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Exam 2 Flashcards

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1
Q

What are the clinical signs of pyloric obstruction?

A 
Projectile vomiting
Undigested mucus and bile
Rapid fluid loss
Electrolyte loss (H+, Cl-, Na+, K+)
Hyponatremia, hypochloremia, alkalosis
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2
Q

What are treatment options for gastric foreign bodies?

A

Spontaneous passage
Induction of vomiting
Endoscopy
Surgery

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3
Q

What are the two layer closures you would use for a gastrotomy?

A

Cushing- submucosa
Lembert- seromuscular- submucosa

Use absorbable suture

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4
Q

What are the breed incidences for GDV?

A 
Large/giant breeds:
Great Dane
St. Bernard
Weimeraner
Irish setter
Gordeon setter
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5
Q

What are the proposed etiologies for GDV?

A 
Diet
Overeating
Post-prandial exercise
Anatomic factors
Delayed gastric filling
Bacterial fermentation (clostridia)
Aerophagia
Hypergastrinemia
Gastric myoelectric dysrhythmias
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6
Q

What are the clinical signs for GDV?

A 
Restlessness, discomfort, pain
Hypersalivation
Nonproductive vomiting/retching
Abdominal distention
Hyperpnea (>30rpm)
Shock
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7
Q

What is the pathophysiology of GDV?

A

Dilation precedes volvulus
Angulation of gastroesophageal junction
Volvulus - 270 degree clockwise rotation
Dilation alone - 90 degree counterclockwise

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8
Q

Does ability to pass a stomach tube distinguish between GD and GDV?

A

No

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9
Q

What percent of dogs with GDV end up in DIC?

A

40%

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10
Q

What is the initial management of GDV?

A

Decompression (orogastric intubation or trocharization)

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11
Q

T/F? In all cases of GDV, surgical intervention should be recommended even if distention is relieved and the stomach is shown to be in a normal position

A

TRUE

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12
Q

Is it okay to medically manage a GDV and then take to surgery 24-48 hours later?

A

NO

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13
Q

What are the objectives of GDV surgery?

A

Reposition stomach
Evaluate GI tract
Prevent recurrence

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14
Q

How can you assess gastric wall viability?

A 
Color
Temperature
Peristalsis- pinch test*
Thickness
Fluorescien
Surface oximetry
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15
Q

What are the advantages of tube gastrostomy?

A

Rapid, easy procedure
Creates a permanent adhesion
Allows for gastric decompression
Allows tube feeding

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16
Q

What are the advantages and disadvantages of incisional gastropexy?

A

Advantages:
Rapid, easy procedure
Does not enter stomach lumen

Disadvantages:
No post-op alimentation
No good clinical follow up

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17
Q

What characterizes a simple complete obstruction?

A

Ischemia and devitalization -> decreased fluid absorption

Bowel wall edema -> fluid accumulation

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18
Q

What are the 3 types of mechanical intestinal obstruction and what commonly causes them?

A
  1. Luminal: foreign body, polypoid mass
  2. Intramural: neoplasia, fungal granuloma
  3. Extramural: adhesions, strangulated hernia
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19
Q

What type of obstruction results in rapid dehydration?

A

Duodenal

Loss of salivary, gastric, pancreatic duodenal secretions

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20
Q

What type of obstruction will result in more chronic signs?

A

Low jejunal obstruction

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21
Q

What is the size of a normal dog, cat, and ferret intestine?

A

Dog: 1.6 x the height of the body of L5

Cat: 12mm

Ferret: 5-7mm

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22
Q

What do you see on radiographs with linear foreign body?

A

Pleated bowl/accordion pattern

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23
Q

How can you diagnose foreign body on ultrasound?

A

Dilated, fluid-filled SI loops

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24
Q

What is the pinch test?

