exam 1 material Flashcards
(179 cards)
1
Q
define absorbable suture
A
loss of tensile strength within 60-90 days
2
Q
define non-absorbable suture
A
retains tensile strength >60 days
3
Q
describe catgut/chromic gut
A
natural, completely absorbed in 2-3 weeks, high reactivity, chromium gut has chromium salt added to decrease reactivity, accelerated loss of tensile strength in infected wounds
4
Q
name some uses for catgut/chromic gut
A
ligation of small vessels, rapidly healing tissue like mucosa, gingeva
5
Q
describe monocryl
A
poligelecaprone 25, monofilament, synthetic, absorbable, 50% loss of tensile strength at 1 week
6
Q
uses for monocryl
A
subcutaneous tissue, bladder
7
Q
decribe vicryl
A
polygalactin 910, braided multifilament, synthetic, 50% tensile strength lost at 2-3 weeks
8
Q
describe vicryl rapide
A
vicryl treated with irradiation that loses 50% strength at 5 days
9
Q
when should you not use braided suture
A
infected wounds and delicate tissue
10
Q
describe PDS
A
polydiaxanone suture, monofilament, synthetic, longest lasting of absorbables, 50% strength at 5-6 weeks
11
Q
describe silk
A
natural, braided multifilament, high reactivity, 56% tensile strength at 12 weeks
12
Q
describe prolene
A
polypropylene, monofilament, resistant to degradation, non-absorbable, low tissue reactivity
13
Q
uses for prolene
A
tendons, ligaments, joint capsule, fascia, things you want to hold as long as possible
14
Q
describe nylon
A
polyamide, usually monofilament, non-absorbable, 50% tensile strength at 12 weeks in acidic environment
15
Q
most common feline cutaneous neoplasm that likes the ear
A
basal cell tumor
16
Q
second most common feline cutaneous neoplasm
A
mast cell tumor
17
Q
who can benefit from lateral ear canal resection? what does it acheive?
A
mildly affected patients with chronic ear infections, no stenosis, no boney changes. allows owner to get drops directly into the horizontal canal
18
Q
who can benefit from vertical ear canal resection
A
when vertical ear canal is affected, but horizontal is clear. uncommon
19
Q
what are the indications for total ear canal ablation
A
unresponsive chronic otitis externa, stenotic canals, failed previous resections, neoplasia, soft tissue extension of infection
20
Q
what procedure must be paired with a total ear canal ablation
A
lateral bulla osteotomy
21
Q
what is the goal of lateral bulla osteotomy? what is special about this procedure in cats?
A
improves drainage by removing secretory epithelium. cat bulla has 2 chambers and both must be treated
22
Q
what procedure can be done for otitis media
A
TECA with LBO
23
Q
how do you remove a nasopharyngeal polyp? bulla polyp?
A
traction and VBO, respectively
24
Q
what procedure can be done for otitis interna
A
establish drainage usually with VBO. signs may or may not improve
25
where do large breeds vs brachycephalics usually get entropion
lateral canthus and medial canthus, respectively
26
who can benefit from temporary tacking for entropion
young animals or those with high anesthetic risk or spastic entropion
27
what is the most common surgical technique for permanent correction of entropion
hotz-celcus
28
what techniques may be combined for entropion involving the lateral canthus
holz-celcus and lateral wedge resection
29
what are indications for tarsorrhaphy
proptosis, lagophthalmos
30
how are proptosis and exophthalmus different
proptosis involves the eyelid entrapped behind the globe
exophthalmus has the globe pushed forward but no entrapment of lids
31
what are good prognostic indicators for vision following proptosis
menace, dazzle, consensual PLR
32
what are indications for enucleation with a proptosis case
ruptured globe, optic nerve avulsion, 3 or more extraocular muscles severed, complete hyphema
33
how are eye meds applied after tarsorraphy
medial canthus left open
34
what structures are removed in enucleation
globe, third eyelid and gland, conjunctiva, eyelid margins with meibomian glands
35
what are the indications for enucleation
-blind, painful eye
-ocular congenital defects resulting in chronic problems
-severe intraocular infections with significant globe destruction and source or systemic infection
-extensive intraocular tumors
-extensive intraocular inflammation that is uncontrolled and/or blind
-extensive trauma
-end-stage glaucoma
36
what are the two approaches to enucleation
subconjunctival - faster and less pain
