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Year 3 respiratory > surgical conditions > Flashcards

surgical conditions Flashcards

1
Q

what would be a clinical sign of a congenital rhinarium deformity?

A

nasal discharge

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2
Q

what are 6 causes of nasal discharge?

A 
chronic hyperplastic rhinitis
trauma
dental disease
intranasal neoplasia
mycotic rhinitis
foreign body
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3
Q

what is chronic hyperplastic rhinitis?

A

prolonged inflammation in the nasal cavity stimulates hyperplasia of mucous memebranes and increased mucous secretion

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4
Q

how can you treat chronic hyperplastic rhinitis?

A

rhinotimy and turbinectomy if severe and intractable

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5
Q

when would you surgically intervene with nasal trauma?

A

if need to orthopaedically elevate depressed fragments

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6
Q

what nasal discharge can be seen with dental disease?

A

mucopurulent discharge, epistaxis

unilateral

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7
Q

what neoplasias are common intranasally?

A

carcinoma
adenocarcinoma
chondro/fibro/osteo-sarcoma

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8
Q

when would you surgically intervene with mycotic rhinitis?

A

if medical penicillin fails so place irrigation tubes to facilitate enilconazole therapy

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9
Q

what is seen with a congenital defect in the palate?

A

failure to thrive
cant suckle
nasal return of milk
resp signs of aspiration pneumonia

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10
Q

how can you get an acquired palate defect?

A

trauma
electrical burns
tooth extraction
forceful separation

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11
Q

what signs would you see with an acquired palate defect?

A

aspiration pneumonia
chronic nasal discharge
sneezing

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12
Q

what are the primary and secondary consequences of bracycephalic airway obstruction syndrome?

A

primary - stenotic nares, long soft palate

secondary - eversion of lateral laryngeal ventricles, laryngeal collapse, tracheal hypoplasia, redundant pharyngeal mucosa, scrolling of epiglottis

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13
Q

what are the signs seen with brachycephalic airway obstruction syndrome?

A

exercise intolerance
dyspnoea
noise on inspiration and expiration
acute cyanosis and collapse with stress/heat

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14
Q

how do you diagnose brachycephalic airway obstruction syndrome?

A
  • thoracic rads - often pulmonary oedema
  • lateral rad of larynx
  • pharyngeal and laryngeal examination
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15
Q

what are the surgical options for brachycephalic airway obstruction syndrome?

A

1) rhinoplasty - bigger nostrils
2) staphylectomy - trim soft palate to level of caudal pole of tonisl
3) resect everted mucosa of lateral laryngeal ventricles
- temporary tracheostomy?

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16
Q

what are the post-op recommendations for brachycephalic surgery?

A
  • monitor very closely
  • keep quiet for 7-10 d
  • no exercise for 2 w
  • soft food for 3-5 d
  • suture out and chest rads in 10-14 d
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17
Q

what breed is tracheal hypoplasia common in?

A

bulldogs

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18
Q

how do you manage tracheal hypoplasia?

A

nothing is have a good URT

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19
Q

when would you consider a tracheotomy?

A
  • before URT surgery

- emergency to bypass URT obstruction

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20
Q

how do you manage a tracheotomy tube?

A
  • remove and clean sleeve every 2 hrs
  • nebulise every 4 hrs to keep mucous loose so can come out of tube
  • limit physical activity
  • remove tube once have adequate upper airway movement
  • suction only if really necessary
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21
Q

how do you place a tracheotomy tube?

A

1) ventral midline skin incision 2-4 cm caudal to larynx
2) separate sternohyoid/sternothyroid muscles in midline to reveal trachea
3) place stay sutures around tracheal rings
4) incise between 4th and 5th tracheal rings between the stay sutures
5) place tube in lumen
6) close skin around tube and secure
7) leave stay sutures in so can reposition if needed

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22
Q

what are 4 surgical laryngeal conditions?

A

laryngeal collapse
laryngeal paralysis
laryngeal neoplasia
granulomatous laryngitis

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23
Q

what are 2 emergency obstructive crisis’s?

