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SAMS 1 > Lecture 27: Surgical Respiratory Disease > Flashcards

Lecture 27: Surgical Respiratory Disease Flashcards

(75 cards)

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1
Q

What muscle is affected in laryngeal paralysis

A

cricoartenoideus dorsalis

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2
Q

what nerve is affected in laryngeal paralysis

A

caudal laryngeal nerve (terminal of recurrent laryngeal from vagus)

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3
Q

what breeds is congenital laryngeal paralysis common in

A

bull terriers, Siberian huskies, bouvier des Flanders

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4
Q

what is caused of acquired laryngeal paralysis

A

idiopathic

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5
Q

what breeds are most common with acquired laryngeal paralysis

A

labs/goldens

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6
Q

what are some signs of laryngeal paralysis

A

voice change, gagging/coughing, exercise intolerance, stridor, dyspnea, cyanosis, syncope

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7
Q

what are some comorbidities associated with laryngeal paralysis

A
  1. Geriatric onset laryngeal paralysis polyneuropathy
  2. Megaesophagus
  3. Hind limb weakness
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8
Q

how do you dx laryngeal paralysis

A

oral exam
1. Light sedation (butorphanol, ace)
2. Doxapram- stimulate breathing
3. Evaluate and confirm lack of arytenoid movement

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9
Q

what drug is used to stimulate breathing in dx laryngeal paralysis

A

doxapram

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10
Q

what medical tx for laryngeal paralysis

A
  1. Sedation/ anti-anxiety- trazadone, ace
  2. Weight loss
  3. Stress reduction
  4. Environmental control
  5. Doxepin- controversial
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11
Q

what is MOA of doxepin

A

tricyclic antidepressant
Inhibits reuptake of NE and 5Ht
Antihistamine properties

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12
Q

what are adverse effects of doxepin

A

hyperexcitability, GI distress, vent arrhythmia (overdose)

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13
Q

what is goal of laryngeal paralysis sx

A

widen rima glottis by removing or abducting arytenoid cartilage

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14
Q

what are sx options for laryngeal paralysis

A
  1. Unilateral arytenoid lateralization
  2. Vocalcordectomy
  3. Artytenoidectomy
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15
Q

what is most common complication following laryngeal paralysis surgery

A

aspiration pneumonia

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16
Q

what are some complication from permanent tracheostomy

A

mucus plug, stenosis, dehiscence

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17
Q

what is epiglottis retroversion

A

ventral tip of epiglottis sits on dorsal surface of soft palate

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18
Q

what is tx for epiglottis retroversion

A
  1. Epiglottopexy
  2. Epiglottal resection of tip of epiglottis
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19
Q

what are the 4 components of brachycephalics airway disease

A
  1. Stenotic nares
  2. Elongated soft palate
  3. Hypoplastic trachea
  4. Everted laryngeal saccules
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20
Q

what are some co-morbidities associated with brachycephalics airway disease

A
  1. GI signs +/- hiatal hernia (d/t increase negative pressure)
  2. Non-cardiogenic pulmonary edema (increase negative pressure)
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21
Q

what is tx for elongated soft palate

A
  1. Staphylectomy- resection of soft palate at caudal aspect of tonsilar crypt
  2. Folded palatoplasty: shorten and thins palate
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22
Q

normal soft palate stops at __

A

tip of epiglottis

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23
Q

what is tx for everted laryngeal saccules

A

resection/sharp excision with metzenbaum scissors

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24
Q

what is treatment for increase nasal turbinate contact points in brachycephalics airway disease

