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SA Surgical Diseases > Mid-Term 2 > Flashcards

Mid-Term 2 Flashcards

1
Q

What are characteristics of congenital brachycephalic airway syndrome (BAS)?

A
  • Stenotic nares
  • Aberrant turbinates
  • Soft palate elongation and hyperplasia
  • Tracheal hypoplasia
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2
Q

What are characteristics of secondary brachycephalic airway syndrome (BAS)?

A
  • Everted laryngeal saccules
  • Laryngeal collapse
  • Mucosal Edema
  • Gastroesophageal reflux
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3
Q

What are some clinical signs of brachycephalic airway syndrome?

A
  • Heat, stress, and exercise intolerance
  • Snoring, inspiratory dyspnea
  • GI signs: vomiting and regurgitation
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4
Q

What anatomical configuration do pugs have that causes BAS?

A
  • Dorsal rotation of the maxillary bone
  • Severely underdeveloped/absent frontal sinuses
  • Ventral orientation of olfactorial bulb
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5
Q

What are two causes of BAS?

A
  • Anatomic changes leading to increased inspiratory resistance
  • Secondary conditions contributing to clinical signs
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6
Q

What 3 structures are debated to be the greatest contributors of BAS?

A

Soft palate, nose, and rima glottidis

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7
Q

What do you need to diagnose BAS?

A

History, Physical Exam, Diagnostic imaging (rads, CT, fluoroscopy, endoscopy)

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8
Q

What type of imaging is needed to help you diagnose the causes of BAS?

A

Thoracic rads, head and cervical CT, and endoscopic evaluation of upper airway

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9
Q

How do you treat an animal with BAS that is in acute respiratory distress?

A
  • Cooling, oxygen, corticosteroids, if GI signs (gastric acid reduction and prokinetics)
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10
Q

What are some indications for surgical therapy of BAS?

A

Stenotic nares, hyperplastic/elongated soft palate, turbinectomy, laryngeal conditions

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11
Q

If a dog with BAS has stenotic nares, what surgical procedure should you perform?

A

Obliteration of the nares via Alaplasty with wedge excision approach
DIRECT PRESSURE FOR HEMOSTASIS

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12
Q

An abnormal soft palate extends how many mm beyond the epiglottis?

A

> 1-3 mm

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13
Q

When completing a staphylectomy for an elongated soft palate, what is VERY important?

A

Gentle, meticulous tissue handling

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14
Q

What are the landmarks of a staphylectomy?

A

Tip of epiglottis and middle to caudal palatine tonsils/crypt

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15
Q

What is another procedure you can do that corrects excessive length and thickness of an elongated soft palate?

A

Folded flap palatoplasty

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16
Q

For everted laryngeal saccules and aberrant turbinates, how do you treat them?

A

Remove them (not sure if treatment actually helps)

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17
Q

What 3 procedures are you going to consider for a patient with BAS?

A

Alaplasty, Staphylectomy, or Folded flap palatoplasty

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18
Q

What is the most important thing to remember for surgically recovering BAS patients?

A

Maintain ET tube for reintubation if needed

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19
Q

With patients diagnosed with BAS, when do you recommend surgical correction?

A

As soon as possible

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20
Q

What are the 3 stages of laryngeal collapse?

A
  • Stage I: laryngeal saccule eversion
  • Stage II: medial displacement of cuneiform process
  • Stage III: collapse of corniculate process
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21
Q

How do you treat laryngeal collapse?

A

Treat primary disease and do an arytenoid lateralization (if needed!)

Can do permanent tracheostomy if needed

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22
Q

What is the most common cause of hindlimb lameness in dogs?

A

CCL Rupture

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23
Q

What are the 3 types of CCL rupture?

A

Complete tear, Partial tear, Avulsion

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24
Q

What are the 3 types of movement that the stifle joint is capable of?

A

Axial rotation, Flexion/extension, and translation

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25
Q

What are the functions of the CCL?

A
  • Limits cranial translation of the tibia with respect to the femur
  • Prevents hyperextension of the stifle joint
  • Limits internal rotation of the tibia
  • Limited degree of valgus-varus support to the flexed stifle
  • Mechanoreceptors —> proprioceptive feedback
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26
Q

What is the co-contraction theory in relation to CCL injuries?

