Flashcards
Dr. Campbell Surgery
Cards in this deck (200)
- 1How long does the inflammatory/debridement phase last? What are the main cell type involved What form of debridement do they perform and what does that mean? What do these cells secrete and what do these products do?The inflammatory/debridement phase lasts from day 0-3-5
The main cells involved are WBC's
These WBC's perform selective autolytic debridement, which means they destroy unhealthy tissue and leave the healthy tissue behind.
WBC's secrete cytokines that are involved in the repair phase - 2How long does the repair phase of wound healing occur? What are the 3 phases of wound healing and what occurs in each one?The repair phase starts at day 3-5 and last for 2-4 weeks
Phases of wound repair:
1.Formation of granulation tissue:
Fibroblasts and endothelial cells, build ECM and build BV's
2.EPitheliazation-epithelial cells, form new skin
2.Contraction-myofibroblasts, pull skin over wound
The last 2 steps occur simultaneously - 3What classifies as a clean, clean-contaminated, contaminated and dirty wound?Clean-wound made via surgery with no entry in oral cavity, GI, etc
Clean-contaminated: Wound made via surgery but entering oral, GI, respiratory, minor break in aseptic technique or clean surgical wound with a drain
Contaminated:
Spillage of Gi contents/urine into abdomen
Major break in aseptic technique
Traumatic wound, no purulent fluid
Dirty-contains purulent, devitalized tissue, foreign material, feces - 4What is the purpose of debridement and the benefits?The purpose is to remove damaged tissue and foreign material
Benefits:
1.Remove media for bacteria
2.Remove physical barriers to perfusion and granulation
3.Decrease exudate production
4.IMprove ability to assess wound
5.Release pro-healing inflammatory mediators to stimulate healing - 5What are the 5 traits use dot determine if tissue is viable?1.Attachment-if unattached/no blood supply remove it
2.Color-it relates to the water content of the tissue, lower in dark tissue and higher in lighter tissue, if low remove it
3.Texture-Eschar is a dry leather like necrotic tissue, can leave as a bandage if not infected/no signs of infection. Removes moist necrotic skin slough as it slows healing
4.Temperature:
The differentials for cold tissue are:
1.Hypovolemia
2.Hypothermia
3.Devitalized
TX for the first two before assessing temp of tissue.
5. Bleeding:
could be cause by hypovolemia, hypothermia, or devitalized tissue. - 6Leaving necrotic tissue does what?Delays healing and increases infection rate.
- 7What is the stock solution of chlorohexidine and iodine and what is the desired concentration of each of these in our final lavage product?Chlorohexidine, comes in 2% we want 0.05% at the end.
Iodine comes in 10%, we want 0.1-1% at the end
C1XV1=C2XV2 - 8What is the correct lavage pressure? What happens if lavage pressure is too high or low?7-8PSI, you'll inflate the bag up to 300 mmHG
Use a 18 gauge needle
Too high:
Damage tissue, drive bacteria nd debris deeper
Too low:
Ineffective at removing debris and bacteria - 9When can a wound be closed and not treated as an open wound?1.All remaining tissue is viable
2.NO more contamination
3.Closed without excessive tension - 10Why are wet-dry dressings not the standard of care now?They cause non-selective debridement and they delay healing, increase infection rate, they hurt and are more expensive then moist wound healing
- 11What is the goal of moist wound healing?TO keep the wound fluid in contact with the wound to support the bodies own healing mechanisms
- 12What is the biggest benefit of moist wound healing?It allows 24/7 selective wound debridement
- 13What carries out selective autolytic debridement?WBC's and their proteases
- 14Why choose MWH over wet-dry?1.Debridement is selective
2.MWH support granulation tissue formation, BV formation, epithelization and contraction/Repair phase
3.Wound temp is kept at body temp
4.INfection rate is decreased
5. More comfortable
6.Increased healing rate and less expensive - 15How to apply MWH bandages?1.Fit dressing to wound
2.COver with bandage
3.Change every 2-3 days while still moist - 16What are 3 potential pitfalls or using MWH?1.Maceration of surrounding tissue/is damage to surrounding tissue due to excess moisture
2.Bandage can look purulent, leave it - 17How to correctly select a MRD for a wound and what are the 4 types?We select a moisture retention dressing by asking ourselves how much exudate wound will produce and what are the needs of the wound.
MRD:
1.Calcium alginate-high exudate and good for wounds that need debridement
2.Hydrophilic foam-high-moderate exudate, promotes epithelization
3.Hydrocolloid-moderate-low exudate
4.Hydrogel-low exudate, good at rehydrating wounds - 18Why use stents and what suture pattern is used?Stents are used to gradually stretch skin to allow closure overtime.
