Fichas
Thoracic surgery
Fichas del conjunto (64)
- 1What is a thoracocentesis?- Procedure involving the puncture of the inter-pleural space for diagnostic and/or therapeutic purposes
- 2When is thoracocentesis used?- Essential for dyspnoeic animals (+ oxygenotherapy)
- 3How do you do thoracocentesis?- Needle: butterfly needle catheter or an over the needle catheter attached to an extension set and three way tap
- Site of puncture is 7th or 8th intercostal sace
- Need to advanced as parallel to rib cage as possible to minimise the risk of lung damage - 4What tubes does the fluid need to be placed in following the thoracocentesis?EDTA and red top tube for cytology and biochemical analysis
- 5Why would you place a chest tube?- To provide drainage of air/fluid from chest
- Diagnostic/ therapeutic
- Following all thoracic surgery - 6What are the 2 general techniques for placing a chest tube?- Closed or Open (in surgery)
- 7How must all chest tubes be placed?- With tunnelling (under the 1st rib space) under the muscle and skin before entering the pleural space - prevents increasing the thoracic pressure (potentially causing a pneumothorax)
- 8What are the different chest tubes available?- Without Trocard
- With Trocard/ Stylet
- Through the needle-wire/ Seldinger technique
- Different sizes available (6-8 Fr (Mila) up to 20 Fr) - 9What are the different sized chest tubes useful for?- Large size will induce large trauma and potential leaks
- Air can be drained via small bored drains whereas thick fluid may not - 10How do you care for a chest tube?- Ends need to be protected if not continuous suction
- Stoma site inspected regularly for discharge/ break
- Air leaks possible at stoma site
- Removed when production of fluid is decreased - 11Where normally are animals kept who have chest tubes in?ICU
- 12What is the normal length of time to have a chest drain in for?3-4 days
- 13What is intermittent chest tube drainage?- Fluid and air
- Every 4 to 8 hours
- Check for dyspnea and adjust rate of drainage - 14What is continuous chest tube drainage?- More physiological
- Different methods:
i. Drainobag/ concertina
ii. Heimlich valve - 15How many approaches are there to opening/entering the chest? And name them.2 ways:
- Thoracotomy
- Sternotomy - 16Where is the incision site for a thoracotomy and therefore the positioning of the animal?- Incision through intercostal space midway between the 2 ribs
- Most common site: 4th, 5th or 6th ICS (L or R)
- Patient in lateral recumbency
- Entire side of chest is clipped and prepared sterile - 17Describe the incision for a thoracotomy.1. Incision of the skin
2. Exposure and
3. Incision (move away) of the thoracic superficial muscles (lat dorsi, serratus ventralis, ext. oblique, pectoral superficial.)
4. Incision of intercostal muscles between 2 ribs
5. Incision of the pleura (3 and 4 together in small dogs and cats)
6. Placement of rib spreader (Finochietto retractor) - 18What is the name of the rib spreaders?Finochietto retractor
- 19How is a thoracotomy closed?- Cirumcostal sutures
- Absorbable or nonabsorbable sutures
- All preplaced (can see deeper structures and get all in)
- Tied alternatively - 20With a thoracotomy, what defines where the incision and opening is made?- What structures need to be seen
- Not a lot of give in the retraction of the thoracic wall and therefore the structures can be easily missed - 21What is a sternotomy?- Midline approach (patient positioned in dorsal recumbency)
- Exploration of both hemi-thorax
- Osteotomy with saw blade - 22How is a sternotomy closed?- Wires mainly or sutures in smaller animals
- 23What are potential complications of surgical approaches to the chest?- Haemorrhage (intercostal vessels)
- Pneumothorax (drain chest)
- Postoperative pain -> respiratory failure
- Seroma
- Lung laceration
- Infection - 24Why are most thoracic surgeries at specialist level?- Several indications for surgery
- Technical skills required to do the surgery but also the technical support needed
(ventilator, round the clock checks, nursing staff etc.) - 25Give a list of potential surgical thoracic diseases.- Pulmonary neoplasia
- Pulmonary blebs or bullae
- Pulmonary abscesses
- Chest and lung trauma
- Thoracic oesophageal foreign bodies
- Pyothorax
- Mediastinal mass
- Pericardial effusions
- Diaphragmatic rupture - 26What are the majority of the pulmonary neoplasia?- Malignant (carcinomas)
- 27What are the clinical signs of pulmonary neoplasia?- Cough, dyspnoea, incidental
- 28How are pulmonary neoplasias diagnosed, treated and what is the prognosis?- D: rads or CT
- Tx: Lung lobectomy and lymph node removed
- P: clinical signs, size and LN dependent also histopathology - 29What normally causes lung abscesses (consolidated lung lobes)?- Secondary to foreign bodies, chronic bacterial bronchopneumonia, penetrating wounds, vascular obstruction and neoplasia
- 30What are lung abscesses the main differential for?Neoplasia (same radiographic signs)
- 31How are lung abscesses treated?- Surgically (lung lobecctomy) if consolidated or fail medical management
- 32What is chest and lung trauma associated with?- Rib fractures, bite wounds and RTA