A

The quadriceps starts losing some of its force and the gastrocnemius being a stronger muscle keeps pulling the tibia in caudal translation which damages the CCL

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27
Q

What are the muscles surrounding the CCL?

A

Caudal belly of sartorius, gracilis, and semitendinosus

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28
Q

What are the functions of the surrounding musculature of the CCL?

A
  • Stifle flexion and internal rotation
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29
Q

What is the external rotator of the tibia?

A

Biceps femoris

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30
Q

The cranial and caudal cruciate ligaments, medial and lateral meniscus, and medial and lateral collateral ligaments are considered what type of restraint of the stifle?

A

Passive restraint

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31
Q

What are the 3 etiologies of CCL rupture?

A

Chronic degenerative changes, acute trauma, and conformation

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32
Q

What is the biggest conformational etiology of CCL ruptures?

A

Obesity

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33
Q

When diagnosing CCL ruptures, what is the difference in history of acute vs chronic injury?

A

Acute - sudden, onset non-weight bearing lameness
Chronic - prolonged weight bearing lameness

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34
Q

A “click” during walking or on stifle flexion and extension is suggestive of what?

A

Meniscal injury

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35
Q

With CCL rupture, what should you be able to palpate on physical exam?

A

Joint effusion

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36
Q

This is excessive craniocaudal movement of the tibia relative to the fetus as a result of cruciate ligament injury?

A

Cranial drawer motion

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37
Q

When performing a cranial drawer test, in what ways should you perform it?

A

Extension, Standing angle of 135 degrees, 90 degrees of flexion

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38
Q

Which test can diagnose complete AND partial tears with CCL ruptures?

A

Cranial drawer motion test

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39
Q

Which test can ONLY diagnose complete tears with CCL ruptures?

A

Tibial thrusts

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40
Q

With complete and partial tears, when will you have a drawer?

A

Partial - no drawer in extension and a drawer in flexion
Complete - drawer in flexion AND extension

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41
Q

This test will show cranial movement of the tibial tuberosity in the cranial cruciate ligament-deficient stifle when the hock is flexed and the gastrocnemius muscle contracts

A

Cranial Tibial Thrust

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42
Q

(T or F): You can have positive tibial thrust and a negative cranial drawer

A

False

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43
Q

(T or F): You can have a positive cranial drawer and a negative tibial thrust

A

True

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44
Q

(T or F): You can have both negatives and both positives of a cranial drawer and tibial thrust tests

A

True

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45
Q

This test is performed standing or in lateral recumbency with the foot in moderate extension and should be repeated in different degrees of stifle flexion

A

Tibial compression test

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46
Q

With a positive tibial compression test, you will feel what?

A

Cranial advancement of the tibial crest as the hock is flexed

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47
Q

What are some things you will see in radiographs of a CCL rupture?

A
  • Articular cartilage degeneration
  • Periarticular Osteophytes development
  • Capsular fibrosis
  • Joint effusion
  • Subchondral sclerosis
  • Thickening of medial fibrous joint capsule
  • Evidence of avulsion
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48
Q

What is the main goal of arthroscopy?

A

To evaluate the meniscus

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49
Q

Which meniscal injury is more common?

A

The medial meniscus

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50
Q

What are the reasons medial meniscus injury is more common?

A
  • Firm attachment to tibial plateau
  • No femoral attachment
  • Caudal pole often wedges between medial femoral condyle and tibial plateau
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51
Q

What are the reasons lateral meniscus injury is less common?

A
  • More mobile
  • Femoral attachment
52
Q

What are the functions of the menisci?

A
  • Load transmission across the stifle
  • Energy absorption
  • Rotational and varus-valgus stability
  • Lubricate joint
  • Joint congruity
53
Q

In the medial meniscus, a longitudinal tear in the caudal body is most common and also known as?

A

Bucket handle tear

54
Q

What are the two types of diaphragmatic hernias?

A

Traumatic and Congenital

55
Q

What are the two types of congenital hernias?

A

Pleuroperitoneal and Peritoneopericardial

56
Q

What is the most common source of trauma causing diaphragmatic hernias?

A

Vehicular trauma

57
Q

What is the most common diaphragmatic trauma?

A

Diaphragmatic costal muscle rupture

58
Q

What organ most commonly herniates from diaphragmatic trauma?

