Unit 2 Objectives Flashcards
What is biological and regenerative therapy?
a branch of research dealing with the process of replacing, engineering, or regenerating cells, tissues, or organs to restore normal function
What do most therapies in veterinary medicine aim to do?
reduce inflammation, promote, neovascularization, or modulate/promote an anabolic local environment during healing
What does IRAP stand for?
autologous conditioned serum
What is autologous conditioned serum?
-Anti-inflammatory cytokine “interleukin-1 receptor antagonist protein” (the ‘IRAP’ protein binds to IL-1 receptors to block cellular signaling of inflammation
How do you acquire IRAP?
- collect whole blood from an animal
- expose blood to select surfaces to stimlate monocytes to secrete IL1
- Keep at body temperature for 24 hours
- Centrifuge and aspirate serum off
- ACS serum then injected into joint
What are the different broad sub-types of regenative therapies?
autologous conditioned serum, platelet rich plasma, autologous protein solution, and stem cells
What is platelet rich plasma therapy?
a blood-derived therapy focusing on enriching plasma substrate from whole blood with growth factors released from platelets
What are the two types of platelet rich plasma?
centrifuged-based or filtration-based
What is PRP used for?
soft tissue injuries (horses) or osteoarthritis (dogs)
What is autologous protein solution?
a combination of PRP and IRAP
What is autologous protein solution also called?
pro-stride
What are the types of stem cells?
embryologic and adult
What is autologous stem cell treatment?
when cells are collected from the same patient to be treated
What is allogenic stem cell treatment?
cells collected from a donor animal and given to a patient of the same species
Where are bone marrow stem cells collected from?
the sternum, tuber coxae, and the humerus (dogs)
Where are adipose stem cells retrieved from?
fat at the base of the tail head or inguinal region
What are conditions in which regenerative therapy can be used to treat primary injury/disease or augment healing post-surgery?
in musculoskeletal disease - joint disease/osteoarthritis or tendon and ligament injury
What are the four different wound closure technique categories?
primary closure, delayed primary closure, secondary closure, and second intention healing
When does primary closure occur?
it is immediate closure of viable tissue within 6 hours of injury
What type of wounds do you do primary closure on?
clean and clean-contaminated wounds
When does delayed primary closure occur?
3-5 days after wound occurs but before the appearance of granulation tissue
What is secondary closure also known as?
third intention healing
When does secondary closure occur?
over 5 days after injury, after granulation tissue appears
What type of wounds is secondary closure done on?
contaminated or dirty wounds
What must you do before performing secondary closure?
debride the granulation tissue and skin edges before closing
What is second-intention healing?
when the wound is allowed to heal by granulation, contraction, and epithelialization
What are main differences in equine wound management?
the wounds are often very contaminated, there is a less intense inflammatory response, and wounds on the limbs have delayed healing, they develop exuberant granulation tissue
Do horses or ponies heal faster?
ponies
How is exuberant granulation tissue managed/treated?
minimize inflammation and motion, excise granulation tissue (repeat every 2 weeks in horses), topical treatment
If excising granulation tissue, where should you start?
from the bottom of the wound because the granulation tissue will bleed a lot
How do you properly bandage a large animal limb?
wrap from dorsal to lateral, wrap from joint to joint, and leave 1 inch of padding above and below - you will need lots of padding
In small animals, what is the proper way to bandage a limb?
tape stirrups, don’t wrap too tight, leave out the toes
What is a Robert Jones bandage?
a bandage that is 3 times the width of the limb - decreases swelling and protects fractures
What is a modified robert jones bandage?
a robert jones with less padding
What is a fracture?
when the continuity of the bone is broken
What is a simple fracture?
a fracture of only the bone - no penetration through the skin
What is a compound fracture (open)?
fracture in which a broken piece of bone pierces the skin
What is a comminuted fracture?
breaking of bone into two or more pieces
What is coaptation?
joining or reuniting of two surfaces - often in terms of a splint designed to immobilize a fracture
What are the principles of fracture stabilization?
evaluate patient completely, evaluate fracture, and pain management
What are the goals of fracture stabilization?
prevent soft tissue damage, decrease patient anxiety, minimize eburnation, keep fracture closed, and protect blood vessels and nerves from stretching
How do you stabilize a horse before transport for a fracture repair?
external coaptation - bandage, splint, or cast
How do you transport a horse with a front limb fracture?
face them backwards in the trailer
How do you transport a horse with a hind limb fracture?
face them forwards in the trailer
What complications are associated with casting?
pressure sores, cannot visualize wounds, must change every 2-3 weeks, need to monitor heat, drainage, lameness
What fractures are in zone 1 of equines?
phalanx fractures
What is the splinting process for zone 1 fractures?
spling from the ground to the proximal MC3/MT3
What fractures occur in zone 2 of equine fractures?