transpalpebral - preferred for severe infection and large neoplasia
37
how much of the eyelid margin is removed to include the meibomian glands
5-8mm
38
what are the layers of closure for enucleation
orbital cone, subQ, skin
39
are eyelid tumors more aggressive in dogs or cats
cats. remove as soon as you see it or it will just get harder
dog eyelid tumors usually benign
40
what size tumors are able to be removed with wedge or house resection
involving <1/3 of lid length
41
what are the layers of a wedge resection or lateral canthotomy closure
tarsoconjunctival later and skin layer
use figure 8 for margin of skin closure
42
what is the normal size of the kidneys
2-2.5 x length of adjacent vertebrae
43
how much kidney function is lost in an azotemic patient
>75%
44
why are we moving away from renal needle biopsy and nephrotomy
damage to kidney
45
why is pyelolithotomy preferred over nephrotomy
no occlusion of renal blood flow, no damage to renal parenchyma
but moving away from this as well
46
where should you ligate ureters during a nephrectomy
close to the bladder to decrease risk of infection of blind stump
47
why should ureter surgery be preformed by specialists
prone to leakage and stricture
48
what is neouteterocystotomy for
treatment of ectopic ureters
49
what is ureterotomy for
removal of calculi
50
what do you have to be careful of at the bladder trigone
ureters enter there, so avoid suturing this area
also, a lot of cell regeneration occurs there, so be careful in general
51
why do you have to be careful with the lateral ligaments of the bladder
ureters and umbilical arteries live there
52
what is the blood supply to the bladder
cranial vesicular artery in 50% of adult dogs (branch of umbilical artery), caudal vesicular artery (branch of urogenital a.), internal pudendal veins
53
what is the innervation to the bladder
hypogastric (sympathetic, retention), pelvic (parasympathetic, bladder emptying, pudendal (somatic, to external urethra sphincter)
must preserve nerves during surgery to preserve bladder function
54
how do you ensure no leakage after closing cystotomy
retrograde flush
55
how long for cystotomy site to heal
14-21 days
56
which direction should you flush when doing cystotomy for calculi
normograde and retrograde. finish with retrograde
57
what must you do after stone removal surgery
post-op radiographs! 15-20% have residual stones
58
how much of the bladder can be removed
75%
59
what are the preferred locations of urethrostomy in dogs and cats
scrotal in dogs, perineal in cats
60
should you place a catheter after perineal urethrostomy
no!
61
what is the quantitative definition of infection
10^5 bacterial organisms/gram
62
how long does it take a normal skin wound to heal
7-14 days
63
what percent of clean surgeries become contaminated? infected?
100% contaminated
2-5% infected
64
what are good go-to antibiotics for surgical site infection
cephalexin as 1st line
clavamox as 2nd line
65
define clean surgery
do not enter organs and no current infection
66
define clean contaminated surgery
enter hollow viscous organ without spillage
67
define contaminated surgery
spilled contents from hollow organ during surgery
67
define dirty surgery
enter surgery with active infection
ex: pyometra, cystotomy w/ UTI, pyoderma
68
what endocrinopathies increase risk of surgical site infection
hyperadrenocorticism, hypothyroidism
68
what are the most important factors in preventing surgical site infection
aseptic technique and maintaining healthy tissue
69
what NRC surgical classifications should you give perioperative antibiotics to?
clean-contaminated, contaminated, and dirty
not clean!
70
what are halsted's principles
gentle tissue handling, meticulous control of hemorrhage, strict aseptic technique, preserve blood supply to tissues, eliminate dead space, appose tissues accurately with minimal tension
71
what NRC surgical classifications should you give therapeutic antibiotics to?
dirty (contaminated is controversial)
71
what are the key points to prophylactic antibiotics
target expected bacteria, ensure peak tissue concentration at the time of incision and throughout period of contamination, discontinue within 24 hours of surgery
72
T/F: aseptic scrubbing gets rid of all bacteria on the skin
F - 20% remains after scrub b/c bacteria live in hair follicles
73
what is the suggested perioperative antibiotic for most surgeries? when should it be given?