A

Tests viability of intestine

See if pinch incites peristalsis

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25
What are the advantages and disadvantages of enterotomy?
Advantages: Less risk of surgical dehiscence Retain absorptive capacity Disadvantages: Wrong guess- perforation and peritonitis
26
Where do you make incision in foreign body enterotomy?
Aboral side of foreign body Foreign body may have partially or fully eroded through mucosa. Making incision over foreign body may impede healing.
27
What suture type and pattern do you use for enterotomy?
4-0 PDS Simple interrupted or continuous May want to use cushing for animals with pre-existing peritonitis
28
What are the two enterotomy techniques used for linear foreign body removal?
Multiple enterotomy technique | Catheter passage technique
29
What are the advantages and disadvantages of intestinal anastamoses?
Advantage: removes all questionable tissue ``` Disadvantages: Longer surgical time Greater risk of leakage Greater potential for stricture Potentil weightloss and diarrhea ```
30
What suture would you use on intestinal anastamoses?
Moncryl Maxon PDS
31
What should you always do after suturing an intestinal resection and anastamoses?
SEAL WITH OMENTUM
32
What animals most commonly get intussusception?
Young dogs and cats | Most often associated with worms
33
What is the most common part of intestinal for intussusception?
Ileo cecal colic
34
What are the clinical signs of intussusception?
Inappetence Vomiting Tenesmus Melena
35
How do you diagnose intussusception on ultrasound?
Bulls-eye/target sign
36
What surgical techniques are used to prevent recurrence of intussusception?
Enteropexy- (Most of the time this is not done, no good data to show that this will prevent recurrence) Enteroplication
37
What is the prognosis of intestinal volvulus?
Grave 95% mortality rate Survivors may have short bowel syndrome Must retain >20% bowel
38
What are the clinical signs of megacolon?
``` Constipation Obstipation Tenesmus Dyschezia Hematodyschezia ```
39
What is idiopathic megacolon in cats and how do you medically manage it?
Mid to older age cats No sex predilection Inability of smooth muscle to contract Give lactulose and cisapride
40
What is peritonitis?
Inflammation of peritoneum Aseptic or septic Primary or secondary
41
When is the most common time of dehiscence of GI surgery?
3-5 days post-op
42
What is septic peritonitis?
Bacterial contamination -> influx of protein rich fluids
43
What is the difference between bacteremia and septicemia?
Bacteremia: bacteria in bloodstream Septicemia: body's response to bacteremia
44
What is the criteria for systemic inflammatory response syndrome?
``` Dogs (2 or more of criteria): Temp >104 or <100.4 HR >120 RR >20 WBC > 18000 or <5000 ``` ``` Cats (3 or more criteria): Temp >103.5 or <100 HR >225 or <140 RR >40 WBC >19500 or <5000 Bands >5% ```
45
Does a lack of superficial infectious rule out septic peritonitis?
NO
46
What is the best way to diagnose septic peritonitis?
Abdominocentesis 4 quadrant technique Needs to be done sterily
47
How do you treat septic peritonitis?
``` Antimicrobials: based on C + S, give ASAP! Debride Lavage Omental/serosal patching Drains (open or closed) ```
48
What is the prognosis for peritonitis?
Ultimately depends on underlying cause | High mortality rate
49
What is MIS?
Minimally invasive surgery Any surgery that is less invasive and/or results in less tissue trauma compared to open surgery Endoscopy, laparoscopy, thoracoscopy
50
What are the different methods of peritoneal access in laprascopic ove/ohe?
Veress needle Modified hasson Mini-laparotomy
51
What is the safest laparoscopy technique and why?
Modified Hasson Make incision first and then insert camera
52
What is the Veress laparoscopy technique?
Has blunt, spring-loaded obturator that can retract to expose cutting needle Protects from lacerating viscera
53
What is a threaded cannula?
Used in laparoscopic surgery to make a port for instruments Prevents slipping in/out Screw-in, rubber reducer valves, +/- insufflation
54
What are the 3 components of the tower in laparoscopic surgery?