A

laryngeal collapse

laryngeal paralysis

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24
Q

what can you do for laryngeal collapse?

A

orotracheal intubation
salvage and place permenant tracheostomy
partial laryngectomy

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25
Q

what are the 3 ways to get laryngeal paralysis?

A

congenital (bouvier des flandres, husky)
acquired (trauma, neoplasia, secondary to polymyopathy)
idiopathic (labrador, retriever, afghan, st.bernard, setter)

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26
Q

what are the signs associated with laryngeal paralysis?

A 
progressive exercise intolerance
dysphonia
increased resp noise (man sawing wood) on insp
cough
cyanosis and collapse
aspiration pneumonia
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27
Q

what do you do if faced with an obstructive crisis?

A
  • sedate with low dose ACP
  • oxygen
  • cool IV fluids
  • external body cooling
  • rapid induction and orotracheal intubation if needed
  • tracheostomy
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28
Q

what are the surgical options for laryngeal paralysis?

A
  • left arytenoid lateralisation (suture cartilage to thryoid) or laryngoplasty (suture to cricoid)
  • pallative but have aspiration risk
  • will cough for 2-3 wks post op
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29
Q

what are the common laryngeal neoplasia?

A 
congenital rhabdomyosarcoma
sq cell carcincoma
adenocarinoma
chrondrosarcoma
fibrosarcoma
lymphoma
30
Q

what do you never do with a patient with laryngeal neoplasia?

A

place an ET tube

31
Q

what signs are seen with laryngeal neoplasia?

A

dysphonia
sonorous respiration
exercise intolerance
respiratory distress

32
Q

how do you diagnose granulomatous larynitis?

A

biopsy

33
Q

what are 3 tracheal conditions?

A

tracheal collapse
tracheal trauma
tracheal FB / obstruction

34
Q

what can predispose to tracheal collapse?

A
  • toy and small terriers
  • poor tracheal cartilage development
  • LRT inf
  • heart disease
  • laryngeal dysfunction
35
Q

what are the signs of tracheal collapse?

A
  • goose-honk cough
  • vibrant inspiratory and expiratory noise exacerbated by excitement and exercise
  • cyanosis and collapse
  • can occlude trachea on palpation
36
Q

what are the 2 common presentations of tracheal collapse?

A
  • primary collapse in the young

- middle aged collapse with concurrent disease

37
Q

how do you diagnose tracheal collapse?

A

fluoroscopy and endoscopy to see dynamic collaspe

38
Q

what are the surgical options for tracheal collapse?

A
  • stent if old as a pallative measure as lasts 3-4 yrs
  • prosthetic rings around trachea to hold open if primary collapse
  • treat underlying disease
39
Q

what signs may be seen with tracheal trauma?

A

subq emphysema

  • pneumomediastinum and pneumothorax
  • resp distress
40
Q

how do you diagnose tracheal trauma?

A

peritracheal + intramuscular subq emphysema on rads

bronchoscopy to locate lesion

41
Q

what is seen with primary lung tumours?

A

cough with haemoptysis
dyspnoea
lethargy
wt loss

42
Q

how can you surgically treat lung tumours?

A

lung lobectomy

43
Q

what is a spontaneous pneumothorax?

A

when lung is source of leak and air is atmospheric
- caused by: ruptures bullae/bleb, migrating inhaled plant material, bacterial pneumonia, chronic obstructive lung disease, asthma, TB, pulmonary neoplasia, parasites

44
Q

what are signs of a spontanous pneumothorax?

A

tachypnoea
dyspnoea
exercise intolerant
no lung sounds

45
Q

how do you treat a spontaneous pneumthorax

A
  • drain with thoracocentesis to stabilise
  • exploratory thoracotomy and fill thorax with saline to find holes and remove diseased lobe
  • chest drain for prolonged evacuation
46
Q

what dogs are more common to get a lung lobe torsion?

A

narrow deep chested

47
Q

what lung lobes are most commonly affected by torsion?