- 33What can happen with pneumothorax, pulmonary haemorrhage in trauma?- Traumatic pneumothorax: managed by chest drain
- Haemorrhage: usually self limiting - 34How can surgery be used in chest and lung trauma?- Repair chest wall (fractures ribs, flail chest and open wounds)
- LARGE pulmonary leaks - 35What is flail chest?- Chest wall (part of) moves in when the animal breathes out
- Moves the opposite way to what it should - 36What are the possible lung surgeries?- Lung lobectomy
i. Partial or complete
ii. Hand suture technique: individual ligatures for vessels and bronchus
iii. Mechanical sutures (stapler) - 37When and how do you perform lung sutures?- For small leaks
- Mattress sutures - 38What are pulmonary blebs and bullae?- Accumulation of air between the visceral pleura and the lung parenchyma (blebs) or within the lung parenchyma (bullae)
- Results in tension pneumothorax - 39What is the initial treatment for pulmonary blebs and bullae?- Thoracentesis and/or chest drain placement
- 40What is the definitive treatment for pulmonary blebs and bullae?- Partial or complete lung lobectomy
- Less risk of recurrence than conservative treatment - 41What is a common location for thoracic oesophageal foreign bodies in dogs?- Hiatus of the diaphragm
- 42What are the clinical signs, diagnosis and treatment for thoracic oesophageal foreign bodies?- CS = retching, gagging, hypersalivation
- D = plain rads/ oesophagoscopy
- T = Oesophagoscopic or fluoroscopic retrieval
If not successful = surgery - 43What is the surgery treatment for thoracic oesophageal foreign bodies?- Left sided thoracotomy: 7th-8th ICS for caudal FBs
- FB removal via an oesophagotomy
- Prognosis fair to good depending on perforation and leakage (pre and post surgery) - 44What are the complications possible from surgery for thoracic oesophageal foreign bodies?- Suture dehiscence: pyothorax
- GI reflux and oesophagitis (treat with H2 blockers (ranitidine) and PPI (omeprazole))
- Strictures - 45What is required for thoracic oesophageal foreign body surgery?Initial oesophageal by-pass (gastrostomy or PEG tube)
- 46Give 2 causes of pericardial effusion (PE).Idiopathic
Neoplastic - 47What are the clinical signs with PE?Cardiac tamponade
- 48How can you treat PE?- Surgery (pericardiectomy) via open chest approach (thoracotomy L or R) or thoracoscopy if recurrence of clinical signs post-centesis
- Untreated PE can lead to constrictive pericarditis
- Better prognosis for idiopathic effusion than neoplasia - 49What is a pyothorax?- Intrapleural accumulation of septic effusion
- 50What can cause pyothorax?- E.coli (dogs) and Pasteurella (cats), nocardia, actinomyces, anaerobes
- Idiopathic (cats), FB migration, puncture wounds, oesophageal tears, pulmonary infection - 51What are the clinical signs and diagnosis with pyothorax?CS: dyspnoea, lethargy, innapetence
D: radiographs, thoracocentesis, cytology, culture - 52What is the treatment for pyothorax?- Conservative in cats: drainage (+/- lavage) and antibiotic therapy (Ampicillin-sulbactam IV; Metronidazole +Fluoroquinolones)
- Surgery in dogs (surgical exploration/ debridement/ biopsies, chest tubes) + targeted antibiotic therapy
- Surgery in cats only if not responding to conservative treatment - 53What is the prognosis of pyothorax?- Fair to good: risk of pleuritis and pleural fibrosis
- Relapse possible
- Complications (SIRS, PTE) - 54What happens in diaphragmantic rupture?- Loss of continuity of the diaphragm - traumatic aetiology
- Circumferential/ radial/ combined tear
- Cats more than dogs
- Dyspnoea, shock, other concurrent lesions - 55How do you diagnose diaphragmatic rupture?Radiography = MAIN
- Ultrasound - 56What can be seen on radiographs with diaphragmatic rupture?- Obscured thorax due to sot tissue and gas
- No normal lung appearance and cardiac silhouette is obscured - 57What is the treatment of diaphragmatic rupture?- Resuscitation (O2 support, fluid therapy)
- Surgery: check herniated organs (+/- resection) and suture diaphragm - 58What is the prognosis with diaphragmatic rupture?Good if no re-expansion injury
- 59What causes abnormal opacity in the heart on a radiograph?Peritoneo-pericardial diaphragmatic hernia (PPDH)
- 60What is PPDH?- Congenital defect in the diaphragm and pericardium
- Diagnosis usually later in life
- Liver and intestinal loops around the heart - 61What is the treatment for PPDH?- Surgical treatment if animal dyspnoeic
- Elective procedure
- Don't operate unless there are reasons to - 62What is the most common mediastinal mass?- Thymoma = surgical treatment
- Lymphoma = non-surgical
- Others: cysts, thymic involution - 63How can you diagnose mediatinal masses and treat?- FNA-TruCut biopsy
- Imaging (CT)
- Surgery: resection via median sternotomy
- Prognosis: depends on invasiveness and presence of paraneoplastic syndrome (myasthenia gravis) - 64What should be done to all dyspnoeic animals?Thoracocentesis and O2
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- (SA respiratory surgery - Guillaume Chanoit) Respiratory - CVS1 Fichas sobre Thoracic surgery, creado por Rachael Jones el 01/05/2018.
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- Rachael Jones
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