1. Light: xenon 2. Video control unit 3. Insufflator
55
What is used for insufflation in laparoscopic surgery and why?
CO2 Soluble, not flammable, no emboli
56
What is triangulation in laparoscopic surgery?
The orientation of instruments and self with monitor
57
What are different curves in instruments used for in laparoscopic surgery?
Looking around corners, getting different views
58
What are the indications for laparoscopy?
Elective procedures Client requests Decreases patient morbidity Hospital reputation
59
What are contraindications of laparoscopy?
Lack of experience or comfort in surgeon or staff Instrumentation missing Advanced/exploratory procedures
60
What is the goal insufflation pressure for cats and dogs during laparoscopy?
Cats: <8 mmHg Dogs: <12mm Hg
61
What are the physiologic effects of insufflation?
Pressure against diaphragm and vena cava -> Decrease in thoracic compliance and venous return -> Decreased cardiac output and tidal volume -> Hypoventilation, hypoxemia, acidemia
62
What are the sources of pain during laparoscopy?
Incisions Peritoneal CO2 (acidosis, desiccation) Stretching of diaphragm
63
How can you decrease pain from laparoscopy?
``` NSAIDs Local nerve blocks Evacuate residual CO2 Humidify gas Limit insufflation pressure Limit duration of surgery ```
64
When do pyometras typically occur?
High progesterone Low estrogen, LH (Diestrus)
65
What is the best method for laparoscopic OVE
2 port lap
66
What type pf table do you use for laparoscopic procedures?
Tilt table Use gravity to help move viscera
67
What local analgesia is used in laparoscopic OVE prior to port placement?
Bupivicaine 1mg/kg prior to port placement
68
Where do the ports go for laparoscopic OVE and OHE?
OVE: Camera 1cm caudal to umbilicus Instruments 2-4cm cranial to umbilicus OHE: Camera 1cm caudal to umbilicus Instruments 2-4cm cranial to umbilicus or 1/3 distance fro umbilicus to pubis
69
What is ligasure?
Bipolar electrosurgery that compresses and denatures tissue to create a seal Good for >7mm vessels Can hold up to 3x systolic pressure
70
What are specimen bags used for in laparoscopic procedures?
Neoplastic tissue to prevent seeding elsewhere when removing tissue
71
What layers do you close close in the port incisions in laparoscopic OVE?
5 mm incision: SQ and skin 10mm incision: linea, SQ, skin
72
What are possible complications of laparoscopic OVE?
``` Splenic laceration/hemorrhage Pedicle hemorrhage SQ emphysema Loss of insufflation Dropped ovary or pedicle ```
73
What are indications for prophylactic gastropexy?
At-risk dogs: Relative with GDV, large breed, deep chest Great danes, Irish wolfhound, standard poodle
74
What side is the lap-gastropexy done on?
Right
75
What are possible complications of lap gastropexy?
``` Seroma (very common) Splenic laceration/hemorrhage Serosal tearing Loss of insufflation Dropped stomach ``` Conversion to keyhole technique is possible
76
What are the benefits of MIS?
``` Less pain Less tissue trauma Less analgesics Less infection Precision and safety Reputation ```
77
What are the advantages/disadvantages of standing castration (equine)?
Advantages: inexpensive, fast, avoids anesthesia Disadvantages: dangerous, uncomfortable Not recommended for mules, donkeys, ponies, AMH
78
What are the advantages/disadvantages of recumbent castration (equine)?
Advantages: IV anesthesia, better access, safe for surgeon Disadvantages: Time consuming
79
What is a closed castration and what are the advantages/disadvantages?
Skin incision only Advantages: removes a lot of tunic (reduces swelling) Disadvantages: Need careful dissection not to cut into tunic
80
What are the two types of emasculators for equine castration and what is "the rule"?
Serra: 2 handles Reimer: 3 handles Rule: "nut to nut"- puts crushing edge on top and cutting edge on bottom
81
What is included in the aftercare of equine castration?
Walking exercise at least 2x daily (reduces swelling) Hydrotherapy NSAIDs Antibiotics rarely used Digital opening of incision (rarely needed)
82
What are possible complications following equine castration?