MC3, MT3, carpal, and tarsal
What is the splinting process for zone 2 fractures?
splint from ground to elbow/stifle, use RJ bandage, splint caudal and lateral
What fractures occur in zone 3 of equine fractures?
radial and tibial fracture
What is the splinting processes of a zone 3 fracture?
RJ bandage from ground to elbow, splint ground to shoulder
What fractures occur in the zone 3a/b equine fractures?
olecranon or ulna fracture
What fractures are in zone 4 of equines?
humerus and femur
What is the splinting process of zone 4 of equines?
there is none - you do not need to splint due to the high muscle mass
What is physical rehabilitation?
the science of the application of anatomy, biomechanics, psychology, physics, and physiology to animals with dysfunction, injury, pain, or physical abnormalities
What type of patients can benefit from physical rehabilitation?
athletes, neurologic injuries, orthopedic injuries, arthritic animals, obese animals, geriatric animals, and non-compliant owners
Why is analgesia important during rehabilitation therapy?
because the patient needs to feel comfortable in order to perform therapy excercises (essential before and during therapy)
What are the benefits of cryotherapy?
skeletal muscle relaxation, vasoconstriction, slows nerve conduction, reduced edema
What are the benefits of hyperthermia?
increases sensory and motor nerve conduction velocity to reduce pain and muscle spasms, increases blood and lymphatic flow
What are passive range of motion excercises used for?
warm-up for land exercises
What does massage therapy do?
increase blood/lymph flow, break down adhesions, relax muscles, positive emotional state, reduces aggression and cribbing in horses
What are the contraindications for massage therapy?
infection, neoplasia, open wounds, and thromboembolic disease
What are the benefits of land exercises?
to improve tissue strength, increase coordination and cardiovascular fitness, decrease joint stiffness/pain, decrease muscle atrophy
What are the contraindications for land exercises?
persistent pain, unstable fractures or luxations
What are some examples of land exercises?
sit-to-stand, cavaletti rails, balance board, land treadmill, stretching
What are the benefits of water exercises?
resistance and viscosity thermotherapy, surface tension, buoyancy benefits
What are the contraindications for water exercises?
cardiac or respiratory dysfunction, decreased thermal sensation, severe peripheral vascular disease, infection, diarrhea/incontinence, upper pelvic lameness, acute joint inflammation, acute myositis, fever, fearful
What are the benefits of laser therapy?
decrease inflammation, promote healing, increase blood flow, pain relief
What does ultrasound therapy use?
it uses sound waves and converts them into heat
What are the benefits of ultrasound therapy?
increase exxtensibility of tissues, relax muscle spasms, and help wound healing
What does TENS stand for?
transcutaneous electrical nerve stimulation
What does TENS do?
muscle strengthening, muscle re-education, enhanced function of muscles, pain control, edema reduction, muscle spasm reduction
What are the benefits of external joint support in horses?
increase proprioception, strength, and range of motion
What are the disadvantages of external joint support in horses?
bandage sores
What is evaluated when assessing the outcomes of rehabilitation therapy?
pain assessment, gait assessment, goniometry, measure muscle mass, repeated orthopedic and neurologic exams, owner questionaire
What are the components of a colic exam?
pain, pulse, perfusion, peristalsis, pings, paunch, passing a nasogastric tube, palpation, PCV, and peritoneal fluid
What is considered a high BPM in horses?
greater than 60
What is the normal amount of gut sounds in 1-2 minutes in a horse
2-3 episodes
What is an abnormal amount of reflux in horses and what is it indicative of?
greater than 2 liters - suggestive of a small intestine lesion
What are some causes of abdominal pain in horses?
pressure and colic
What is a type 1 rectal prolapse in a horse?
rectal mucosa and submucosa projects through the anus
What is a type 2 rectal prolapse in a horse?
compete prolapse of full thickness of all or part of the rectal ampulla
What is a type 3 rectal prolapse in a horse?
small colon intussusception into rectum in addition to type 2 prolapse
What is a type 4 rectal prolapse in a horse?
peritoneal rectum and small colon form intussusception through the anus
How should a surgeon prepare for standing surgery?
caps, mask, aseptic hand preparation, gloves, and maybe a gown
How should a patient be prepared for standing surgery?
restraint, antibiotics, NSAIDs, tetanus, prep the surgery site, prep the surgeon
What are the types of physical restraints for standing surgery?
stocks and twitch (nose, ear, skin, lip)
What are the types of chemical restraints for standing surgery?
chemical - sedation (acepromazine, alpha 2 agonists) and analgesics (opiods and local anesthetics)
What is a type of acepromazine?
phenothiazine tranquilizer
What does phenothiazine tranquilizer do?
calm anxiety, no analgesia - hypotension side effects
What are some alpha 2 agonists used in surgery?