With continual stretch collagen fibers realign and and elastin molecules break
Use horizontal mattress patterns - 19Antibiotics can never replace good?Debridement and lavage
- 20When do abx need to be given?Pre op abx need to be started 30 minute before and then given every 90 minutes intraop
- 21How do you decide if you need pre-intraop abx and what about post op?Use pre-intraop abx if we anticipate surgery:
1.Lasting longer than 90 minutes
2.Entering nonsterile lumen
3.Devitalized or contaminated tissue
4.perineal or perianal area
5.Ortho
6.IMplant
7.Immunocompromised
Post op:
Is there significant contamination, was infection found, is patient highly compromised - 22What should you keep in mind with bullet and bite wounds?1. Tip of the iceberg/There is the damage you can see but also the damage to the collateral tissue.
These need to be explored to the greatest extent possible
TX of choice is exploratory celiotomy if abdomen penetration, the risk that it perforated the GIT is high and it leaking is life threating - 23How to prepare a client properly about degloving injuries?They look bad, but usually heal well, but may require several surgeries to get this done.
- 24Lecture 3Yerp
- 25List the criteria a wound must meet to be closed?1.All remaining tissue must be viable
2.ALL contamination is removed
3. Can be closed without extensive tension - 26What can premature closer of a wound lead to and what are the 4 types of wound healing?If you close a wound prematurely is might dehisce and become infected.
Surgical closure techniques:
1.Primary closure-within 6-8 hours of wound insult
2.Delayed primary-before granulation tissue forms/1-3 days post wound
3.Secondary-after granulation tissue formation
4.Secondary intention-wound that is not closed and heals via epithelization, and contraction - 27With closure what can you do to reduce tension?Close in layers, meaning use multiple tissue planes to close.
- 28What are the 7 principles of Halstead?1.Gentle tissue handling
2.Aseptic technique
3.Meticulosis hemostasis
4.Minimal tension
5.Accurate tissue apposition
6.Obliterate dead space
7.Preserve blood supply - 29Where does the blood supply to the skin arise from and what layer do you need to undermine to preserve blood supply to the skin?The blood supply to the skin arises from the subdermal plexus, which are branches of blood vessels that arise in the cutaneous muscle layer and then reach up to supply the skin.
To preserve the blood supply to the skin you must undermine deep to the cutaneous muscle or the SQ if no cutaneous muscle. - 30Explain what a walking and tacking suture are and why are they useful?Both these suture types involve taking your first bite on the underside of the skin and then in the wound bed. They are both used to try to obliterate dead space and walking sutures try to stretch the skin to close a wound.
Tacking sutures, bite goes straight down
Walking sutures-bite goes from underside of skin to advanced location in wound bed to attempt to advance skin - 31What are the advantages and disadvantages of walking and tacking sutures?Tacking:
Advantages:
1.Decrease DS
2.DIstribute tension
Disadvantages:
1.INcrease risk of infection if too many placed
2.Can compromise BS
3.Compartmentalize DS
Walking sutures:
Advantages:
1.Decrease DS
2.Distribute tension
3.Advance skin over wound
Disadvantages:
1.TOO many increase infection risk
2.Can compromise BS
3.Can compartmentalize DS - 32When closing a symmetrical ellipse which direction do you suture in?From dominant hand to non-dominant
- 33What technique may help close asymmetrical ellipses?The split the difference technique, with sutures on longer side further apart then short side
- 34With advancement flaps what is the proper length to width ratio?NO more than 2:1
- 35What are the 3 negative effects of fluid accumulating in wounds?1.Media for bacterial growth
2.Decreases perfusion
3.Increase pain - 36Should drains be placed inside to out or vice versa?Inside to out to try to reduce contamination
- 37Lecture 4Surgical Oncology
- 38What is the most common mistake in oncological surgery and how can this be prevented?The biggest mistake is not being aggressive enough with our first surgery. We can prevent this by a proper pre op assessment
- 39What 7 things do we need to describe with neoplasias?1.Size
2.Shape
3.Density
4.Appearance
5.Location, on body and in what tissue plane
6. Mobility
7.Painful - 40Can FNA rule in Neoplasia? can it rule it out?FNA can rule in neoplasia but cannot rule it out
- 41What do you want to do with a mass before you remove it?You want to ID it with FNA or a incisional biopsy
- 42What can happen if you leave tumor cells behind on your excisional removal of the tumor?Doing this and leaving cancer cells behind means your selecting for the most neoplastic cells, these were the ones that were spreading out already and have the worst metastasis potential.
- 43Other than the reasons mentioned above surgery alters what? Which if on a failed first surgery/neoplastic cells left behind can cause?Surgery alters vascularity, immune system and tissue planes, which can allow neoplasia to metastasize.