``` Swelling (edema Infection Hemorrhage (testicular a. Or pampiniform plexus- mostly seen in donkeys/mules) Evisceration (bowel or omentum) Severe pain Unaltered behavior Hydrocele Urethral transection Peritonitis ```
83
In a unilateral cryptorchid stallion, why would you not want to remove the descended testicle only?
Cryptorchid testicle will still produce testosterone Will behave like stallion but look like gelding
84
What species have intra-abdominal testicles?
Elephant | Rock hyrax
85
What are common penile diseases of horses?
Squamous cell carcinoma | Penile paralysis
86
What is a common site of metastasis of equine penile squamous cell carcinomas?
Lungs
87
What is penile reefing?
Segmental posthetomy used to removed neoplastic lesions using two parallel circumfrential incisions
88
What is penile amputation (equine)?
Amputation to sib-ischial area where urethra is cut open and exteriorized
89
What is an episioplasty (caslick's operation) (equine)?
Procedure done for mare that have age-related, poor peritoneal conformation Prone to pmeunovagina ("wind sucking") Combined with other treatments for urine pooling and perineal injuries Creates better seal and prevents air/feces from being pulled into vagaina
90
What is urethral extension (mares)?
Procedure done for mare that have age-related, poor peritoneal conformation Poor conformation leads to incomplete emptying or urine Urine can flow back into uterus and predispose mare to infections
91
What are types of 3rd degree perineal lacerations mares can experience, what are the risk factors, and how are they treated?
Rectovaginal laceration Rectovaginal fistula Foals feet push straight up and break through vaginal and into rectum Risk factors- first foal, unassisted delivery Tx: not considered an emergency. Clean, give analgesics and antibiotics. Wait 30 days to surgically close.
92
What is the purpose of ovariectomy in mares and what surgical techniques are used?
To remove granulose cell tumor or make a "jump" mare laparoscopy, flank, oblique paramedian, ventral midline All approaches: HEMORRHAGE
93
When is cesarean section indicated in mares?
After other approaches have been considered (assisted vaginal delivery, controlled vaginal delivery, fetotomy) Usually to save mare, foal is usually dead Time (<90 min to save foal) Hemorrhage from uterine incision
94
What is controlled vaginal delivery (mares)?
Delivery of foal under general anesthesia
95
How do you diagnose a lesion as neoplastic?
``` FNA Tru-cut biopsy Incisional biopsy: take a fragment of mass out Excisional biopsy: remove entire mass Presumptive diagnosis ```
96
When would you take an incisional biopsy and what techniques are used?
FNA non-diagnostic Easy to access mass Diagnosis will change surgery done Needle-core biopsy (Tru-cut or Jamshidi) Wedge biopsy Punch biopsy Principle: the structure of the tumor remains intact, no seeding go the tumor or disruption of fascial planes around tumor
97
Where would you want to get a biopsy of a bone lesion?
Center of bone, endosteum
98
What are the margins for mass cell tumors? Vaccine tumors (sarcomas)?
Mass cell tumor: 3 cm margin, 1 fascial plane Vaccine tumor: 5 cm margin, 2 fascial planes
99
When should biopsy be done?
For diagnosis of neoplastic vs non-neoplastic disease Results will change treatment Results may lead to -/+ aggressive treatment Results may change what owners want to do
100
When should you not biopsy?
Diagnosis is certain Emergency situations High risk/complex location Results will not change treatment
101
What are the two methods of bone biopsy?
Jamshidi needle | Michel trephine
102
What dictates where you should get your sample from when getting a biopsy?
Type of tumor- Large soft tissue masses: center may be necrotic Bone masses: periphery may be necrotic (Where the blood supply comes from)
103
What are principles of oncologic surgery?
Excise all biopsy and fistulous tracts Early vascular ligation Wide margins Gentle manipulation Avoid contamination of healthy areas Avoid (if possible) use of grafts/flaps Pre-treat animals with diphenhydramine (MCT) Avoid using drains
104
