Exam 1 Flashcards
(154 cards)
1
Q
What are the 4 characteristics of a good surgeon?
A
Honesty
Diligence
Wisdom/humility
Compassion
2
Q
What does the suffix “-centesis” mean?
A
To pierce
3
Q
What does the suffix “-desis” mean?
A
A binding
4
Q
What does the suffix “-ectomy” mean?
A
To excise
5
Q
What does the suffix “-ostomy” mean?
A
Stoma, mouth
6
Q
What does the suffix “-otomy” mean?
A
To incise
7
Q
What does the suffix “-pexy” mean?
A
Fixation
8
Q
What does the suffix “-plasty” mean?
A
Formed or shaped
9
Q
What does the suffix “-orrhaphy” mean?
A
Suture
10
Q
What is the least traumatic method for incising tissue?
A
Scalpel
11
Q
What are the two scalpel handle grips and what are they used for?
A
Fingertip grip - large incision
Pencil grip- small incisions
12
Q
What are the advantages and disadvantages of using scissors?
A
Disadvantages- increased tissue trauma due to shearing force
Advantages- ease of cutting, improved visibility and control
13
Q
What type of scissor tip improves control and visibility?
A
Curved
14
Q
What is the purpose of tissue forceps and what grip should you hold them with?
A
Purpose - tissue manipulation with non-dominant hand
Use pencil grip!
15
Q
What does needle holder size depend on?
A
Needle size, not surgeon size
16
Q
Moving your hand closer to the tip of an instrument decreases _____ but increases ____.
A
Leverage; control
17
Q
What are the 3 grips used to hold needle holders?
A
Thumb-third finger or “tripod” grip
Palm grip
Thenar-eminence grip
18
Q
What are the two classifications of retractors?
A
Self-retaining
Hand-held
19
Q
What is the purpose of using suction tips?
A
To remove blood or fluid from operative site
20
Q
To avoid corrosion, what should you do to instruments before cleaning?
A
Hinged instruments- open them Rinse under distilled or tap water (NOT saline) Hand scrub remaining soil Use instrument milk Separate delicate instruments
21
Q
What are Halsted’s Principles?
A
Gentle handling of tissue Meticulous hemostasis Preservation of blood supply Strict aseptic technique Minimum tension on tissues Accurate tissue apposition Obliteration of deadspace
22
Q
What are the shock fluid doses for dogs and cats?
A
Dogs- 90ml/kg
Cats- 60ml/kg
23
Q
What will a 25% decrease in blood volume result in? 40%?
A
25%- tachycardia, decreased BP
40%- severe shock, death
24
Q
What is primary hemostasis?
A
Platelet plug
vWB factor
Fibrin plug
25
What is secondary hemostasis?
Coagulation cascade (extrinsic, intrinsic, and common pathways)
26
What does PTT and PT test?
PTT- extrinsic and common pathways
| PT- intrinsic and common pathways
27
What might influence an animals ability to coagulate?
```
Drugs (aspirin, rodenticide toxicity)
Acquired conditions (liver disease, DIC)
hereditary conditions (vWB deficiency)
```
28
What should be done first in hemostasis?
Apply pressure
Use pressure pads for 1-5 minutes
29
What do hemostatic forceps do?
Crush vessel
| Injured vessel activates native coagulation mechanism
30
What sized vessels would you use ligation for hemostasis?
Vessels >2mm
31
What is the most secure form of hemostasis?
Vascular ligation
32
What do vascular forceps do?
They are atruamatic and are used when vessel needs to be preserved
33
What topical agents are used in hemostasis?
Gelfoam
Surgicell
Bone wax
Epinephrine
34
What is electrosurgery?
High frequency AC current applied to tissue
| Tissue resistance generates heat which causes cut, coagulation, dessication, etc.
35
What type of electrosurgery requires a grounding unit?
Monopolar
36
What are the disadvantages of monopolar electrosurgery?
Peripheral tissue injury
Improper grounding may result in thermal burns
Cannot us in wet field
Cannot use near heart, spinal cord, etc.