- 44What does tumor grade and stage tell us?Grade-metastasis potential/cell differentiation/what is it
Stage-where is it and how much has it spread - 45What are the 4 surgical doses for surgical removal of tumors?1.Debulk-macroscopic disease remains, remove at least 90%
2.Marginal-microscopic disease remains
3.Wide-1-2 cm margins, 2-3 for MCT and 3 for STS with 5 cm for injection site fibrosarcoma's
4.Radical-remove compartment/amputation, whole mammary chain - 46What are the desired margins and tissue planes for mammary tumors, MCT, STS, and vaccine associated sarcomas?Mammary gland tumors-1-2 cm margins with option of taking 1 tissue beyond deepest layer of tumor
MCT-2-3 cm margins, or tissue layer deep to tumor
STS- 3 cm margins or +1 tissue layer deep to tumor
Vax associated STS- 5 cm margins or 2 tissue layers deep to tumor - 47When removing deeper tissue should you take a cylinder or a cone shape?Cylinder
- 48Lecture 5Conditions of the skin
- 49What is the medical term for declaw?Onychectomy
- 50Alternatives for onychectomy?1. Trimming cats nails often
2.Artificial nail caps
3.Scrtching post, etc - 51What 4 things are more common in declawed cats than non-declawed ones?1.Chronic back pain
2.INappropriate urination
3.Biting
4.Overgrooming - 52Describe how to perform a declaw?A declaw is performed by disarticulating P3/phalanx 3 from P2.
Requires general anesthesia, scrub the area but do not clip, do a ring block and then place a tourniquet distal to the elbow. Disarticulate between P2 and P3. Close with single suture or surgical glue - 53What are the complications of declaw?1. Hemorrhage-keep cat in hospital 1-2 nights to avoid this
2. lameness if you cut P2 or digital pad
3. Leave part of ungual crest-nail regrows and can cause abscessation
4. Ischemia due to too tight post op bandage - 54When is neonatal dewclaw removal done and what about non-neonatal dewclaw removal?Neonatal is done at 3-5 days old
and Non-neonatal is done at 12 weeks old or older - 55What do you disarticulate for dewclaw removal?Metacarpophalangeal joint/ where P1 and metacarpal 1 meet. You need to close the SQ and skin with non-neonatal dewclaw removal
- 56What is a hygroma? What are they caused by? Where are they commonly seen? Treatment of hygroma?Hygromas are fluid filled pseudocysts
They are caused by repeated trauma to an area over a bony prominence, they are most common in heavy dogs over the elbows
Treatment-do not stick a needle in it, it will just come back
The best treatment is to place a donut bandage over the area to allow pressure eon healthy tissue not hygroma - 57When you amputate should the SQ be longer than the bone and what about the skin?When your doing an amputation the SQ should be longer than the bone and the skin should be longer than the SQ
- 58What is the name for a tail amputation and how do you do this?Name=caudectomy
Make a duckbill incision so there are dorsal and ventral flaps that extend beyond the disarticulation area. For a better looking incision make the dorsal flap longer than the ventral. Ligate blood vessels, mostly ventral and laterally located, not so much dorsal - 59What are the top differentials for subungual mass in dogs and cats? What digits are main weight bearing ones?Dog subungual mass-SCC, MCT, malignant melanoma
CAT-primary pulmonary neoplasia
Digits 3 and 4 bear most of the weight - 60Procedure for limb amputation?First do a complete neuro and ortho exam to make sure dog will do well on 3 legs
Forelimb amputation is MC- and we need to remove the entire limb including the scapula - 61What type of suture do we need to use for ligation of large blood vessels?SILK, it is nonabsorbable, braided, easy to remove and coated with bees wax.