What are the different prognoses when only surgery is used for tumor removal?
Spleen hemangiosarc: 1-2 months Osteosarc: 3-5 months Oral melanoma: 7-8 months Oral squam cell: 7-11 months AGASACA: 18 months
105
What animals are predisposed to needing airway surgery?
Brachycephalic breeds Beagles Cocker spaniels Poodles
106
What is the common presenting complaint of animals needing airway surgery?
Episodic or continuous respiratory distress/strenuous breathing Gagging/regurgitation Cyanosis or collapse
107
What are the components of brachycephalic airway disease?
``` Stenotic nares elongated soft palate Everted laryngeal saccules Laryngeal collapse/stenosis Hypoplastic trachea Enlarged tonsils ```
108
What diagnostic should always be included in work up of airway disease?
Radiographs
109
What are pre-surgical considerations for airway surgery?
Tracheostomy site preparation | Reduce swelling- pre-op steroids?
110
What is the goal of the caudal wedge technique in airway surgery?
Lifts and lateralizes nares
111
What suture pattern would you use for ellongated palate resection and why?
Simple continuous | Compresses vessels
112
What is the Co2 laser used for in airway surgery?
Hemostasis
113
What is a folding flap palatoplasty?
Soft palate surgery used to opens choanal area Removes 50-60% of palatine muscle using electrocautery Brings free caudal edge of palate cranial and suture to open wound bed Keeps suture line away from tip of epiglottis Increased diameter of nasophharynx and reduces snoring Good for dogs with thickened palates: nose breathers (french bulldogs) Good for revisions (pugs)
114
What causes laryngeal paralysis and what is the treatment?
Heriditary or idioiopathic (most common) Older, large breed dogs (labs, st bernard, irish setter) Bilateral paralysis Tx: arytenoid lateralization (tieback) Causes increased risk of aspiration pneumonia
115
What are indications for temporary tracheostomy?
``` Trauma to larynx Laryngeal collapse Post surgery for brachiocephalic airway syndrome Laryngeal paralyisis To allow surgical access to oral cavity ```
116
Where is a tracheostomy done?
Between 3rd and 4th cartilaginous ring of trachea Transverse incision
117
What is required for post-op management of tracheostomy surgery?
Observation Oxygen Suction q2-4 hrs with whistle tip catheter Tracheostomy tub kit ready
118
What causes collapsing trachea?
Miniature or toy breeds ~7 years old Etiology unknown Cartilage is hypocellular and deficient in glycoprotein and GAG content Often concurrent main stem bronchus collapse occurs
119
What is a classic clinical sign for tracheal collapse and what diagnostic procedures would you use to diagnose it?
"Goosehonk" cough, severe respiratory distress, and cyanosis Radiographs, fluoroscopy (best), tracheoscopy, transtracheal wash and culture
120
How do you treat tracheal collapse?
Medical- antitussives, sedatives, anabolic steroids Surgical- external rings (cervicotracheal collapse) or intraluminal stents (thoracic collapse, most common)
121
What is the #1 need in thoracic surgery?
Ventilation
122
What are common sutures used in thoracisc surgery and what are they used for?
Prolene for tiebacks (non-absorbable) PDS or Maxon for rib approximation Silk- vessel ligation
123
What are hemoclips commonly used for?
Bleeding vessels PDA Lung lobectomy (cats) Thoracic duct ligation
124
What are the two surgical approaches to the thoracic cavity and when would each be used?
``` Lateral/intercostal thoracotomy (PDA surgery) Median sternotomy (removal of large masses) ```
125
What is an important landmark to remember with thoracic surgeries?
Scalenius m. Inserts on 5th rib
126
What suture material do you use to close lateral thoracotomy? Midline sternotomy?
Lateral- PDS/ Maxon Midline- need to close sternum Dogs >10kg: 22-24 ga wire Cats/dogs <10kg: 1 or 2 polypropylene suture
127
What vessels do you have to ligate and what suture pattern do you use to close lunglobectomy?
Pulmonary a. followed by pulmonary v. (Non-absorbable suture) Horizontal mattress (prolene, PDS)
128
How do you handle traumatic pneumothorax vs spontaneous pneumothoax?