A

R middle and R cranial

48
Q

what can lung lobe torsion be associated with?

A 
pleural effusions
trauma
thoracic surgery
neoplasia
chronic resp distress
49
Q

what signs are seen with lung lobe torsion?

A

depressed,, inappetant, febrile, dyspnoea, cough, muffled lung sounds

  • pleural fluid and necrotic lung lobe
50
Q

how do you diagnose a lung lobe torsion?

A

thoracocentesis
US
CT

51
Q

how do you surgically repair a lung lobe torsion?

A

lung lobectomy

DONT untwist as will release infl mediators and necotic toxins

52
Q

how can you get an acquired diaphragmatic rupture?

A
  • blunt trauma causing a sudden elevation in intra-abdominal pressure that results in rapid forced expiration when the glottis is open
  • get pleuroperitoneal pressure gradients which results in rupture of the weakest part of the diaphragm
53
Q

what signs are seen with a acquired diaphragmatic rupture?

A 
dyspnoea
reduced lung volume
effusion from trapped organs
hydrothorax
GI signs from trapped organs
muffled heart sound
loss of lung sounds
'empty' abdomen on palpation
54
Q

how can you diagnose a diaphragmatic rupture

A

rad - contrast?

and repeat rads after removing effusion as may mask cause

55
Q

how do you treat an acquired diaphragmatic rupture?

A
  • if acute then can allow 24 hrs to stabilise before surgery
  • break down any adhesions between abd and thoracic organs
  • place a thoracostomy tube before closing defect
56
Q

when must surgery become an emergency with diaphragmatic rupture?

A

if the stomach is in the thorax then need to deflate it so can breath and maintain a gastric tube until surgery

57
Q

what is the process behind a congenital peritoneopericardial diaphragmatic hernia?

A
  • failure of septum trasversum to advance leaving space between the two advancing lateral pleuroperitoneal folds
  • or failure of the lateral pleuroperitoneal folds to unite
  • or due to intrauterine trauma
58
Q

when is surgery elective with a congenital hernia?

A

in older patients if stable

59
Q

in young animals how is a congenital diaphragmatic hernia repaired?

A

-quickly surgically to prevent adhesions

60
Q

what is a congenital oesophageal hiatal hernia?

A
  • defect in formation of the hiatus
  • either the abdominal oesophagus and cardia slide into thoracic cavity or a portion of the stomach enters the thoracic cavity adjacent to abdominal oesophagus
61
Q

what breed is an oesophageal hiatal hernia hereditary?

A

shar-pei

62
Q

what signs are seen with a oesophageal hiatal hernia?

A
  • chronic gastroesophageal reflux
  • regurg and vom
  • chronic oesophagitis
  • oesophageal hypomotility
  • aspiration pneumonia
  • ill thrift
63
Q

how do you diagnose an oesophageal hiatal hernia?

A
  • rads - gas filled viscus in dorsocaudal thorax

- alveolar pattern in cranioventral lung fields from asp pneumonia

64
Q

how do you surgically repair a oesophageal hiatal hernia?

A

1) return stomach
2) close defect beginning dorsally
3) oesophagopexy between oesophagus and hiatus
4) gastric fundupexy

65
Q

what is an example of a non-penetrating thoracic wall trauma?

A
  • rib fractures

- superficial bite wounds

66
Q

what is the difference in management between a penetrating and non-penetrating thoracic wall trauma?

A

-penetrating needs an exploratory thoractotomy to remove devitalised tissue, provide wound drainage and close wall

67
Q

how do you manage a patient with multiple fib fractures?

A
  • stabilisation is key as can relieve pain and improve ventilation
  • may need mechanically assisted ventilation until definitive repair
68
Q

what tumours of the thoracic wall are common?

A

-osteosarcoma and chondrosarcoma from costochondral junction

69
Q

what can cause pulmonary osteoarthropathy?

A

lameness - from a thoracic wall tumour

70
Q

how can you surgically remove thoracic wall neoplasia?

A

full thickness wall resection and reconstruction

Year 3 respiratory (11 decks)

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