- 62Lecture 6Principles of abdominal surgery
- 63List normal TPR, BP, and big 4 for dogs?Dog:
T-99.5-102.5
P:80-120
R: 15-30
BP/systolic: 90-140
PCV: 37-55
TP: 5.5-7.5
BUN-7-26
Glucose: 80-120
Lactate: < 2 - 64List normal TPR, BP, and big 4 for cats?T-100-102.5
P-130-140
R: 16-40
BP-80-140
PCV: 30-45
TP:5.7-8
BUN: 10-30
Glucose:63-130
Lactate: < 2 - 65What are the 5 most common complications of any surgical procedure?1. Adverse anesthesia events
2.Hemorrhage
3.Infection
4.Dehiscnence
5.Seroma - 66What are the 2 most common prophylactic abx given at WSU?Cefazolin and Cefoxitin
- 67How do you prioritize surgical procedures when more than one needs to be done?Always do life threatening first, then might consider, clean over contaminated, Major before minor problem
Remember that contamination can be bacteria or neoplastic cells - 68What must we consider in post op care of our patients?1.Monitor-TPR, MM/CRT, BP, BIG 4, urination and defecation
2.Hydration and electrolytes
3.Analgesia
4.+/- ABX
5.Nutrition/4-6 hours post surgery, bland food
6.Incision-monitor for redness, swelling, ice for 24-72 hours, then warm compress, suture removal in 10-14 days
7.Exercise-2 week restriction with gradual return to exercise - 69What are the possibilities for ascites from hollow viscera?1.Urine
2.BIle
3.GI contents
4.Chyle - 70Differential diagnosis and CS of shock?DxDX:
1.Trauma
2.Coagulopathy
3. Neoplasia
4. Non-neoplastic mass
5.Torsion
CS:
1.Tachycardia
2.Tachypnea
3.Pale MM
4.INcreased CRT
5.Weak pulses
6.Hypotension - 71Blood in abdomen is extravascular if?it does not clot and is intravascular if it does clot
- 725 Initial steps to stabilize our patients with hemoabdomen1. IV fluids to correct deficit
2.Blood transfusion if necessary
3.Stop the bleed
4.Restore BP
5.Oxygen - 73Causes of peritonitis?1.Inflammation
2.Infection
3.Chemical - 74What is the mc cause of contamination in the peritoneal cavity?GI
- 75Explain the pathophysiology of peritonitis?A massive fluid and protein shift into the peritoneal cavity causes hemoconcentration, hypovolemia and hypoproteinemia
The inflammation that causes the fluid and protein shift also results in the release of endotoxin which causes visceral vascular vasodilation and neutrophils dumping into the abdomen, this leads to high hepatic energy demands, metabolic acidosis, septic shock and multiorgan failure - 76CS of peritonitis?1.Vomiting/diarrhea
2.leathrgy
3.Anorexia
4.Distended abdomen
5.Weight loss
6. Ascites
7.Abdominal pain
8.Fever - 77Explain what the fluid from a septic peritonitis looks like?> 5000 cells, mostly degenerative neutrophils
Protein> 4
Bacteria
Absence of bacteria does not rule out septic peritonitis - 78What will glucose and lactate of abdominal fluid caused by septic peritonitis look like?BG will be greater than abdominal fluid glucose by at least 20
Lactate in abdominal fluid will be greater than blood lactate by at least 2
The glucose is used by the bacteria and in turn they produce lactate - 79Treatment of septic peritonitis?1.Fluids, abx, analgesia, vasopressors
Abx need to be broad spectrum and given IV
Unasyn (ampicillin or amoxicillin plus sublactam) + enrofloxacin
Unasyn-G+ and G- aerobes and anaerobes-bactericidal
Enrofloxacin-bactericidal G+ and G-
2nd or 3rd generation cephalosporins - 80DO most cases of peritonitis require surgery?Yes, most do and most are emergencies
- 81What is the amount of lavage fluids for septic abdomens?200-300 ml/kg of PSS
- 82What is the survival rate of animals with septic peritonitis?50%
- 83When can small umbilical hernias close by? When is surgery of umbilical hernias indicated?Umbilical hernias usually close by 6 months if they are going to close on their own.
They most commonly contain fat.
WE want to take them to surgery if:
1.hernial ring size is greater than size of intestinal loop
2.Hernia contains abdominal organs - 84Who are congenital inguinal hernias more common in? What about acquired inguinal hernias?Congenital male
Acquired is female - 85How do you approach umbilical and inguinal hernias?With umbilical you want to incise over the hernia. With inguinal hernias you want to do ventral midline abdominal incisions
- 86When do incisional hernias most commonly appear and why?They commonly appear 3-5 days after surgery , this is do to inflammation that causes swelling of the tissues and can loosen everything up
- 87Lecture 7GIT surgery
- 88List 4 emergency GI surgeries?1. Complete GI obstruction
2.Perforation of GI tract
3.Vovulus or torsion
4.Stragulation of GIT vasculature - 89What are differentials for GI tract obstruction?1.FB
2.Neoplasia
3.Intussussecption
4.Torsion/volvulus
5.Herniation
6.Stricture
7.Extramural compression - 90What are the consequences of GIT obstruction?1.GIT/fluid distension proximal/orad to obstruction
2.Venous and lymphatic stasis in bowel wall
3. Fluid moves into lumen and eventually across serosa
4. Bacteria/toxins move into circulation and across serosa
5.Ischemic necrosis - 91What will cause the acuteness and severity of the signs associated with GIT obstruction to increase?1.Complete obstruction
2.More orad obstruction
