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RUSVM Small Animal Surgery 1 > Trachea And Thoracic Surgery > Flashcards

Trachea And Thoracic Surgery Flashcards

1
Q

A cervical ventral midline approach allows access to what structures?

A 
Cranial cervical trachea 
Sternohyoideus and sternohyoideus mm 
Recurrent laryngeal n 
Vagosympathetic trunk 
R and L common carotid arteries 
Thyroid glands 
Esophagus
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2
Q

A median sternotomy allows access to what structures?

A

Caudal cervical and cranial thoracic trachea

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3
Q

An intercostal thoracotomy through the right 3rd ICS allows access to what structure?

A

Cranial thoracic trachea

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4
Q

An intercostal thoracotomy through the right 4th ICS allows access to what structure?

A

Tracheal bifurcation

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5
Q

What are the surgical diseases of the tracheal?

A 
Tracheal collapse 
Esophagotracheal/esophagobronchial fistual 
Foreign body 
Neoplasm 
Trachea rupture (trauma) 
Hematoma
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6
Q

How is tracheal collapse managed medically?

A

Cough suppressants (lifelong) - hydrocodone, or butorphanol
Corticosteroid (pred) to reduce inflammation
Antibiotic if secondary to infection

Sedation for events that cause excessive excitement/stress - acepromazine

Bronchodilator (theophylline) useful in some cases

Lifestyle changes and weight loss

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7
Q

When do we surgically treat tracheal collapse?

A

Only when medical management has failed

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8
Q

What are possible surgical treatments for tracheal collapse?

A

External prosthetic tracheal rings - for cervical trachea only

Intraluminal stent

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9
Q

How are external prosthetic tracheal rings placed?

A

Only in cervical tracheal

Ventral midline cervical approach

Secured to cartilaginous rings

Must start and end ring placement in area of normal trachea

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10
Q

What are complications for external prosthetic tracheal rings?

A

Laryngeal paralysis. -> damage during surgery or continued trauma from implants

Tracheal necrosis -> secondary to damage to trachea’s segmental blood supply (life threatening)

Pneumothorax -> diffusion of air through mediastinum during surgery

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11
Q

How is an intraluminal stent placed?

A

Self-expanding nitinol stent

Placed fluoroscopically or endoscopically

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12
Q

Advantages of placing an intraluminal stent?

A

Minimally invasive
Shortened anesthesia time
Can be used in cervical and thoracic trachea

Immediate improvement in clinical signs

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13
Q

Complications of using intraluminal stenting?

A

Stent fracture
Stent migration
Tracheitis
Collapse beyond stented region —> mainstream bronchi

Tracheal obstruction secondary to granulation tissue formation —> can respond to treatment with corticosteroid and colchicine

Tracheal rupture

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14
Q

What is internal tracheal trauma usually caused by?

A

Rupture or necrosis secondary to ET tube (cats > dogs)

Foreign bodies

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15
Q

When is external trachea trauma seen?

A

Blunt or penetrating injuries
Bite wounds
Lacerations

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16
Q

Clinical signs of tracheal trauma?

A 
SQ emphysema 
Anorexia 
Lethargy 
Stridor 
Coughing 
Dyspnea
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17
Q

How are minor treachal tears treated?

A

Medically

  • cage rest
  • O2 supplement
  • sedatives
  • thoracocentesis/thoracotomy for pneumothorax
  • temporary tracheostomy (maybe)

If dyspnea persists or worsens —> surgical repair

  • primary closure of tear
  • simple continuous pattern
  • fine absorbable suture
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18
Q

Surgical intervention is indicated for tracheal tears when… ?

A

Dyspnea persists or worsens with medical management

Pneumothorax persists >2-3 days

Severe damage is visits

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19
Q

What technique is used for tracheal resection/anastomoses?

A

Split cartilage technique

  • results in least amount of stenosis postop
  • difficult in small dogs and cats

Can resect 25-50% of trachea in adult dogs, only 20-25% in puppies

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20
Q

Complications for tracheal resection and anastomoses?

A 
SQ emphysema 
Pneumomediastium and pneumothorax 
Infection 
Stricture
-> poor apposition of mucosa
-> tension 
-> inflammation
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21
Q

When is a permanent tracheostomy indicated?