37
What are the advantages of bipolar electrosurgery?
More precise
Can use in wet field
No risk of distant injury
38
What is Ligasure?
Bipolar vessel-sealing device
Senses tissue impedance and automatically adjusts energy and output
Can seal vessels up to 7mm
39
What is the infection rate for clean procedures?
<5%
40
What are the two methods of sterilization?
Physical and chemical
41
What are the most common methods of physical sterilization? Chemical sterilization?
Physical- heat (dry and wet), radiation, filtration
| Chemical - ethylene oxide, gluteraldehyde, H2O2 plasma
42
In steam sterilization, what is pressure used for?
To achieve high temperatures
43
What are the standard temp/pressure/time settings for steam sterilization?
250 F, 15 psi, for 15 minutes
| 262 F, 20 psi for 5 minutes
44
What has the longest shelf life for wrapping sterilized instruments?
Polypropylene peel pouches (12 months)
45
What should you not autoclave?
```
Plastics
Suture material
Electronics
Powders
Glassware
Liquids
```
46
What is ethylene oxide?`
Colorless, odorless, toxic gas used in chemical sterilization
Must aerate objects for hours to days
Temperature range 84-150 F
Can manipulate concentration, humidity, and temperature
47
What is cold sterilization?
Sterilization by immersing items in gluteraldehyde
48
What is sterilization by radiation?
Sterilization using lethal ionization (gamma radiation most popular)
Used in commercially sterile products
49
What are the different types of indicators?
Physical
Chemical
Biological
50
Preparation of the surgical site prior to surgery includes what?
Wide clip
| Antiseptic scrub
51
What is the difference between antiseptic and disinfectant?
Disinfectant is for inanimate objects
| Antiseptic is for person/animal
52
What are the most common types of antiseptics?
Chlorhexidine
Iodophors (betadine)
Alcohols
53
What are some advantages and disadvantages of chlorhexidine solution?
```
Advantages:
Non-irritating
Good residual activity
Not affected by organic matter
Effective against a wide array of microbes
```
Disadvantages:
Allergies/irritation from chronic exposure
Ototoxicity
Corneal toxicity
54
What are some advantages and disadvantages of iodophores?
Advantages:
Cheap
Effective against a wide array of microbes
```
Disadvantages:
Can cause dermal irritation
Decreased activity in organic matter
Unreliable residual activity
Stains
```
55
What are some advantages and disadvantages of alcohols?
Advantages:
Very rapidly acting
Cheap
```
Disadvantages:
Decreased activity in organic matter
Poor residual activity
Drying effects on skin
Rapid heat dissipation
```
56
To minimize trauma to tissue, what needle point is typically used?
Tapered point or diamond point
57
When would you use a straight needle vs. curved needle?
Straight: external procedures
Curved: tighter, smaller areas
58
What is the difference between simple continuous and running suture patterns?
Simple continuous- only advances with new bite
| Running- advancement with new bit AND across tissue
59
What is the difference between a cushing and connell suture pattern?
Connell penetrates into lumen, cushing does not.
Connell has "L" for lumen
60
What does the strength of a surgical knot depend on?
Material used
Length of cut ends
Configuration of knot
61
Pulling ____ rather than ___ will minimize suture friction
horizontally; vertically
62
The ideal suture material is what?
Bioinert
Easily sterilizable without consequences
Handles well and produces secure knots
Cheap
63
How is suture classified?
Absorbable vs non-absorbable
Multifilament vs monofilament
Natural vs synthetic
Coated or impregnated
64
Sutures are absorbed through what two methods?
Enzymatic degradation or hydrolysis
65
What is the difference between multifilament and monofilament?
Multi- flexible, handles well, has capillary action, superior knot security
Mono- stiff, has memory, non-capillary, poorer knot security, more easily damaged
66
What is the difference in absorption rates for natural vs synthetic sutures?
Absorption rate is more variable with natural sutures
67
You would expect moderate to marked tissue reaction with what kind of suture?