3.Strangulation or torsion versus luminal obstruction - 92What is the acid base status if the obstruction is orad to major duodenal papilla or aborad to it?Orad to major duodenal papilla equals vomiting of gastric secretion's and metabolic alkalosis
Aborad to major duodenal papilla means that yo vomit gastric secretions, bile and bicarb from pancreas=metabolic acidosis - 93What can you use as a quick estimate of whether or not a loop of bowel is dilated?Any small intestinal loop should not be bigger than 2.4X that of the vertebral body of L5
- 94What is on your differential list for GI perforation?1.Neoplasia
2.Any cause of GIT obstruction
3.Thrombosis
4.Strangulation
5.Ulceration
6.Trauma
7.Iatrogenic - 95Common locations of GIT perforation?1.Esophagus-cervicalor thoracic region
2.Gastric or intestinal in abdomen
3.Rectal into pelvic canal - 96When is GIT perforation not a surgical emergency?When it occurs in the cervical esophagus and it is small and composed of healthy tissue
- 97Difference between congestion and strangulation and what are the consequences of volvulus/torsion?Congestion is occlusion of a vein only
Strangulation is obstruction of vein and artery
Volvulus/torsion causes obstruction of lumne and vasculature, illeus, ischemia, bacterial translocation, thrombosis, shock and death
Once you correct these there is a high chance of a reperfusion injury - 98What happens in reperfusion injuries and how can we best prevent them?Their is a torsion or volvulus that causes hypoxia, and poor perfusion, then anaerobic metabolism starts and their is production of hypoxanthine and xanthine oxidase. Then when reperfusion occurs oxygen and hypoxanthine and xanthine oxidase form reactive oxygen species, which cause cell death
Prevent this by treating without derotating if possible - 99What GI tract neoplasia should not be removed surgically and why not? How do you safely remove GI tract neoplasia?LSA is usually diffuse and heals poorly, it is better treated with chemo
If we are removing a tumor we need to resect with 4-8 cm margins of healthy intestine on either side - 100What are the MC GI neoplasia's in dogs and cats?Dog-adenocarcinoma
cat-LSA - 101What's your abx plan for routine gastrotomy, enterotomy or Resection and anastomosis without spillage?Prophylactic abx/ 30 minutes before and Q 90 minutes intra op with cessation of abx post surgery if everything went well
- 102What bacteria are commonly present in oral cavity, esophagus, stomach, small intestine, and colon, rectum?Oral cavity-G+, anaerobes, G- if periodontitis.
Esophagus-G+. anaerobes
Stomach-insignificant
Small intestines-G+, G- anaerobes as you go more aborad
Colon, rectum-G-, anaerobes - 103Before incising into a lumen of the GI tract what two steps are crucial?1.Pack off with moist laparotomy pads and milk contents out of incision area and have assistant then occlude each side
- 104How to collect a GIT biopsy?Trim a full thickness piece
- 105How to close stomach?Stomach:
Close with 2-3-0 absorbable PDS. Close in a two layer pattern with simple continuous overlayed with a inverting cushing or lembert.
Include the serosa, muscularis, and submucosa in your layer/do not enter lumen
PDS is monofilament - 106How to close the small intestines?3-0 or 4-0 absorbable monofilament/PDS. Close with simple interrupted sutures all the way around and engaging each of the intestinal layers
- 107What portions of the Gi tract have arcadial blood supply and why is this significant?Jejunum and partially ileum
If you damage a main branch with arcadial blood supply it is usually okay because there is lots of collateral circulation.
Arcadial blood supply occurs when you have many branches going up to supply an area - 108What areas of the GI tract have segmental blood supply and what is the significance of this?Large intestine and rectum, duodenum and esophagus
With segmental blood supply you have one brach on each end and then a long branch running below intestine to provide blood. Thus if you damage one of the main branches ischemia will likely occur - 109What are the 4 signs of viability in the GI tract?1.Pink
2.Pulses
3.Palpation
4.Peristalsis - 110Benefits of enteral feeding?1. Increases GIT blood flow
2.Prevents ulceration
3.Stimulates IS
4.Stimulates wound repair - 111How long can you use nasogastric, esophagostomy and gastrostomy tubes for?Nasogastric-days to a week
Esophagostomy-wks to months
Gastrostomy-wks to months, must stay in 7-10 days before you pull it to allow it to adhere to the body wall and stop leakage into abdomen - 112What kind of food is best for post op feeding?Highly digestible/low insoluble fiber and low fat
- 113Lectures 8 and 9Acute Abdomen
- 114What are the cs of acute abdomen and what classify as causes of acute abdomen that require surgery?The most common CS is the sudden onset of abdominal pain. There can be other cs obviously though
Causes that are surgical:
1.Complete obstruction
2.Perforation
3.Volvulus/torsion
4.Herniation/strangulation
5.Abscess/infection
6.Necrosis ischemia - 115How do we decide if we need to remove a foreign body in the GIT?This depends on the state of our patient, the object and also monitoring to see if the object will move. We also want to pay attention to where it is located, if its past the ileocecal orifice it is likely to pass on its own.