Traumatic: can put chest tube Spontaneous: need to figure out cause- median sternotomy allows for exploration of entire chest
129
What are the functions of upper airway vs lower airway?
``` Upper: Conduct for airflow Olfaction Phonation Thermoregulation Filters and conditions air Protects lower airway ``` Lower: gas exchange
130
What are the primary structures of resistance in upper airway?
*oral cavity* Nasal valve Rostral nasopharynx Larynx
131
In upper airway dysfunction, what results from increased resistance? Increased turbulence?
Incesed resistance -> decreased ventilation -> poor performance Increased turbulence -> increased noise
132
What types of endoscopy is performed on horses when assessing airway?
ALWAYS DO UNSEDATED Resting or exercising (gold standard) Oral endoscopy or sinoscopy
133
What are important structures seen on radiographs of horse head and what is important to remember?
Paranasal sinuses Dental arcades Beware of superimposition
134
When using ultrasound for assessing a horse's airways, what is a limiting factor?
Bone
135
What is a main advantage of CT or MRI when assessing a horse's airways/head?
No superimposition | CT is method of choice
136
What are problems of nasal passage (horses)?
``` Epidermal inclusion cysts (atheromas) Redundant alar folds nasal lacerations nasal septal disease Engorgement of nasal mucosa (Horner's) Wry nose ```
137
Which of the horses sinuses are paired?
``` Frontal Caudal maxillary Rostral maxillary Dorsal conchal Ventral conchal Sphenopalatine ```
138
What are common diseases of the paranasal sinuses in horses?
``` Sinusitis Sinus cyst Ethmoid hematoma Neoplasia Trauma ```
139
What are the different kinds of sinusitis seen in horses and how are they treated?
Primary: strep; lavage (trphine), abx +/- sx debridement Secondary: dental dz; address underlying cause! Diagnose with endoscopy and rads Sinocentesis for culture and sensitivity
140
What are the landmarks for trephination of the frontal sinus (horses)?
Draw a line from midline to medial canthus 60% of distance from midline along this line and 0.5 cm caudal to the line
141
What are the landmarks for trephination of the caudal maxillary sinus (horses)?
2 cm ventral to the medial canthus
142
What are the landmarks for trephination of the rostral maxillary sinus (horses)?
Draw a line from medial canthus to infraorbital foramen 1cm ventral to this line and midway between canthus and rostral extent of facial crest
143
What is the most common type of sinus neoplasia in horses and what is the prognosis?
Squamous cell carcinoma Poor; often dx late in disease process
144
What is a progressive ethmoid hematoma?
Mass arising from ethmoids or sinus of horses Results in mild, intermittent epistaxis or facial deformation/airway obstruction (rarely) Dx by endoscopy Tx: intralesionsal formalin, laser photoablation, sx
145
T/F? The pharynx has no rigid support?
True
146
What are common diseases of the pharynx in horses?
``` Lymphoid hyperplasia Dorsal displacement of soft palate Pharyngeal collapse Palatal instability Pharyngeal cicatrix ``` Foals: Cleft palate Choanal atresia Nasopharyngeal dysfunction
147
What is the common clinical sign of dorsal displacemtn of the soft palate in horses and how is it diagnosed and treated?
CS: noise during expiration Dx: exercising endoscopy Tx: laryngeal tie forward
148
What is recurrently laryngeal neuropathy n horses and how is it diagnosed and treated?
Demyelination and axonopathy of the RLN Paresis leads to paralysis of intrinsic laryngleal muscles Inspiratory obstruction and noise at exercise (commonly left side) Affects large horses (TB, draft) Dx: resting endoscopy, laryngeal u/s/ Tx: prosthetic larygnoplasty (tie back)
149
What is the difference between lateral vs medial compartments of gutteral pouches in horses?
Lateral: smaller, contains ex.carotid a., maxillary a., facial n. Medial: larger, contains int. Carotid, cranial cervical ganglion, sympathetic trunk, CN 9-12, ventral straight muscles
150
What is gutteral pouch mycosis (cause, dx, tx)?