cefazolin 30-60 min prior to incision and redosed every 90 min
74
what is the rule of thumb for redosing antibiotics during surgery
time dependent antibiotics should be given every 2 half lives as long as incision is open
75
T/F: postoperative antibiotics are not indicated for prophylaxis
T - prophylactic antibiotics should be discontinued within 24 hours of surgery
exceptions - some implants where infection would be disastrous, devitalized tissue or dead space you can't eliminate
76
what are the main cells active in the inflammatory phase of healing and what do they do
1 - platelets form blood clot and send signals to attract neutrophils
2 - neutrophils kill bacteria, debride necrotic tissue, and attract macrophages
3 - macrophages are the "master conductors", day 3-5, phagocytosis
76
what are the classic signs of inflammation
heat, redness, swelling, loss of function
77
what are the gross characteristics of the inflammatory phase of healing? how long does this last?
cardinal signs of inflammation, purulent exudate, more exudate than wounds in proliferative phase, necrotic tissue, lasts 5-6 days
78
if necrotic skin is present, what stage of healing is the wound in
inflammatory
79
what cells are key to the proliferative phase of healing
fibroblasts
80
what are the gross characteristics of the proliferative phase of healing? when does this phase begin?
glanulation tissue (angiogenesis and collagen), epithelialization, contraction. starts around day 4
80
T/F: granulation tissue is prone to infction
false. HIGHLY resistant to infection
80
what cells are responsible for wound contraction
myofibroblasts
81
describe contraction vs contracture
contraction is a normal process that shrinks wounds
contracture is contraction that occurs over joints or natural orifices and is a pathologic process
82
what happens during the maturation phase of wound healing
closed wound strengthens, but never reaches the original strength
83
neutrophils need oxygen to work. below what level impairs their function
below 40 mmHg
83
does the center of a wound in the inflammatory phase have increased or decreased oxygen
decreased b/c larger gap between vessels
84
does the center of a wound in the proliferative phase have increased or decreased oxygen
granulation tissue has increased capillary density, so increased oxygen
85
how can the doctor control the phases of healing
debride to shorted the inflammatory phase
86
why does poor tissue oxygenation delay wound healing
neutrophils rely on oxygen, so increased risk of infection
collagen production requires oxygen, so shower proliferation
87
when you see a patient with a fresh wound, how do you decide to give antibiotics or not
contamination becomes infection in 6 hours. if you get to the wound before 6 hours, you can lavage and prevent infection. after 6 hours, should give antibiotics
87
what should you use to clean a wound
same solutions you use for surgical prep. not scrub! nothing with bubbles b/c hey inhibit fibroblasts
87
what is the best way to debride a wound
surgically!
87
what is autolytic debridement
done by the body and takes weeks
88
if in doubt, cut it out. but...
if it's skin, leave it in.
(dead skin reveals itself after a few days. be more aggressive with debridement of subQ and muscle)
89
what is the most effective way to reduce bacterial numbers on the surface of a wound
lavage
saline ideal, but may use any IV fluid or tap water
may add chlorhexidine solution or povidone iodine solution
90
what is the ideal pressure for lavage
8 psi
91
what is primary wound closure
closing the wound the day you meet it
92
what is delayed primary wound closure
closing days later, but before granulation tissue
93
what is secondary wound closure
closing skin over granulation tissue
94
what is second intention healing
allowing the wound to heal by contraction and epithelialization
95
when should you not use primary closure
dirty/infected wounds, if waiting for new tissue to declare itself dead, burns, bite wounds, gunshot wounds, snake bites, too much tension
96
what are the goals of the primary bandage layer during the inflammatory phase
debridement and reduce bacterial contamination
97
what are the goals of the primary bandage layer during the proliferative phase
don't disrupt new tissue, hold cells and cytokines in. want something non-adherent and occlusive
98
what general type of wound dressings are recommended
moist wound healing dressings
99
describe telfa + triple antibiotic in terms of debridement, antibacterial, non-adherent, and occlusive
no debridement
very antibacterial
is non-adherent
is occlusive
100
describe petroleum infused gauze in terms of debridement, antibacterial, non-adherent, and occlusive
no debridement
no antibacterial
is non-adherent
is occlusive
101
describe honey/sugar in terms of debridement, antibacterial, non-adherent, and occlusive
yes debridement
pretty antibacterial
is non-adherent
+/- occlusive
102
describe hydrogel in terms of debridement, antibacterial, non-adherent, and occlusive
no debridement
no antibacterial
pretty non-adherent
pretty occlusive
uncommonly used
103
describe polyurethane foam in terms of debridement, antibacterial, non-adherent, and occlusive
no debridement
no antibacterial
pretty non-adherent
is occlusive
basically bandaids/probably won't stay on
104
describe calcium alginate in terms of debridement, antibacterial, non-adherent, and occlusive
yes debridement
no antibacterial
pretty non-adherent
is occlusive
105
which specific dressing is more desirable during the inflammatory phase
honey/sugar b/c has debridement and antibacterial properties
106
how often do you change bandages during the inflammatory phase? proliferative phase?