- 116What pennies do we need to worry about causing hemolytic anemia, V/D, red urine, anemia, icterus, etcThose minted after 1983 that contain zinc
- 117What does the GIT mucosa do when it encounters a sharp FB?It dilates do to the mucosal withdrawal reflex
- 118DO you always need current images with foreign bodies?YES, ALWAYS
- 119What happens to the intestines in linear FB's and where is the MC anchor point in dogs and cats?Linear foreign bodies result in bunched up intestines, due to them continuing peristalsis
IN cats=anchor point is under tongue
DOGS anchor point is pylorus - 120Eventual progression of a LFB leads to what?Sawing through of the mesenteric side of the bowel, and causing perforation. They often cause several small perforations and the bowel will then require a resection and anastomosis
- 121What do you see on a radiograph or US that indicate a LFB?Plicated intestines
- 122How to remove a LFB?Remove anchor and allow to zing down GI tract then do gastrotomy or enterotomy to remove it
DO NOT pull on the LFB in the intestines or you risk further damage to the GIT - 123What is an intussusception?It occurs when the intussusceptum slides into the intussuscipien.
The intussusceptum is the inside of the bowel and the intussicipien is the outside of the bowel - 124Where are the 2 most common locations for intussusceptions and what causes them?The most common locations are the ileocecal junction and the jejunum.
Causes:
1.Idiopathic-MC
2.Enteritis
3.Change in bowel pliability/mobility - 125With an intussusception what can you palpate?A firm tubular structure in the abdomen
- 126Best way to diagnose and treat intussusception?DX-US, you'll see a target lesion
TX:
Fix underlying disease if identified, resection and anastomosis, +/- enteroplication - 127When does Bowel become black and distended following a herniation, volvulus or thrombus that result in strangulation.8-12 hours
- 128When to operate on mesenteric volvulus?NOW, DO NOT WAIT
- 129How do Linear FB's progress?Often start as partial obstruction that cause increasing intestinal damage and eventually lead to complete obstruction
- 130Lecture 10-11GDV
- 131Hypoalbuminemia going into surgery can predispose to what post op?Dehiscence
- 132Explain how the stomach moves to form a GDV and what organ systems are affected and what cs are associated with each one?In a normal dog the pylorus sits in the right hand side of the body, in a GDV it starts to move left and ventral and then eventually sits on the left side as it moves ventrally and pulls the omentum over the stomach.
Body systems affected by GDV and CS seen>
1.Gastrointestinal:
1.Retching
2.Abdominal distension and pain
2.Cardiovascular:
1.Hypovolemia
2.Tachycardia
3.INcreased CRT
4.Pale MM
5.Weak pulses
Respiratory:
1.Dyspnea
2.Tachypnea
3.Shalow breaths - 133Explain the pathophysiology of GDV?GDV causes:
1.Compression of the CVC and Portal vein:
This results in hypovolemia, decreased cardiac output, hypotension/Decreased perfusion, hypoxia
2.Pressure on diaphragm-Decreases tidal volume, causes a VQ mismatch and decreases paO2
3.Compresses gastric vessels, wall, and obstructs outflow-fluid gets sequestered and we see electrolyte and acid base imbalances, this contributes to hypovolemia, heart arrhythmia, decreased function, kidney failure
The end result of all 3 is that they cause DIC, multiple organ failure, stomach necrosis, endotoxic shock, SIRS. pancreas necrosis and release of myocardial depression factor that causes arrhythmia - 134The clinical presentation of GDV/Rapid onset abdominal pain, non-productive retching, and abdominal distension, with shock leave you with what two differentials?GDV, gastric dilation with no volvulus and mesenteric volvulus
- 135What are our two top priorities with GDV's?IV fluids and decompression of the stomach at the same time
- 136Fluid rate, type and route for GDV? What are your options to decompress the stomach and how do you do them?Fluids are LRS in front cephalic at 90 ml/kg. Give over 1 hour/ with 1/4 of shock dose being given every 15 minutes, then reassess
Decompression?
orogastric tube 1st choice-measure from nose to 13th rib, lubricate tube and place, do not force
2nd choice-gastrocentesis
3rd choice-intra op decompression - 137What arrhythmia are common in GDV's?VPC
- 138Once patient is stabilized how do you diagnose GDV? Be specificRight lateral radiograph. Only done after IV fluids and decompression of stomach
- 139Other than our normal complications what ones are specific to GDV's?1.Splenectomy if torsion occurs
2.Gastric necrosis
3.Reperfusion injury
4.Arrhythmia-before, during and after surgery - 140Intra op steps for GDV'sDecompress again
DE rotate
Explore
Gastropexy - 141How to perform a Gastropexy?The pyloric antrum needs to sutured to the transvers abdominis muscle.
You will start by making an incision in the pyloric antrum, all the way down through the serosa an submucosa. Then suture the stomach to the body wall starting dorsal most.