A

Liver

59
Q

What is the mechanism of action that is an indirect injury with diaphragmatic trauma?

A

Acute increase in intraabdominal pressure

60
Q

What is the most common clinical sign with traumatic hernias?

A

Dyspnea

Other signs: Hypovolemic shock (acute trauma), GI signs, lethargy and difficulty lying down, or no clinical signs at all

61
Q

This patient has the following PE:

  • Muffled heart and lung sounds
  • Thoracic borborygmi
  • “Tucked up” abdomen

OR PE presents normally

What do you suspect?

A

Diaphragmatic hernia

62
Q

What are the most useful diagnostics for a diaphragmatic hernia?

A

Ultrasound and radiographs

63
Q

What are 3 anesthetic considerations for diaphragmatic hernia patients?

A

Poor ventilation, poor gas exchange, and poor perfusion

64
Q

When in surgery for a diaphragmatic hernia, what should be placed in the patient?

A

Thoracostomy tube

65
Q

What surgical approach is taken for diaphragmatic hernias?

A

Ventral midline celiotomy

66
Q

What are some considerations when dealing with chronic hernias?

A

Mature adhesions, fibrosis, reperfusion injury, re-expansion of pulmonary edema, loss of domain, primary apposition not possible

67
Q

Acute relief of obstruction with reperfusion injuries leads to what?

A
  • Free O2 radicals
  • Inflammatory cytokines
  • SIRS
68
Q

What are 3 alternative closure methods for diaphragmatic hernias?

A

Muscle flaps, autogenous grafts, exogenous graft

69
Q

If a patient survives the peri operative period of the diaphragmatic hernia, what is their prognosis?

A

Excellent

70
Q

Name the 4 laryngeal cartilages

A

Epiglottis, Arytenoid, Thyroid, Cricoid

71
Q

This is the opening of the larynx

A

Glottic inlet

72
Q

What is the muscle of the larynx and what is it innervated by?

A

Cricoarytenoid muscle innervated by the recurrent laryngeal nerve

73
Q

What are the functions of the larynx?

A
  • Prevent aspiration
  • Controls airway resistance
  • Voice production
74
Q

Is this congenital or acquired laryngeal paralysis?

  • Seen in: bouvier des flandres, Dalmatians, huskies, Rottweilers
  • Onset of clinical signs: <1 year old
  • Progressive neurologic degeneration
A

Congenital

75
Q

Is this congenital or acquired laryngeal paralysis?

  • Seen in: Labs and Goldens, St. Bernard’s, Irish setters
  • Median age of onset: 9 years
A

Acquired laryngeal paralysis

76
Q

What are some associated etiologies for acquired laryngeal paralysis?

A

Idiopathic, neoplasia, endocrine polyneuropathy, immune-mediated polyneuropathy, iatrogenic

77
Q

What are two EARLY signs of laryngeal paralysis?

A

Voice change and gagging/coughing with food and water intake

78
Q

What are some clinical signs of laryngeal paralysis?

A

Voice change, gagging/coughing when eating food/water, exercise intolerance, inspiratory stridor, acute respiratory distress, peripheral polyneuropathy

79
Q

What diagnostics would you run on a patient with laryngeal paralysis?

A
  • CBC/Chem, UA
  • T4 and TSH
  • Thoracic and cervical rads
  • Esophagram/ swallow studies
80
Q

In patients with LARPAR, what are they also at risk of and what can PRE-treat with?

A

Aspiration pneumonia; metoclopramide

81
Q

How do you DEFINITIVELY diagnose LARPAR?

A

Laryngeal Exam

82
Q

How do you medically manage a LARPAR emergency?

A
  • Cool environment + water/ice bath
  • O2 and IVC
  • IV sedation and corticosteroids
  • Intubation, surgery
  • Temporary tracheostomy
83
Q

What is the goal of surgery for LARPAR and what is the standard technique?

A

Decrease airway resistance; arytenoid lateralization

84
Q

What is the surgical approach to LARPAR and the incision is parallel and ventral to what vein?

A

Left lateral cervical approach; incision parallel and ventral to JUGULAR vein

85
Q

What type of needle do you want to AVOID using for LARPAR surgery?