A

Salvage procedure

  • untreatable upper airway obstruction
  • upper airway treatment failure
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22
Q

What is the long-term care for a permanent tracheostomy ?

A

Excessive secretions for weeks pot op

Maintenance of opening - clip hair
No swimming
Protection from foreign bodies- plant material
Harness

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23
Q

What is the prognosis for permanent tracheostomies?

A

Good for indoor dogs if underlying dz in benign

Poor to guarded in cats
-mucous plugs are common
Median survival time is 20-42days
Soft tracheal cartilage may predispose to collapse

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24
Q

What is the most common surgical approach to the thoracic cavity?

A

Lateral thoracotomy

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25
Q

What surgical approach allows access to the thoracic cavity during celiotomy or other procedures that may require access to the abdominal cavity?

A

Transdiaphragmatic

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26
Q

What are the indications for a median sternotomy?

A

Bilateral thoracic exploration
Cranial mediastinal masses
Cranial thoracic trachea

*Leave manubrium/xyphoid intact

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27
Q

How is a median sternotomy closed?

A

Figure 8 of polypropylene sutures or orthopedic wire

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28
Q

What are minimally invasive approaches for thoracic surgery?

A

Thoracoscopy
-> can have intercostal or trandiaphragmatic subxiphoid portals

Video assisted
-> uses thoracoscopy telescopes and either standard surgical instruments/ endoscopic

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29
Q

T/F: positive pressure ventilation is required for thoracic surgery

A

True

30
Q

Removal of an entire lung is called?

A

Pnumonectomy

31
Q

When is a pneumonectomy indicated?

A

Disease is diffuse through multiple lung lobes (neoplasia, abscess, trauma, infiltrative inflammatory disease)

32
Q

What is the surgical approach for a pneumonectomy?

A

Lateral intercostal approach

33
Q

You are doing a total lung lobectomy on on the left cranial lobe. Which intercostal space do you enter through?

A

Left 5th

34
Q

You are doing a total lung lobectomy on on the left caudal lobe. Which intercostal space do you enter through?

A

Left 7ths

35
Q

You are doing a total lung lobectomy on on the right cranial lobe. Which intercostal space do you enter through?

A

Right 5th

36
Q

You are doing a total lung lobectomy on on the right middle lobe. Which intercostal space do you enter through?

A

Right 5th

37
Q

You are doing a total lung lobectomy on on the right caudal lobe. Which intercostal space do you enter through?

A

Right 7th

38
Q

What suture technique can be used for partial lobectomy??

A

Suture proximal to clamps

  • one to two rows of continuous suture patter
  • excise mass and oversew transection site

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

39
Q

What suture technique is used for complete lobectomy?

A

Triple ligation of vessels
-cut between middle and distal ligatures

Place horizontal mattress sutures in bronchus

Oversew transacted end of bronchus with simple continuous pattern

40
Q

What is the stapling technique for portion/complete lobectomy?

A 
Thoracoabdominal stapler (TA) 
Locate hilus of lobe and stable entire pedicle (vessels and bronchus)

Excise lobe distal to staples

41
Q

You just did a lobectomy on a dog.. what are you going to check for prior to closing?

A

Bleeding/hemorrhage
Air leakage
- fill thoracic cavity with saline and look for bubbles
-ventilate up to 25-30cmH2O
-very small leaks will likely seal within 24-48hours

Chest tube placed via separate intercostal incision

42
Q

What are surgical disease of the pulmonary parenchyma?

A 
Spontaneous pneumothorax 
Traumatic pneumothorax 
Brochoesophageal fistulas 
Lung lobe consolidation and abscessation 
Bronchiectasis 
Lung lobe laceration 
Lung lobe torsions 
Neoplasia
43
Q

What is the recommended treatment for spontaneous pneumothorax?

A

Partial or complete lung lobectomy —> access via median sternotomy

The conservative treatment is by placing thoracostomy tubes but this is associated with a high rate of recurrence

44
Q

What are causes of lung laceration?

A

Iatrogenic

  • thoracocentesis
  • thoracostomy tube
  • inadvertent cut during thoracotomy

Rib fractures
Penetrating trauma

45
Q

When is surgical treatment of a lung laceration indicted?

A

Uncontrollable or unresolving pneumothorax

Ongoing intrathoracic hemorrhage

46
Q

What techniques can be used to surgically treat lung lacerations?