The mucosa and submucosa should be left behind - 142When do arrhythmias occur in GDV patients?They can occur before and during surgery, but Most commonly they are seen 12-36 hours post op
- 143Prognosis for GDV?85-90% success rate with surgery
- 144How to try to prevent GDV in large breed dogs with deep chests?1.Feed more than 1 meal a day
2.Avoid exercise in close association with feeding
3.Food dish on ground
4.Prophylactic gastropexy - 145Lecture 12Oral Cavity
- 146When performing oral surgery are prophylactic antibiotics recommended? What bacteria do we need to worry about?Prophylactic antibiotics are recommended for oral surgery.
There are G+, G- anaerobes and aerobes in oral cavity.
Good choices for ABX include:
Clindamycin
Amoclan
Cephalexin - 147Most common cause of dehiscence post op in oral cavity surgery?Tension
- 148Can you ligate the carotid artery in dogs or cats?DOGS yes even bilaterally, cats NO
- 149If a incision in the oral cavity dehisces when do you want to repair it?When the tissue is healthy again, can take several weeks
- 150What is the difference between primary and secondary cleft palate?Primary-lip and premaxilla only
Secondary-hard and soft palate - 151When to repair cleft palates and why wait this long?8 weeks of age
Waiting gives them time to improve BCS, less risk of secondary malocclusion, larger area to work with, less fragile tissue, and better metabolism of anesthetic drugs. - 152What must you communicate to owners who have a dog with cleft palate?1.Preoperative management is intense-tube feed, every 2 hours, large risk of AP and death
2.Surgery at 8 weeks
3.Multiple surgeries are often required
4.Spay or neuter-cleft palate is hereditary - 153Benign oral neoplasia's. Make sure to mention those that invade bone?1.Acnathomatous ameloblastoma-invades bone
2.Peripheral odontogenic fibroma - 154Malignant oral neoplasia's?All invade bone:
1.Malignant melanoma-fast to met
2.SCC-worse in cat than dog
3.FIbrosarcoma
4.OSA
5.Chondrosarcoma - 155What's important to remember with oral tumors?Most invade bone, so what you see is often the tip of iceberg
- 156Where to look for oral tumors?1.Lungs
2.Bone
3.Draining LN - 157Surgical margins for acanthomatous ameloblastoma? Malignant neoplasia?AA-1 Cm margins
Oral malignant neoplasia-3 cm - 158Prognosis for oral neoplasia?1.OSA, MM, maxillary FSA-8-9 months
2.Mandibular FSA-12 months
3.SCC-18 months - 159What is a sialocele?It is a fluctuant non-painful swelling due to an accumulation of saliva that leaks form a SG or duct.
The sialocele does not have a secretory lining, its lined by GT - 160What is the treatment of choice for sialoceles?Excise salivary gland responsible. Must removes mandibular and sublingual salivary glands. They share a common draining duct
- 161What is a ranula?It is a sialocele under the tongue that prevents respiration
- 162Know these salivary gland locations?
- 163What suture is commonly used in the oral cavity?Vicryl/polyglactin 910-it is absorbable and braided-it is softer than monofilament PDS
- 164Are Nsaids okay with oral surgery?Yes, most of the time
- 165What does the fluid from a sialocele look like?It is viscous and yellow-pink with a low cell count
- 166Lecture 13Surgical disease of the esophagus
- 167What CS are consistent with esophageal disease?1.Regurgitation
2.Ptylasim
3.Bulging esophagus
4.Pain on palpation - 168Differential diagnosis for regurgitation?1.FB
2.Neoplasia
3.Stricture
4.Vascular ring anomaly
5.Hiatal hernia
6.Esophageal intussusception
7.Megaesophagus - 169Common causes of megaesophagus?1.Idiopathic
2.Polyneuropathy
3.Congenital
4.MG - 170What are the most common locations for esophageal foreign bodies?1.Thoracic inlet
2.Base of heart
3.Diaphragm - 171What are the layers of the esophagus from inner to outermost?Mucosa, submucosa, muscularis and adventitia
- 172What are the top 3 choices for removing an esophageal foreign body?1. Endoscopy
2.Push into stomach and do gastrotomy
3.Eshophagotomy - 173What is the patient at risk for if an esophageal FB is longstanding?If the FB remains the patient is likely to get an esophageal perforation due to esophagitis and pressure necrosis
- 174Ways to detect esophageal perforations?1.Esophagram-with sterile non-ionic iodinated contrast
2.Endoscopy
3.Surgery - 175How much of the esophagus can you remove?20-30%
- 176What is the most common form of vascular ring anomaly and why does it happen?The most common vascular ring anomaly is PRAA.
