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Flashcards

Thoracic surgery

Rachael Jones Respiratory - CVS1 English 64 cards

Cards in this deck (64)

  1. 1What is a thoracocentesis?- Procedure involving the puncture of the inter-pleural space for diagnostic and/or therapeutic purposes
  2. 2When is thoracocentesis used?- Essential for dyspnoeic animals (+ oxygenotherapy)
  3. 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
  4. 4What tubes does the fluid need to be placed in following the thoracocentesis?EDTA and red top tube for cytology and biochemical analysis
  5. 5Why would you place a chest tube?- To provide drainage of air/fluid from chest
    - Diagnostic/ therapeutic
    - Following all thoracic surgery
  6. 6What are the 2 general techniques for placing a chest tube?- Closed or Open (in surgery)
  7. 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)
  8. 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)
  9. 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
  10. 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
  11. 11Where normally are animals kept who have chest tubes in?ICU
  12. 12What is the normal length of time to have a chest drain in for?3-4 days
  13. 13What is intermittent chest tube drainage?- Fluid and air
    - Every 4 to 8 hours
    - Check for dyspnea and adjust rate of drainage
  14. 14What is continuous chest tube drainage?- More physiological
    - Different methods:
    i. Drainobag/ concertina
    ii. Heimlich valve
  15. 15How many approaches are there to opening/entering the chest? And name them.2 ways:
    - Thoracotomy
    - Sternotomy
  16. 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
  17. 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)
  18. 18What is the name of the rib spreaders?Finochietto retractor
  19. 19How is a thoracotomy closed?- Cirumcostal sutures
    - Absorbable or nonabsorbable sutures
    - All preplaced (can see deeper structures and get all in)
    - Tied alternatively
  20. 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
  21. 21What is a sternotomy?- Midline approach (patient positioned in dorsal recumbency)
    - Exploration of both hemi-thorax
    - Osteotomy with saw blade
  22. 22How is a sternotomy closed?- Wires mainly or sutures in smaller animals
  23. 23What are potential complications of surgical approaches to the chest?- Haemorrhage (intercostal vessels)
    - Pneumothorax (drain chest)
    - Postoperative pain -> respiratory failure
    - Seroma
    - Lung laceration
    - Infection
  24. 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.)
  25. 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
  26. 26What are the majority of the pulmonary neoplasia?- Malignant (carcinomas)
  27. 27What are the clinical signs of pulmonary neoplasia?- Cough, dyspnoea, incidental
  28. 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
  29. 29What normally causes lung abscesses (consolidated lung lobes)?- Secondary to foreign bodies, chronic bacterial bronchopneumonia, penetrating wounds, vascular obstruction and neoplasia
  30. 30What are lung abscesses the main differential for?Neoplasia (same radiographic signs)
  31. 31How are lung abscesses treated?- Surgically (lung lobecctomy) if consolidated or fail medical management
  32. 32What is chest and lung trauma associated with?- Rib fractures, bite wounds and RTA
  33. 33What can happen with pneumothorax, pulmonary haemorrhage in trauma?- Traumatic pneumothorax: managed by chest drain
    - Haemorrhage: usually self limiting
  34. 34How can surgery be used in chest and lung trauma?- Repair chest wall (fractures ribs, flail chest and open wounds)
    - LARGE pulmonary leaks
  35. 35What is flail chest?- Chest wall (part of) moves in when the animal breathes out
    - Moves the opposite way to what it should
  36. 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)
  37. 37When and how do you perform lung sutures?- For small leaks
    - Mattress sutures
  38. 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
  39. 39What is the initial treatment for pulmonary blebs and bullae?- Thoracentesis and/or chest drain placement
  40. 40What is the definitive treatment for pulmonary blebs and bullae?- Partial or complete lung lobectomy
    - Less risk of recurrence than conservative treatment
  41. 41What is a common location for thoracic oesophageal foreign bodies in dogs?- Hiatus of the diaphragm
  42. 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
  43. 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)
  44. 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
  45. 45What is required for thoracic oesophageal foreign body surgery?Initial oesophageal by-pass (gastrostomy or PEG tube)
  46. 46Give 2 causes of pericardial effusion (PE).Idiopathic
    Neoplastic
  47. 47What are the clinical signs with PE?Cardiac tamponade
  48. 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
  49. 49What is a pyothorax?- Intrapleural accumulation of septic effusion
  50. 50What can cause pyothorax?- E.coli (dogs) and Pasteurella (cats), nocardia, actinomyces, anaerobes
    - Idiopathic (cats), FB migration, puncture wounds, oesophageal tears, pulmonary infection
  51. 51What are the clinical signs and diagnosis with pyothorax?CS: dyspnoea, lethargy, innapetence
    D: radiographs, thoracocentesis, cytology, culture
  52. 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
  53. 53What is the prognosis of pyothorax?- Fair to good: risk of pleuritis and pleural fibrosis
    - Relapse possible
    - Complications (SIRS, PTE)
  54. 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
  55. 55How do you diagnose diaphragmatic rupture?Radiography = MAIN
    - Ultrasound
  56. 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
  57. 57What is the treatment of diaphragmatic rupture?- Resuscitation (O2 support, fluid therapy)
    - Surgery: check herniated organs (+/- resection) and suture diaphragm
  58. 58What is the prognosis with diaphragmatic rupture?Good if no re-expansion injury
  59. 59What causes abnormal opacity in the heart on a radiograph?Peritoneo-pericardial diaphragmatic hernia (PPDH)
  60. 60What is PPDH?- Congenital defect in the diaphragm and pericardium
    - Diagnosis usually later in life
    - Liver and intestinal loops around the heart
  61. 61What is the treatment for PPDH?- Surgical treatment if animal dyspnoeic
    - Elective procedure
    - Don't operate unless there are reasons to
  62. 62What is the most common mediastinal mass?- Thymoma = surgical treatment
    - Lymphoma = non-surgical
    - Others: cysts, thymic involution
  63. 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)
  64. 64What should be done to all dyspnoeic animals?Thoracocentesis and O2

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Respiratory - CVS1 (SA respiratory surgery - Guillaume Chanoit) Flashcards on Thoracic surgery, created by Rachael Jones on 01/05/2018.
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Rachael Jones
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