inflammatory - once per day for 2-5 days
proliferative - once you see the granulation tissue, slowly space out the changes. skip one day then if it looks good skip 2 days and so on. max of every 5 days
107
what are the down sides of second intention healing
takes a long time, alopecic, thin, shiny, fragile
108
when should topical antibiotics be used on wounds
generally indicated during inflammatory phase
not necessary and may be detrimental during proliferative phase
109
when can systemic antibiotics be used for wounds
indicated with infected tissue, controversial for contamination in inflammatory phase, not indicated for healthy wound during proliferative phase
110
how much fluid can be picked up with abdominocentesis
5-25 mL/kg
111
how do you determine if abdominal fluid is hemorrhagic or not
compare PCV/TS to serum. closer to serum level = more likely hemorrhage.
for DPL, >2-5% is diagnostic. do not need to compare with serum
112
what values are higher in free fluid than in serum? lower? what type of effusion is associated with each change?
higher - creatinine (urine), potassium (urine), bilirubin (bile), lactate (septic)
lower - glucose (septic)
113
how much fluid can be detected with diagnostic peritoneal lavage
1-5 mL/kg
114
how long does it take for a bilious effusion to show clinical signs? what are your first steps as a clinician?
4-6 weeks before detection
stabilize patient first. not emergent surgery
115
what are your steps as a clinician treating uroabdomen
drain with peritoneal catheter abdominocentesis and urinary catheter, stabilize patient, then surgical repair
116
what are your steps as a clinician treating hemoabdomen
find the source, conservative management (fluids, blood products, compressive bandages, stabilization, keep them calm, pain meds, monitor PCV), intervene surgically if medical management not working. fix them before DIC (petechiae, requiring too much blood, coagulation issues)
117
what are your steps as a clinician treating septic abdominal effusion
find the source (likely a ruptured hollow viscous organ), stabilize patient, EMERGENCY SURGERY
118
define true hernia vs false hernia
true hernia - contents contained within an anatomical hernial sac
false hernia - contents lack a hernial sac
119
what type of hernias are traumatic hernias
false hernia
120
what does incarcerated mean
stuck in a spot
121
what does strangulated mean
stuck and constricted, cutting off blood supply
122
T/F: traumatic hernias are emergent
false - most traumatic hernias are not emergent. stabilize and evaluate entire patient
123
how long can you postpone surgery on a traumatic hernia
3-5 days to allow declaration of nonviable tissues
124
when are hernias emergent?
penetrating wounds, incarcerated or strangulated tissues, other injuries warranting emergent intervention (severe hemorrhage, septic abdomen, pneumoperitoneum)
125
what is primary vs secondary peritonitis
primary has no inciting cause. secondary does
126
is prognosis better or worse with aseptic peritonitis
worse because no pathogen to treat
127
what type of peritonitis is most common
secondary generalized septic
128
what body system is the most likely to cause peritonitis
GIT
129
what clin path changes will be seen with peritonitis
marked neutrophilia (toxic), anemia, hypoproteinemia, hyper/hypoglycemia, electrolyte abnormalities (Na and Cl low with vomit, K low with anorexia), azotemia, liver enzyme elevation
130
what will be seen on abdominal radiographs with peritonitis
lack of serosal detail, ground glass appearance, gas behind diaphragm
131
with peritonitis, neutrophils will be high or low?
usually high but can be very very low with overwhelming inflammation
132
name some negative prognostic factors with peritonitis
refractory hypotension, cardiovascular collapse, respiratory distress, DIC, plasma lactate >2.5 mmol/L, ionized hypocalcemia, MODS
133
T/F: NSAIDs are sufficient for pain control with peritonitis
false. need opioids like methodone
134
what antibiotics should be used for peritonitis
cefoxitin and ampicillin sulbactam, empirical treatment usually accurate, but always good to culture
135
how should the small intestine be closed
full thickness, single later, appositional
136
what kind of hemostats are used to handle intestines
doyans
137
where should you cut for R&A
near a main artery branch for better blood supply to the wound edge. this may be farther from the spot you planned to cut
138
in addition to careful apposition of intestines during R&A, what else needs to be closed
the mesentery to prevent strangulation
139
what should be added to saline for intra-op peritoneal lavage
nothing! just warm saline
140
after peritonitis surgery, the abdomen flushes out well and mild inflammation is present. how should you close?