Rare but life-threatening fungal infection of gutteral pouch in horses Commonly caused by Aspergillus spp. Dx: endoscopy Tx: Medical tx fungus, NSAIDs, nutritional support
151
What are common diseases of the trachea in horses?
Collapse Stenosis Perforation Foreign body
152
Where do you perform tracheotomy and tracheostomy in horses?
Tracheotomy: longitudinal incision at level of junction of prox and mid 1/3 of neck Transverse incision between rings, <50% circumference Tracheostomy: 2-5 tracheal rings
153
What are indications for thoracic surgery in horses?
``` Pleuritis Pleuropneumonia Pulmonary abscess Trauma Diaphragmatic hernia ```
154
What are common thoracic surgical procedures done in horses?
Rib fracture repair (foals) Rib resection and thoracotomy Thoracoscopy
155
What are clinical signs of urethral obstruction and rupture in cattle?
Urethral obstruction: abdominal pain, distended bladder on rectal Rupture urethra: distended bladder on rectal, ventral swelling, cellulitis, uremic smell
156
What is the main difference in clinical signs between ruptured urethra and ruptured bladder?
Ruptured bladder will have no abdominal pain and abdominal distention
157
What are the goals of treatment of urolithiasis?
Steers: Perineal urethostomy with epidural anesthesia (dissect down to penis and transect)- salvage for market Pet goats/pigs: treat with surgery
158
What is the cause of urolithiasis?
Concentrated diets Imbalance in Ca:P ratio Lack of water high urine pH
159
Why are males more prone to urolithiasis?
``` Sigmoid flexure and vermiform appendage (urethral process) Narrowed urethra (early castration) ```
160
What are the clinical signs of urethral obstruction in goats?
Early signs: Restlessness or anxiety Tail twitching ``` Progressive: Excessive vocalization Stretching/arched back Forceful urination Reduced urine flow Bloody urine Crystals on preputial hairs ``` ``` Advanced: Swelling/pain of urethra Ventral edema Sudden cessation of clinical signs Abdominal distention Anorexia Anorexia Depression Weakness Death ```
161
What is the best way to diagnose urolithiasis in goats?
CT!
162
What is the initial management for urolithiasis in goats?
``` Massage or manipulation of urethral process Exteriorization of penis Sedate with diazepam Removal of urethral process Passage of catheter ```
163
How do you medically manage urolithiasis in goats?
Promotion of urethral relaxation (diazepam, ace, AVOID xylazine) Ammonium chloride, walpoles solution: acidify urine
164
How can you surgically manage urolithiasis in goats?
``` Urethral process amputation Percutaneous catheter placement Tube cystotomy Bladder marsupialization Perineal urethrostomy ``` Fluid of choice: NaCl
165
What is the most common surgical procedure for urolithiasis in goats?
Tube cystotomy Allows urethra to rest and complete recovery can occur in a ew months Allows administration of urinary acidifiers MUST change dieet!
166
What are common complications of tube cystotomy?
Blockage of tube Failure of balloon Continued straining Premature removal of tube
167
What is bladder marsupialization?
Surgical management of urolithiasis in ruminants "Permanent" solution after failed tube cystotomy Minimally invasive technique, two inch incision Approximately 4cm stoma is created for urine to drip out
168
What are possible complications of bladder marsupialization?
``` Cystitis Pyelonephritis Premature closure Bladder prolapse Urine scalding ```
169
What is a perineal urethrostomy?
Salvage procedure for urolithiasis in ruminants High rate of stricture Incision ventral to anus, penile body freed from ischium, urethral mucosa spatulated
170
What is the most common type of urolith in horses and where is it commonly found?
Calcium carbonate Neck of bladder
171
How can you surgically manage urolithiasis in horses?
Subischial urethrostomy Lithotripsy Laparocytotomy
172
What is a patent urachus? How is it surgically and medically managed?
Persistent urachus (carrier urine from bladder to allantois) in foals Not life-threatening Can resolve without treatment Medically managed with silver nitrate cautery Surgically managed with umbilical resection
173