Natural
68
What is cat gut?
Absorbable, natural,"twisted"
Made from sheep intestinal mucosa and bovine intestinal serosa
Formaldehyde-treated collagen
50-100% loss of tensile strength within 2-3 weeks
69
What is monocryl?
Synthetic, absorbable, monofilament
Strong but rapidly loses strength - 50% loss of tensile strength in 1-2 weeks
Used for bladder, SQ tissues, vessel ligation
70
What is biosyn?
Synthetic, absorbable, monofilament
| Complete absorption is rapid - 50% of tensile strength within 2-3 weeks
71
What is vicryl?
Synthetic, absorbable, multifilament
Used for intradermal, small vessel ligation, oral surgery
50% loss of tensile strength within ~2 weeks
72
What is dexon?
Like vicryl but with slightly greater knot security
73
What is PDS II?
Synthetic, absorbable, monofilament
Most popular suture in vet med
Slowly absorbed- 50% loss of tensile strength in 5-6 weeks
74
What is Maxon?
Like PDS with greater memory
75
What are the absorbable sutures?
```
Cat gut
Monocryl
Biosyn
Vicryl
Dexon
PDS II
Maxon
```
76
What are the non-absorbable sutures?
Silk
Nylon
Prolene
Stainless steel
77
What is silk?
From silkworm cocoon
Natural, non-absorbable, multifilament
Vessel ligation (PDA, portosystemic shunt)
78
What are braided synthetic non-absorbable sutures?
Very strong
Cheap
Some not even sterile
Tissue trauma
79
What is nylon?
Synthetic, non-absorbable, monofilament
Memory/stiffness/knot security is not the best
Skin is most common use
80
What is prolene?
Synthetic, non-absorbable, monofilament
Strong with good handling
Least likely of non0absorbable sutures to potentiate infection or induce thrombi
Skin, tendon, ligament, herniorrhaphy
81
What is stainless steel suture?
Cheap, autoclave, strong
Poor handling
Cycle to failure
82
What are the functions of skin?
```
Maintain hydration and thermoregulation
Defense against pathogens and chemicals
Vitamin D synthesis
Sensory
Storage
Insulation
```
83
What are the 3 layers of skin?
Epidermis
Dermis
Hypodermis
84
Why is the benefit of the parallel vascular supply in the hypodermis of animals?
Better for wound healing
85
What is the timeline of wound healing?
1. Coagulation (<5 minutes)
2. Inflammation (0-24 hours)
3. Debridement (2-5 days)
4. Proliferation (4-21 days)
5. Maturation (21 days - 2 years)
86
What are some markers of inflammation?
```
Vasodilation (redness, heat)
Leukocytes and serum (swelling)
Platelets
Neutrophils
Macrophages
```
87
What are some markers of debridement?
Removal of necrotic tissue and debris by macrophages ("lag phase")
88
What are some markers of proliferation?
```
Fibroblast influx
Macrophages
Agiogenesis (VEGF)- Granulation tissue formation
Epithelialization
Contraction (myofibroblast)
```
89
What are some markers of maturation?
Collagen remodeling
90
What dose the wound healing curve look like?
Lag phase- debridement (macrophages)
Log phase- fibroblasts
Tissue tensile strength inverse to suture tensile strength
91
What are examples of intrinsic wound factors?
```
Hypoporteinemia
Anemia
Malnutrition
Uremia
DM
```
92
What are examples of extrinsic wound factors?
Mechanism
Foreign material
Irradiation
Antiseptics
93
What are the different types of wound classifications?
1. Based on time and contamination
| 2. Based on surgical factors
94
What is the clinical significance of wound classifications?
Let's you know how to close the wound and when
95
Wound classification based on time and contamination
Class 1: 0-6 hours, minimal contamination, primary closure
Class 2: 6-12 hours, moderate contamination, probably shouldn't do a primary closure
Class 3: >12 hours, gross contamination, never close!