A

Reverse cutting

86
Q

(T/F): LARPAR is common in cats

A

FALSE, LARPAR is NOT common in cats

87
Q

What are the 4 principle biomechanical forces?

A

Bending, Torsional, Compressional, Distraction

88
Q

What are the initial AO priniciples?

A
  • Anatomical reduction
  • Stable fixation
  • Preservation of blood supply
  • Early active movements
89
Q

What are some disadvantages of non-locking plates?

A
  • Reliance on bone-to-plate friction
  • Stability, micro-motion, and fretting
90
Q

What are some advantages of locking plates?

A

Rigid construct, stronger screw-bone interface, monocortical, lock if at all possible

91
Q

Regarding bone displacement, what part of the bone do you use to identify the displacement?

A

Distal segment

92
Q

What are some disadvantages of monocortical locking?

A
  • Compromise in torsional stability
  • Risk of screw pullout in thin cortices, metaphyseal
93
Q

What are some advantages of monocortical locking?

A
  • Reduced vascular damage
  • Versatility (double plating and plate rod combination)
94
Q

What is the equation of stress and strain?

A
  • Stress = Force/Unit area
  • Strain = Change in length/Original length
95
Q

What is the equation for bending moment?

A

Bending moment = Force x Distance

96
Q

What are the two primary blood supplies for skin flaps?

A
  • Subdermal Plexus
  • Direct Cutaneous artery and vein
97
Q

Elliptical incisions should be ______ to tension lines

A

Parallel

98
Q

Skin sutures are for _______ only and not for _______ relief

A

Apposition; tension

99
Q

This is the elongation of skin with a constant load over time

A

Mechanical creep

100
Q

What is an example of biological creep?

A

Stomach stretching from pregnancy

101
Q

This tension relieving technique is done by separating the skin from the underlying tissue

A

Undermining

102
Q

With what do you not want to undermine?

A

Tumors

103
Q

What is a tension relieving technique that can be done before or after surgery?

A

Skin stretching

104
Q

What tension relieving suture uses a cruciate pattern?

A

Subcutaneous sutures

105
Q

What pattern are you using with strong subcutaneous sutures in reconstructive surgery?

A
  • Far, near, near, far
  • Far, far, near, near
106
Q

What is purpose of far sutures versus near sutures?

A
  • Far = relieve tension
  • Near = appose tissue
107
Q

Name the tension-relieving sutures

A
  • Strong subcutaneous
  • Mattress sutures
  • Walking sutures
  • Vertical Mattress
  • Bolsters
108
Q

What are two types of relaxing/releasing incisions?

A

Single relaxing and Mesh relaxing incisions

109
Q

What are 3 types of subdermal plexus flaps?

A

Advancement flaps, rotation flaps, and transposition flaps

110
Q

What is the blood supply for the axial pattern flaps?

A

Direct cutaneous artery and vein

111
Q

What are the two types of axial pattern flaps?

A

Peninsular flaps and island flaps

112
Q

What is the blood supply for free skin grafts?

A

From wound bed

113
Q

What is the process of engraftment for free skin grafts?

A
  • Adherence
  • Plasmacytic imbibition
  • Inosculation
  • Vascular ingrowth/revascularization
114
Q

What are some complications of reconstruction?

A

Necrosis, Dehiscence, Seroma, Infection

115
Q

Remember this slide

A
116
Q

Who created the TPLO surgery?

A

Slocum

117
Q

TPLO moves the ______ to meet the forces

A

Plateau

118
Q

TTA moves the ____ to meet the plateau

A

Forces

119
Q

TPLO _____ joint force and TTA ______ joint force

A

Increases; decreases

120
Q

What is the external rotator of the CCL?

A

Biceps

121
Q

What is the internal rotator of the CCL?

A

Popliteus, semitendinosus, gracilis, and semimembranosus

122
Q

All but the ______ are strongly affected by extension of the CCL

A

Popliteus

123
Q

The TPLO is not influenced by what?

A

Cranial tibial subluxation

124
Q

For TTAs, sagittal plane? Torsional plane?

A

Sagittal plane = yes
Torsional plane = NO

125
Q

For TPLOs, sagittal plane? Torsional plane?

A

Sagittal plane = yes
Torsional plane = yes

SA Surgical Diseases (1 decks)

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