A

laser ablation turbinectomy- removal/ debunking of excess turbinate bone

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25
what are some sx complications of brachycephalics airway disease
1. Bleeding 2. Airway swelling (steroids) 3. Persistent airway obstruction
26
what should you recommend to brachycephalics owners
prophylactic airway surgery to improve breathing and prevent GI and laryngeal/tracheal pathology
27
what are tx options for tracheal collapse
1. Extraluminal ring placement 2. Intraluminal stent
28
extraluminal ring prosthetics are only used for what tracheal collapse
Cervical tracheal collapse
29
what are some complications of extraluminal ring prosthetics
1. Laryngeal paralysis 2. Tracheal necrosis 3. Persistent coughing 4. Implant migration 5. Collapse at different site
30
t or f: intraluminal stents can be used at any location in trachea
true
31
what are complications of intraluminal stents
1. Stent migration or fracture 2. Tracheitis 3. Granulation tissue and partial obstruction 4. Disrupt mucociliary apparatus
32
what are the 3 main muscles in diaphragm
1. Pars sternalis 2. Pars costal is 3. Pars lumbalis
33
What are the three openings in diaphragm
1. Caval foramen (CVC) 2. Esophageal hiatus 3. Aortic hiatus
34
what is function of diaphragm
assist with breathing and lymphatic movement
35
what is most common cause of diaphragmatic hernias
trauma
36
what is a congenital peritoneopericardial hernia
congenital abnormality that allows communication between peritoneum and pericardium- organ herniation into pericardial sacs
37
t or f: 50% of congenital peritoneopericardial hernias are asymptomatic and incidental findings
true
38
what breeds are predisposed to congenital peritoneopericardial hernia
weimaraners and long haired cats
39
what is most common herniated organ in traumatic diaphragmatic hernia
liver
40
what are two main concerns for traumatic diaphragmatic hernias
1. Organs become trapped and strangulated 2. Decrease space of lung expansion
41
what is most common sign of diaphragmatic hernia
dyspnea
42
how do you dx diaphragmatic hernias
rads- lateral projection most useful
43
What is tx for traumatic diaphragmatic hernia
1. Stabilize patient 2. Reduce herniated contents and repair rent (herniorrhaphy)
44
left sided rent with herniated __can lead to acute decompensation from gastric distention and is considered emergent
stent
45
describe surgical approach/sx for diaphragmatic hernia
midline laparotomy, reduce organs, remove organs with compromised blood supply, repair rent, close diaphragm over red rubber catheter to evacuate air from chest
46
what are some complications of diaphragmatic hernia repair
1. Re-expansion pulmonary edema 2. Pneumothorax 3. Increased intra-abdominal pressure
47
describe the sx approach for intercostal lateral thoracotomy
incision between ribs, allows good view of dorsal structures
48
What is a median sternotomy approach good for
full explore of thorax
49
describe lung lobectomy surgery
1. Ligate with sutures 2. Stapling devices (2-3 rows)
50
what is included in post-op care of lung surgery
1. Pain management- too painful or too sedate lead to shallow breaths 2. Monitor for hypo ventilation, fluid, air, pulmonary edema, atelectasis 3. Thoracostomy tube
51
what is a lung bleb
air space in Between pleural and parenchyma
52
what is lung bulla
air filled space within lung tissue/parenchyma
53
what happens if lung bleb or bulla ruptures
spontaneous pneumothorax
54
what breed is at risk for spontaneous pneumothorax
huskies
55
what is tx for lung bleb/bulla
1. Ct scan and explore via median sternotomy 2. Surgical removal of abnormal lung lobes
56
what lobes is lung lobe torsion most common in
right middle and left cranial
57
what breeds is lung lobe torsion most common in
large, deep chested Yorkies and pugs
58
how do you dx lung lobe torsion
rads or CT
59
what is tx for lung lobe torsion
1. Stabilize +/- thoracocentesis 2. Median sternotomy or lateral thoracotomy- remove lung without untwisting pedicle
60
why do you not untwist pedicle during lung lobe torsion surgery
release inflammatory cytokines and endotoxins (reperfusion injury)
61
t or f: primary lung tumors usually malignant
true
62
what is most common lung neoplasia
alveolar or bronchial carcinomas
63
what condition do cats get with lung neoplasia
lung digit syndrome
64
if you see ulcerated mass on feline digit what should you do next
take TXR
65
thoracic duct is on __side in dogs, and __ side in cats
right, left
66
what are some causes of chylothorax
1. Idiopathic 2. Right sided heart disease- HW, pericardial effusion 3. Trauma 4. Masses obstructing
67
what are sx options for chylothorax
1. Thoracic duct ligation 2. Cisterna chyli ablation 3. Subtotal pericardectomy 4. Omentalization 5. Shunting
68
why does thoracic duct ligation work
forces new lymphatic channels to open/relieve pressure
69
how do you do cisterna chyli ablation
ablate with hemostats/blunt dissection and disrupt flow of lymph to lymphatic duct
70
describe a subtotal pericardectomy for chylothorax
remove portion of pericardium to decrease right sided heart pressure
71
describe omentalization for chylothorax
omentum pulled into thorax to help absorb fluid
72
describe shunting for tx of chylothorax
moves fluids from thorax to abdomen via pleuroport that is evaluated via Huber needle
73
what are some complications of chylothorax
1. Recurrent effusion (most common) 2. Lung lobe torsion 3. Pneumothorax or pyothorax 4. Fibrosis pleuritis
74
what are some indications for surgery for pyothorax
1. Primary cause known- lung lobe abscess, necrotic mass, grass awn 2. Failure to improve with medical management in 72hrs 3. Persistent effusion for 3-7 days 4. Thoracostomy tube complications
75
describe surgical management for pyothorax
1. Median sternotomy for full explore 2. Remove lung lobe mass if necessary 3. Check for foreign object- good lavage 4. Culture- migrating plant awn with actinomyces

SAMS 1 (28 decks)

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