at 4th or 5th

intercostal space - less of
pericardium removed

  • Circumferential incision ventral to

phrenic nerves

  • Chylothorax Tx?
63
Q

prognosis Granulomatous pericarditis

A

fair

64
Q

prognosis for idiopathic pericarditis

A

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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