4

Question 1

Describe the pathology of laryngeal paralysis

Answer 1

1. Glottis fails to abduct on inspiration -> inspiratory dyspnoea
2. Glottis fails to adduct during swallowing -> aspiration pneumonia§

Question 2

How is laryngeal paralysis caused?

Answer 2

• Acquired (most common, part of polyneuropathy in mid-large breeds, older, male)
• Congenital eg. white GSDs

Question 3

How is laryngeal paralysis diagnosed?

Answer 3

Laryngoscopy: assess as animal regaining consciousness from light GA. No abduction of glottis during inspiration

Question 4

Describe the clinical signs during emergency presentation and how to combat them?

Answer 4

-cyanosis
-large unproductive inspiratory effort
-‘hollow’ bark
-insp + exp stridor
Sedation-> relaxes larynx, cool, O2 therapy, cage rest

Question 5

How is laryngeal paralysis treated?

Answer 5

Arytenoid lateralisation: suture arytenoid cartilages laterally to permanently open one side of glottis

Question 6

What is brachycephalic airway syndrome and what are the primary disorders?

Answer 6

Shortened nasal cavity in brachycephalic breeds causing soft tissue obstruction of nasal + pharyngeal cavities
(SEEL):
1. Stenotic nares
2. Elongated soft palate
3. Everted laryngeal saccules
4. Laryngeal collapse

Question 7

How would you treat 1. stenotic nares, 2. elongated soft palate?

Answer 7

1. Vertical wedge resection- take wedge out of nostril + stitch open
2. Resection

Question 8

What are everted laryngeal saccades and how are they treated?

Answer 8

Mucosa lining laryngeal ventricles gets sucked out + becomes inflamed/oedematous -> reduces size of glottis -> increases resistance to airflow
Resected

Question 9

What is laryngeal collapse and how is it treated?

Answer 9

Glottis collapses + folds in on itself (dorsal part first)
NO DEFINITIVE SURGICAL TREATMENT. Can try arytenoid lateralisation or perm tracheotomy w/ limited success. Also address other causes of BAS, control weight, limit exercise

Question 10

What are the causes of diaphragmatic hernias?

Answer 10

85% = trauma
10% = unknown (no witnessed trauma)
5% = congenital

Question 11

What are the presenting signs of diaphragmatic hernias?

Answer 11

Dyspnoea + GI signs

Question 12

How are diaphragmatic hernias diagnosed?

Answer 12

PHYSICAL EXAM: dyspnoea + orthopnoea, dull on percussion, muffled heart, auscultation of gut sounds in thorax, shock + external signs of trauma
U/S: abdo organs on pleural side of diaphragm, pleural effusion
RADS: start w/ DV, then lat w/ inflated lung up:
pleural effusion, herniated organs in thorax, loss of continuity of diaphragm, abdo organ detail loss on adbo rads, ‘apparent micro hepatica’ ie. liver herniated into thorax

Question 13

When is immediate surgery for diaphragmatic hernias indicated?

Answer 13

• deterioration despite supportive care
• intrathoracic GDV
• ongoing H+

Question 14

How are diaphragmatic hernias treated?

Answer 14

1. Stabilisation (IVFT, cage rest, O2, analgesia, thoracocentesis)
2. Ventral midline coelitomy w/ table tilted head upwards
3. Reduce contents w/ gentle traction. For parenchymous organs eg. liver -> lift rather than pull through opening as v large, friable and big blood supply
   (If you can’t reduce: enlarge hernia ring, decompress hollow organs, gently disrupt adhesions, medial sternotomy)
4. Suture defect w/ simple interrupted/cont
5. Re-establish -ve pressure by needle thoracocentesis w/ 3 way tap during procedure/intercostal afterwards OR by chest drain

Question 15

What are the complications of diaphragmatic hernias?

Answer 15

• pleural effusion reforming
• pneumothorax
• re-expansion pulm oedema (after forced re-expansion post-op -> alveolar flooding, fatal)

Question 16

Define pneumothorax

Answer 16

Abnormal collection of gas in pleural space causing uncoupling of lung from chest wall

Question 17

List the different classifications of pneumothorax

Answer 17

1. Closed traumatic (e.g.. often fractured rib, common, vast majority seal within 72hours and don’t require trauma)
2. Open traumatic (penetrating injury)
3. Tension = one way valve formed by area of damaged tissue -> air progressively trapped -> emergency (requires chest tube)
4. Spontaneous = primary (unknown) or secondary (underlying pathology e.g.. pulm. cysts, abscess, neoplasia, pneumonia)

Question 18

What are the options for managing pneumothorax?

Answer 18

1. Intermittent thoracocentesis (uni/bilat @ 6-8th intercostal space)
2. Surgery -> refer (if spontaneous/not resolving after 72hrs)
3. Thoracostomy tube placement

Question 19

When would placing a thoracostomy tube for penumothorac be indicated?

Answer 19

• repeated thoracocentesis
• continuous suction required
• pre-emptive following thoracic surgery

Question 20

How would you place a thoracostomy tube and maintain it post-operatively?

Answer 20

1. GA + intubate in dorsal recumbency w/ pad under neck
2. Incise 1/3 circumference between tracheal rings
3. Place suture around tracheal rings
4. Lift up distal stay suture + push tube in
5. Partly close skin + bandage in place

POST-OP CARE: -remove tube every 4-6 hours + clean

• humidify airway
• remove tube asap
• monitor intensively as risk of obstruction if tube dislodges, emphysema, laryngeal paralysis or tracheal stenosis

Question 21

Where are diaphragmatic hernias most often located?

Answer 21

Unilateral, costal + ventral