A

Continuous inverting suture pattern (eg lambert)

Deep hemostatic mattress suture with simple continuous closure of laceration

Partial or compete lobectomy

47
Q

What dogs are most commonly affected by lung lobe torsion?

A

Large dog, deep chested: middle or left cranial lung lobe

Pug: left cranial lung lobe

48
Q

What are possible causes of lung lobe torsion?

A

Pleural effusion

Partial collapse of lung lobe

49
Q

Lung lobe torsion results in ???

A

Venous and lymphatic congestion
Consolidation
Pleural effusion

50
Q

Clinical signs of lung lobe torsion?

A

Acute

Dyspnea, tachycardia, cough
Exercise intolerance
Hemoptysis

Pyrexia, pale mm, decreased lung sounds ventrally

51
Q

You have decreased lung sounds ventrally so you do a thoracocentesis, you see serosanguinous or chylous effusion..
and radiographs show a consolidated lung lobe

what is your dx?

A

Lung lobe torsion

52
Q

What is your initial treatment for lung lobe torsion?

A

For patient stabilization

Thoracocentesis
Oxygen supplementation
IV fluids

53
Q

What is the surgical treatment for lung lobe torsion?

A

Lobectomy
—> intercostal thoracotomy

*** DO NOT untwist lung —> avoid reperfusion injury

54
Q

What is the prognosis for lobectomy due to lung lobe torsion?

A

Good for pugs

Fair to guarded for other breeds
-second torsion can occur

55
Q

How long are chest tubes required after a lobectomy from lung lobe torsion?

A

3-5days

56
Q

You have an idiopathic chylothorax.. how can you visualize the vessels during surgery?

A

Intestinal lymphangiography

  • oil or cream per os
  • methylene blue into ileocecal node or water soluble contrast into catheterized lymphatic
57
Q

What are the surgical options for idiopathic chylothorax ?

A

MUST DO: Thoracic duct ligation or En bloc ligation

Can do these added on..
Pericardectomy
Cisternii chylii ablation
Pleuroperitoneal shunt

58
Q

How is an idiopathic chylothorax surgery managed post op?

A

Chest tube or pleuroport placement for continued drainage

59
Q

Complications of surgery for idiopathic chylothorax?

A

Continues/recurrent effusion

Lung lobe torsion

60
Q

Prognosis for surgical treatment of idiopathic chylothorax?

A

60-100% resolution

Worse in cats

61
Q

What is a diaphragmatic hernia?

A

Loss of continuity of diaphragm resulting in movement of the abdominal organs into the thoracic cavity

62
Q

T/F: congenital diaphragmatic hernias are most common

A

False

Traumatic are most common

63
Q

T/F: Most tears in the diaphragm are seen in the ventral portion

A

True

64
Q

Most common presenting signs with chronic diaphragmatic hernia?

A

Respiratory and gastrointestinal signs

  • dyspnea, exercise intolerance, and lethargy
  • vomiting, regurg, inappetence
65
Q 
Muffled lung sounds 
Borborygmi auscultated in the thorax 
Tachycardia 
Tachypnea 
Empty abdomen on palpation

Dx?

A

Diaphragmatic hernia

66
Q

You want to do diagnostic imaging to confirm a diaphragmatic hernia, what method will you use?

A

Radiographs with Positive contract celiography

  • inject dilute sterile contrast into abdomen
  • look for contrast in thoracic cavity
  • false negative results due to fibrin sealing diaphragm defect with chronicity

Ultrasound (93% accurate)

67
Q

Treatment for diaphragmatic hernia?

A

Stabilize first

  • consider pleural effusion in chronic cases (US thoracocentesis)
  • O2 therap
  • prop patient to move organs caudally
68
Q

When is a surgery for a diaphragmatic hernia an emergency??

A

If stomach is herniated

69
Q

What is the method used for a diaphragmatic herniorraphy ??

A

Ventral midline abdominal approach

Organ resection

  • adhesions in chronic hernia
  • liver lobe torsion

Replace organs into abdomen
Repair tear with continuous suture pattern
-PDS or proline
-large defects with meth or muscle flap

Exploratory for organ trauma
Remove air from thoracic cavity

70
Q

Complications seen with diaphragmatic herniorraphy?

A

Re-expansion pulmonary edema

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RUSVM Small Animal Surgery 1 (39 decks)

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