xylazine, romifidine, detomidine
What is the shortest acting alpha 2 agonist?
xylazine - also cheapest and greatest degree of ataxia
What alpha 2 agonist has the least cardiovascular effects?
romifidine
What is the most common, longest acting, most expensive, and least ataxic alpha 2 agonist?
detmidine
What are some opioids used in standing surgery?
butorphanol (partial agonist.antagonist mu) and morphine (full mu agonist)
What is naloxone?
an opioid reversal
What are some local anesthetics used in standing surgery?
lidocaine, mepivacaine, bupivicaine
What is the longest acting local anesthetic?
bupivicaine
What is the shortest acting local anesthetic (1 hour)?
lidocaine
What common procedures can be performed standing in a bovine patient?
right displaced abomasum, left displaced abomasun, right volvulus, cesarean section, rumenotomy
What head surgeries can be done standing in a horse?
enucleation, third eyelid removal, sinus surgeries
What throat surgeries can be done standing in a horse?
tie back, arytenoidectomy, transendoscopic vocal cordectomy - specialty surgeries
What musculoskeletal surgeries can be done standing in a horse?
neurectomy, medial patellar desmoplasty/otomy, arthroscopy, fracture repair
What abdominal surgeries can be done standing in a horse?
no GP can do these - laparoscopic cryptorchidectomy/ovariectomy, nephrosplenic closure, epiploic foramen closure
What urogenital surgeries can be done standing in a horse?
RV tear, urethral extension, cervical lacerations, castration (only one a GP can do)
What are the different approaches for GI surgery in food animals?
standing, dorsal recumbant, and lateral recumbant
What incision is done in a dorsally recumbent food animal?
paramedian (left and right) - ventral midline
What incision is done in a laterally recumbent food animal?
ventrolateral (left and right) - right paracostal
What are some indications for GI surgeries in bovines?
vagal indigestion, abomasal displacement syndromes, cecal disorders, rectal prolapse
What is a type 1 vagal indigestion in bovines?
failure of eructation
What is a type 2 vagal indigestion in bovines?
failure of omasal transport
What is a type 3 vagal indigestion in bovines?
failure of abomasal outflow
What should be observed in an oral examination?
external structures, occlusion, dentition, and internal structures
What should be recorded for an oral examination?
count the teeth, determine the calculus index, determine the plaque score, determine the gingival inflammation, determine the sulcus depth
What does a rostral infraorbital nerve block (cranial maxillary) block?
ipsilateral 1st to 3rd premolar, canine, incisor, muzzle, and upper lip
What does a caudal infraorbital nerve block (caudal maxillary) block?
ipsilateral molars, premolars, canine, incisors, muzzle, and upper lip
What does the caudal inferior alveolar or mandibular nerve block block?
ipsilateral mandibular molars, premolars, canine, incisors, labial tissues, and rostral lower lip
How do you perform a maxillary nerve block in a horse?
insert a needle into the maxillary foramen at a 90 degree angle and inject 15 mL - blocks ipsilateral maxillary teeth
How do you perform a mandibular nerve block in a horse?
insert a needle into the mental foramen parallel to the mandible and inject 5-10 mls - blocks ipsilateral mandibular canine and incisors
What is the dental formula of the dog?
3142/3143 (upper/lower)
What is the dental formula of the cat?
3131/3121 (upper/lower)
What are the steps of opening the abdomen in small animal surgery?
- ventral midline 2. skin incision 3. remove subcutaneous tissue from the linea 4. grab the linea with forcepts, lift, inverted blade for stab incision 5. feel for adhesions 6. extend with mayo scissors
What patterns are used on the abdominal wall in small animals?
simple interrupted, cruciate, and simple continuous
How should abdominal wall sutures in small animals be spaced?
5-10 mm from incision and from previous bite
What is the holding layer in the abdominal wall?
the external rectus sheath
What patterns should be used in the subcutaneous layer in small animal surgery?
buried cruciates and simple continuous
What is the purpose of subcutaneous sutures?
to appose skin and obliterate dead space
What suture paterns should be used in the skin in small animal abdominal surgery?
intradermal, external sutures (simple interrupted, cruciate, simple continuous), or staples
What are the contamination levels?
clean, clean-contaminated, contaminated, dirty
What is a clean wound?
a non-traumatic, noninflamed operative wound - no tracts are entered
What is a clean-contaminated wound?
operative wounds in which respiratory, gastrointestinal or genitourinary tracts are entered under controlled conditions without unusual contamination
What is a contaminated wound?
operation on traumatic wounds without purulent discharge. Procedures in which spillage of gastrointestinal contents, infected urine, or in which a major break in aseptic technique occur
What is a dirty wound?
operation on traumatic wounds with purulent discharge, devitalized tissues, or foreign bodies - procedures in which a perforated viscus of fecal contamination occurs