96
Wound classification based on surgical factors
Clean (SSI 5%)
Clean-contaminated (SSI 10%)
Contaminated (SSI 30%)
Dirty (Already infected)
97
In what type of wound classification warrants antibiotic use?
Anything besides class 1, clean wounds
98
What do you use to lavage a wound?
0.9% saline
Pressure cuff 300 mmHg
16-22 ga needle
Liberal volume
99
What should you use to wet a wet-to-dry bandage?
Hypertonic saline
100
What are the two types of drains?
Active - vacuum
| Passive - gravity
101
How long should a drain stay in?
3-5 days
| Longer than this indicates something is wrong, wound is infected, etc.
102
What are the types of wound closure?
```
Primary (<6 hours)
Delayed primary (after 6 hours but before granulation)
Late secondary (after granulation)
Second intention (no surgical closure, dependent on wound healing)
```
103
What are the layers incised to perform a celiotomy?
```
Skin
SQ tissue
Linea Alba
Retroperitoneal fat
Peritoneum
```
104
What are the holding layers in celiotomy closure?
Linea Alba
| External Rectus Abdominus Fascia
105
Why should you avoid large bites of muscle when closing celiotomy?
Muscle necrosis loosens closure
106
What type of suture would you want to use to close fascia?
```
Absorbable, monofilament, long retention of tensile strength
PDS, Maxon, Vicryl
Non-absorbable used when slow healing is anticipated
Stainless Steel, Nylon
Size:
<5kgs - 3-0
5-15kgs - 2-0
20-40kgs - 1
Horse - 3
```
107
What are some general guidelines to follow during skin closure?
Keep tissues hydrated
Avoid undermining
Avoid excess manipulation
108
Closing the subcutaneous layer functions to what?
Minimize deadspace
109
What type of suture would you want to close SQ layer?
Monofilament, absorbable, small diameter (1-2 sizes smaller than linea)
PDS, Vicryl, Maxon, Monocryl
Does not require prolonged retention of tensile strength
110
What type of suture would you use for cutaneous layer?
Monofilament, non-absorbable or absorbable
Reverse cutting needle
Nylon, prolene, fluorofil
Cut ends 8-10mm for ease of removal
111
What are some indications for intradermal patterns in skin closure?
Clean wound
Healthy patient
Minimal to no tension
Mass removal or elective spay/neuter
112
What type of suture would you use for intradermal sutures?
Absorbable, monofilament
Vicryl, PDS, Monocryl
Small diameter
Reverse cutting needle
113
What are some pros and cons of using staples?
Pros - decreased operative time
Cons- increased cost, not suited for wounds under tension or thin skin
114
What is included in pre-operative care?
Signalment/presenting complaint/history
Physical exam
Diagnostics (BW, imaging, etc)
Treatment/stabilization (IV access, fluids, oxygen)
115
What are the classifications of surgical risk?
Minimal
Moderate
High
Extreme
116
What are the ASA classifications?
I - normal, healthy patient
II- non-clinical systemic disease
III - systemic disease with clinical signs
IV - severe, potentially life-threatening disease
V - moribund, not expected to survive 24 hours
117
What are the indications for a blood transfusion?
PCV < 20-25%
| >30% blood loss
118
What are some examples of blood products?
```
Fresh whole blood
Packed red cells
Fresh frozen plasma
Frozen plasma
Cryoprecipitate
```
119
When should peri-operative prophylactic antibiotics be given?
<60 minutes but >30 minutes from start of Sx
120
What are some advantages of laparotomy?
Full thickness intestinal biopsies
Organ biopsy/excision
Ability to address/obtain hemostasis
Option for therapeutic intervention
121
?What are some disadvantages of laparotomy?
Increased morbidity (pain, anesthetic risk, cost, dehiscence, infection)
122
What are some therapeutic indications for laparotomy?
```
Free gas
Dilated SI
Foreign body
Herniation
GDV
Abdominocentesis (blood, urine, bacteria, bile)
```
123
What is in the cranial quadrant of the abdomen?