It occurs due to a developmental flaw where the aortic arch forms from the right instead of left 4th aortic arch this leads to the ligamentum arteriosum getting pulled over the esophagus and occluding it. - 177What forms the ring that occludes the esophagus and how to diagnose PRAA?Ventrally-pulmonary artery and base of heart
Left and dorsal-ligamentum arteriosum
Right-aortic arch
We diagnose PRAA using radiographs and looking for dilation of the esophagus cranial to the base of the heart - 178Treatment and post op care of PRAA?Tx-surgery to cut ligamentum arteriosum + spay or neuter its inheritable
Post op care:
1.Feed upright with liquid diet to try to prevent AP
2.Switch to normal feed in 1-2 months
3.Recheck esophagram in 1-2 months - 179Who has the highest incidence of Hiatal hernia and why is it hard to diagnose?It occurs most often in sharpeis and brachycephalic dogs
they are hard to diagnose because they can slide back into their normal position - 180Tx options for hiatal hernias?1.Medical management-H2 blockers, GI protectants and prokinetics.
Surgery is MM is not working - 181Conditions that warrant emergency esophageal surgery?1.Gastroesophageal intussusception
2.Esphogeal perforation
3.Esophageal FB - 182Lecture 14Surgical conditions of the colon, rectum, perineum and anus.
- 183What structures can be palpated on a rectal exam?1.Anal sphincter
2.Rectum
3.Pelvic diaphragm
4.Anal glands
5.Pelvic canal
6.Urethra
7.Prostate or vagina
8.Sublumbar LN - 184What are the 7 preoperative steps for surgery of the perineal/perianal area?1.NPO for 24 hours
2.Purge feces digitally
3.Pursestring suture
4.Padding for patient positioning
5.Prophylactic or therapeutic abx
6.Place gauze in rectum
7.Place urinary catheter - 185What is your differential diagnosis for chronic constipation?1.Increased water loss-vomiting, diuretics, or inadequate intake
2.Painful defecation-DJD, etc
3.Aversion to litterbox
4. Mechanical obstruction-intra or extraluminal
5. Functional problem-nerve damage, drugs decreasing motility, ileus
6.Idiopathic megacolon - 186Treatment options for megacolon?Medical management:
1.Diet-adjust moisture and soluble fiber
2.Laxatives and stool softeners
3.Enemas
4.Prokinetics
5.Colectomy-last resort - 187What is colectomy and which species can we do it in and which one can't we?Colectomy is complete removal of the colon it can be done in cats, but not in dogs
- 188What should we warn owners about if colectomy is performed?Their cat will have diarrhea for weeks-months
- 189What is a perineal hernia and what muscles form the pelvic diaphragm?The pelvic diaphragm is composed the coccygeus and levator ani muscles. These muscles provide lateral support to the rectum and prevent the herniation of abdominal contents into the perineal area
- 190What are the predisposing factors for perineal hernias?1.Being an intact male-hormonal influence
2.Weak pelvic diaphragm
3.Straining/tenesmus - 191What is the treatment for perineal hernias?1.Herniorrhaphy
2.Castration
3.Fix cause of straining if present - 192Where are the anal sacs located and what muscles do they sit between?The anal sacs are located at 4 and 8 o'clock
They sit between the internal and external anal sphincters' - 193Treatment for anal sac diseases and how to perform it?To remove anal sacs you want to do a closed anal sacculectomy.
Clear up any infections first before surgery
This involves placing an instrument in the anal sac, then incising the skin over it, and the external anal sphincter, then dissect anal sac from between the external and internal anal sphincters and ligate and transect duct, suture skin closed - 194What are the complications of anal sacculectomy?1.Draining tract and infection if you leave part of the sac in.
2.Fecal incontinence-must maintain 50% of sphincter function - 195What are your differentials for perianal masses?1.Perianal adenoma
2.Perinanal adenocarcinoma
3.Anal sac adenocarcinoma
4.Abscess - 196Who are perianal adenomas most common in?Male intact dogs-hormonal influence, most regress 4-6 weeks post castration
- 197If you have recurrent Perianal adenomas in castrated males or females think about?1.Residual testicular tissue
2.Perianal adenocarcinoma
3.Cushings - 198Who is perianal adenocarcinoma most common in and treatment?Not hormonally responsive/any one gets it
Excise mass and sub lumbar LN's - 199Who are apocrine anal sac adenocarcinomas common in and treatment?Same incidence in males and females
Common to see paraneoplastic syndrome of hypercalcemia with these
They are highly metastatic and go to sub lumbar LNS first, then liver and lungs
Surgery-not me - 200How to differentiate between rectal prolapse and rectal intussesception?Insert probe between anal wall and wall of prolapsed object-if intussesception probe will move in, if prolapse it will not move in
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- Veterinary Medicine Flashcards on Dr. Campbell Surgery , created by Nicholas Vanderholm on 15/04/2022.
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- Nicholas Vanderholm
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