consider primary closure
141
after peritonitis surgery, the abdomen still has extensive fibrin tags, debris, necrosis, or severe peritoneal inflammation OR you don't know the cause of the peritonitis. how should you close?
consider drainage options. use 2-3 drains because the omentum will clog the drains
142
are malignant tumors in young dogs usually more or less biologically aggressive than older dogs
more aggressive
143
T/F: palpation of regional lymph nodes can be used to determine if a cancer is metastatic
false - palpation alone can't determine if metastatic. gives you a clue, but can feel normal and have metastatic dz
144
what is important to remember about diagnosing mast cell tumors
they love lymph nodes. aspirate nodes even if palpate normally
145
what is needed to grade a tumor
biopsy! not FNA
146
when should you do a biopsy instead of just FNA
when info about tumor type and grade would result in a change in choice of treatment option, extent of treatment (margins), or owner's willingness to treat
147
what type of masses should not be FNA-ed
TCC b/c risk of seeding tumor
adrenal mass b/c sensitive area
148
what type of needle-core biopsy is used for soft tissues? bone?
soft tissue - tru-cut
bone - jamshidi
149
how can you improve diagnostic accuracy with needle-core biopsy
b/c it takes a small tissue sample, you should take multiple samples
150
what techniques are used for incisional biopsy
wedge or punch biopsy
151
T/F: oral tumor biopsy can be done with sedation and without local anesthetic
true. not usually painful
152
what needs to be considered when doing an incisional biopsy
need to be able to resect biopsy scar en bloc with tumor b/c contaminated with tumor cells
153
what needs to be considered before doing an excisional biopsy
resection does not have definitive margins, so it is diagnostic but may not be therapeutic. best to do FNA or needle core biopsy first!
154
what should you plan for when doing an excisional biospy
plan that biopsy tract will have to be surgically removed if incompletely excised. DO NOT TAKE FASCIAL PLANE. only consider in areas with sufficient soft tissue coverage. NOT DISTAL LIMBS
155
what factors are used in the WHO tumor stagins system
local tumor size/invasion, lymph node involvement, metastasis present
156
what is the most common mistake in tumor removal surgery
using too low of a surgical dose
157
what is radical resection
removal of a body part
ex: splenic hemangiosarc, limb amputation for OS
158
what is wide resection
lateral and deep surgical margins to remove the complete tumor burden (gross and microscopic). precise amount depends on tumor type and biological behavior
159
what lateral margins are recommended for wide margin resection
1 cm for most benign masses
2 cm for grade 1 or 2/low grade MCT
3 cm for soft tissue sarcomas
4-8 cm for intestinal tumors
5+ cm for feline injection site sarcomas
160
what deep margins are recommended for wide margin resection
minimum of 1 fascial plane. 2 planes for feline injection site sarcomas
161
what are natural tissue barriers? list examples
any tissue with resistance against tumor invasion
ex: muscle fascia, joint capsule, tendon, sheath, epineurium, cartilage, pleura, peritoneum
162
what is marginal resection
incomplete excision of a tumor with residual microscopic disease
163
what should be paired with marginal resection
adjuvant treatment for microscopic dz, like radiation
164
what are your options following unplanned marginal resection
1. no tx
2. staging resection of surgical wound - take a small sliver and repeat until you got it all
3. wide resection of surgical wound - get it all in 1 revision
4. adjuvant tx, like radiation
165
what is debulking/intralesional surgery
incomplete resection of tumor with residual gross disease. this is rarely acceptable treatment for cancer
166
what should be avoided for cancer surgeries
directly grasping tumor with instruments, penetrating tumor capsule, drains, flaps without confirmation of complete margins
167
what areas are considered contaminated during cancer surgery
biopsy tracts, subQ tissue undermined, donor sites and incisions for flaps, drain tracts
168
what is the most common type of sectioning for histopath
radial
169
what does histopath tell us about tumors
risk of local recurrence and mets, necessity of further tx, prognosis