Diaphragm
Liver, gallbladder
Stomach
Pancreas
124
What is in the mid-abdomen
Spleen
Intestine
Mesenteric lymph nodes
125
What is in the caudal quadrant of the abdomen?
Colon
Bladder
Prostate/Uterus
126
What is in the abdominal gutters?
Kidneys
Ureters
Adrenal
Ovaries
127
In LA GI surgery, where should the initial incision be made?
Midline alone linea alba
| 10-12 inches long
128
In LA GI surgery, what are examples of non-ischemic and ischemic diseases?
Non-ischemic: obstruction, non-strangulating displacements
| Ischemic: strangulating lesions, infarction
129
In LA GI surgery, what can be exteriorized from abdomen?
Jejunum
Apex and body of cecum
Middle of small colon
Most of large colon
130
In LA GI surgery, what cannot be exteriorized from abdomen?
```
Stomach
Duodenum
Part of ileum
Base of cecum
Small colon
R Dorsal colon
Transverse colon
```
131
What are clinical signs associated with enteroliths in horses?
Low-grade, recurrent colic
132
In right dorsal displacement of the colon, the pelvic flexure moves _____.
Cranial
133
What is the treatment for nephrosplenic entrapment/left dorsal displaced colon?
IV phenylephrine and mild exercise
Rolling
Surgery
"Cure by trailer ride"
134
What is GR trocar?
Instrument used to prevent recurrence of nephroplenic entrapment- barbed suture to prevent from moving backwards
135
Strangulating lipomas are most common in what part of equine intestine?
Small intestine
136
Cribbers are more prone to what disease?
Epiploic foramen entrapment
137
What is the difference between inguinal hernias in adult horses vs foals?
Adult: acquired, very painful, needs emergency surgery
Foals: congenital, no strangulation, not painful, usually will go away with time
138
How do you assess viability of tissue with fluorescein?
Strangulated/ischemic tissue does not take up dye and will not fluoresce
139
How much of the equine SI be removed safely?
<40 feet
140
How can you avoid over-inversion of intestine during surgical anastamoses in equine GI surgery?
Cut intestine at 60 degrees
Use lembert suture
Suture close to edge of tissue
141
What are some predispositions that quarter horses have? Broodmares? Foals?
Quarter horses - HYPP
Broodmares - osteopenia
Foals - ascarid impaction
142
What is the risk of death for healthy horses undergoing anesthesia?
1/1000
143
Risk of anesthesia in horses depends on what?
Primary disease
| Overall health
144
When do you fast LA before surgery?
Horses - only with specific procedures where decreased GI fill is needed, NEVER in neonates
Ruminants - fast for 48 hours, NPO 24 hours, no fasting in neonates
145
What should you consider in a location for field procedures (LA)?
```
Shade
Soft ground
Sufficient space for recovery
Relatively clean
Away from other animals
```
146
What are some potential consequences of improper positioning of LA during surgery?
Myopathy (from ischemia)
| Neuropathy (from excessive pressure on nerves)
147
What are some guidelines for positioning LA during anesthesia?
Thick padding
Entire body on pad
Remove halter or other tack
Lateral: Dependent forelimb pulled forward
Dorsal: keep hindlimbs flexed, shoulder trough well padded
148
When is the most dangerous time for equine patients during anesthesia?
Recovery
149
What are some potential post-anesthetic complications that horses experience?
Impaction colic
Increased risk of GI disease/colitis (from NSAID, antimicrobial therapies)
If has cast or splint- pressure sores
150
What are some common complications of LA surgery?
```
Anesthesia complications (myopathy, neuopathy)
Hemorrhage
Airway obstruction
Infection
Dehiscence
Post-op colic
Laminitis
```
151
What muscles are at risk for myopathies in LA surgery?
Masseter
Triceps
Gluteal
152
What nerves are at risk for neuropathies in LA surgery?
Facial n
| Radial n
153
What is the risk of fractures or ST injury in post-anesthetic period for LA?
2/1000
154
Chances of infection following LA surgery increase with ____.
length and type of surgery