What do the urachus, umbilical artery, and umbilical vein become in developed animal?
Urachus- scar at apex of bladder Artery- round lig of bladder Vein- falciform lig
174
What is omphalophlebitis?
Infected umbilical remnants Outward signs of infection -> need to do U/S
175
What is uroperitoneum and what can cause it?
Urine in peritoneal cavity Can be caused by ruptured bladder, urachus, or ureter
176
What are clinical signs of uroperitoneum and how is it diagnosed?
``` CS: History and age (<6 days) Males > females Depression Abdominal distention Abnormal urination ``` ``` Dx: Abdominocentesis Electrolytes- increased K+, creatinine, BUN*** Ultrasonography Dye studies Contrast studies ```
177
What are electrolyte abnormalities for uroperitoneum and how do you medically manage it?
Increased K+, BUN, creatinine Fluid therapy (0.9% NaCl) Dextrose Crystalline insulin Sodium bicarb if acidotic
178
What is the major concern when doing surgery/biopsy of kidneys?
Hemorrage
179
What part of the kidney do you biopsy from and why?
Cortex | Only want glomeruli
180
How do you manage a proximal uretal injury vs a distal uretal injury?
Proximal: CANNOT be re-routed to bladder. Need to remove. Distal: CAN be re-routed to different spot on bladder
181
What do you have to be careful about when manipulating lateral ligaments of bladder?
Large arteries and ureters DON'T LIGATE UNLESS YOU HAVE TO
182
What suture pattern do you use to close bladder?
Simple interrupted
183
How long does it take the urethral mucosa to regenerate?
7 days
184
How do you manage a minor urethral injury vs major urethral injury?
Minor: conservative management (indwelling catheter) Major: requires surgery (anastomosis, urethrotomy, urethrostomy)
185
What surgical techniques are used for ureteral obstruction?
Resection and preimplantation Ureterotomy Ureteral stenting SUB subcutaneous ureteral bypass
186
What is ureteral ectopia?
Ureter attaches to bladder at abnormal spot
187
How long does it take for bladder mucosa to heal?
5 days Full strength/thickness: 14-21 days
188
What are the most common methods/procedure of small animal gonadectomy in US?
Ovariohysterectomy | Castration
189
What are indications for gonadectomy in small animals?
``` Pet overpopulation Sex-based aggression Mammary neoplasia Pyometra Uterine/ovarian neoplasia Prostatic disease Perineal herniation Prostatic neoplasia Testicular neoplasia ```
190
When is the risk of mammary neoplasia reduced with gonadectomy?
If done before 1st or 2nd heat cycle in dog | If before 6 months of age in cats
191
What percent of female dogs have a pyometra by 10 years of age?
25%
192
What percent of male dogs experience bph by 5 years of age?
50%
193
What are friction knots used for the vascular pedicles?
Strangle Miller's Surgeon's (less secure) Modified miller's (less secure)
194
What are the terminal knots used on vascular pedicles?
Used for continuous subcuticular/intradermal patterns Aberdeen Square throws- 10x larger volumes
195
What are possible complications of castration and ovariectomy?
``` Castration: Hemorrhage Urethral/ureteral ligation Prostatic ligation SSI ``` ``` Ovariectomy: hemorrhage Ureteral ligation Ovarian remnant syndrome Sphincter mechanism incontinence ```
196
What are risk factors for ureteral/urethral ligation during small animal castration?
Urethral ligation: Stray dissection, deep bites when closing ureteral ligation: Poor visualization/exposure
197
What is the preferred approach to prostatic ligation?
Caudal midline celiotomy
198
Which side is more common to have ovarian remnant syndrome?
Right
199
What effects does castration have on a dog's urethral sphincter mechanism?
Increased collagen Decreased smooth muscle (Especially in proximal urethra)
200
What percent of spayed female dogs experience incontinence?
Up to 75% Literature says ~12-20%
201
In gonadectomy of small animals, what contributes to surgical site infection?
Traumatic tissue handling Excessive dissection Poor tissue apposition
202
What is the best sterilization method for laparoscopic equipment?
Gas sterilization

Sugery (4 decks)

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