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Surgery final > Resp and Thoracic sx (LA) > Flashcards

Resp and Thoracic sx (LA) Flashcards

(60 cards)

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1
Q

Upper airway function

(nostrils to trachea)

A
  • conduit for airflow
  • olfaction
  • phonation
  • thermoregulation
  • filters and conditions air
  • protects lower airway
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2
Q

Lower airway function

(bronchi to alveoli and pulmonary tissue)

A
  • Gas exchange
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3
Q

normal function UA

A
  • horses obligate nasal breather
  • Inspiration: negative pressure
  • Expiration: positive pressure
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4
Q

UA primary sources of resistance to airflow

A
  • nasal valve
  • rostral nasopharynx and larynx
  • Oral cavity tremendous resistance
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5
Q

Resistance

A
  • proportional to inverse radius4
    • a very small change in radius dramatically increases resistance
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6
Q

Increased resistance

A
  • decreased ventilation
  • increased noise
  • poor performance
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7
Q

Diagnostics

A
  • Signalment and history
  • performance level and intended use
  • Occurence of clinical signs
    • rest/exercise
    • freq
    • progression
  • presenting complaints
    • noise and poor performance
    • nasal d/c
    • cough/dysphagia/halitosis
    • anatomic distortions
    • fever, inappetance, weight loss
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8
Q

Physical exam

A
  • General PE
  • Observe
    • symmetry
    • discharges
    • airflow from each nostril
  • palpate
    • larynx
    • jugular furrow
  • Percuss sinuses
  • auscult
    • heart and lungs
  • +/- oral exam
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9
Q

Endoscopy

A
  • resting
    • epiglottis
    • aretynoid cartilages
    • vocal fold
    • pharynx
    • soft palate (bottom)
    • Guttural pouch
  • when pulling out observe
    • nasal passage
    • ethmoid turbinates
    • drainage angle (nasal maxillary aperture)
  • Then go in other nostril
  • Look at trachea last
    • feed mat (dysphagia)
    • discharges
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10
Q

Exercising endoscopy

A
  • looks for functioning abnormalities
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11
Q

Other endoscopies

A
  • oral endoscopy
  • sinoscopy
    • minor surgical procedures
    • frontal sinus scopable
    • maxillary sinuses not scopable (tooth roots take up space
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12
Q

Radiography

A
  • Anatomy
    • paranasal sinuses
    • dental arcades
    • guttural pouches
    • pharynx
    • larynx
    • trachea
  • fluid lines
  • magnification
  • contrast
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13
Q

Ultrasonography

A
  • Laryngeal ultrasound
    • abnormal anatomy
      • congenital
      • distortion due to disease
    • muscle atrophy
  • bone limits other locations
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14
Q

On ultrasound atretic muscles are

A

hyperechoic

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15
Q

Cross-sectional imaging

A
  • No superimposition
  • Computed Tomography
    • method of choice for
      • dental arcades
      • paranasal sinus dz
      • +/- contrast
      • preop planning
  • MRI (take a long time)
    • soft tissue detail
      • masses
    • contrast
    • flow artifact
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16
Q

Other diagnostics

A
  • nuclear scintigraphy
  • clinical pathology (CBC/Chem)
  • Microbial culture and sensitivity
  • Bronchoalveolar lavage
  • Histopath
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17
Q

Nasal passage Anatomy

A
  • Nares
    • alar cartilage
      • alar fold
    • nasal diverticulum
  • Nasal Cavity
    • nasal septum
    • dorsal and ventral concha
    • dorsal, middle, ventral meatus
    • Nasomaxillary apperture
    • ethmoid turbinates
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18
Q

Nasal Passage diseases

A
  • Epidermal inclusion cyst (atheroma)
    • in nasal diverticulum, good prog
  • Redundant alar fold
  • Nasal lacerations
  • Nasal septal disease (uncommon)
    • thickening of nasal septum
  • Engorgement of nasal mucosa
    • Horner syndrome: pooling of blood and obstruction
  • Wry nose
    • deviation of maxilla in lateral plane
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19
Q

Paranasal Sinuses

A
  • Drain by either
    • middle meatus
    • nasomaxillary opening apperature
  • size and shape change with age
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20
Q

Paranasal sinus dz

A
  • Primary: strep
  • Secondary: dental dz
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21
Q

DX of paranasal sinusitis

A
  • HX and PE
    • primary sinusitis doesn’t stink, secondary does
  • Endoscopy
    • drainage from middle meatus
  • Rads
    • fluid lines
    • space occupying lesion
  • CT
  • Sinocentesis
    • culture and sensitivity
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22
Q

Sinusitis treatment

A
  • Primary
    • irrigation (trephine)
    • Abx
    • +/- debridement
  • Secondary
    • address cause
    • then treat as primary sinusitis
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23
Q

Landmarks for trephination of frontal sinus

A
  • Frontal sinus
    • draw a line from midline to medial canthus
    • 60% of distance from midline along this line, and 0.5cm caudal to the line
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24
Q

Paranasal sinus cyst

A
  • fluid filled masses
  • facial deformation
    • inspiratory airway obstruction
    • secondary sinusitus possible
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25
DX, TX paranasal sinus cyst
* DX * radiographs * TX * surgical debridement * PX * excellent, unless deformation of nasal cavity
26
Sinus neoplasia
* SCC most common * facial deformation * older horse
27
Sinus neoplasia DX, TX, PX
* DX * rads * biopsy * CT, MRI * TX * surgical debridement * radiation * chemo * PX * usually poor unless benign
28
Progressive ethmoid hematoma
* mass arising from ethoids or sius * mild intermittent epistaxis * unilateral \> bilateral * rarely any facial deformation/airway obstruction
29
Progressive Ethmoid Hematoma DX, TX, PX
* DX * **endoscopy** * rads * +/- CT * TX * intralesional formalin * Laser photoablation * Surgical removal (sinus) * PX * good * recurrence possible
30
Trauma
* open vs closed * depression fx * assume it's open into sinus cavity * epistaxis * emphysema * dyspnea * CNS signs
31
Trauma DXs
* Radiographs * CT * helpful for repair * endoscopy * evaluate patency of airway
32
Trauma TX
* Stabilize patient * abx * Analgesia * wound therapy * sinus lavage * to remove blood clots * surgical repair
33
Trauma PX
* good * face has good blood supply * dependant on other concurrent prob
34
Pharynx Anatomy
* Pharyngeal walls * dorsal pharyngeal recess * soft palate * no rigid support * susceptible to negative pressure
35
Pharynx Lymphoid hyperplasia
* bumps in pharynx * young horses * immune stimulation * usually no clinical signs
36
Lymphoid hyperplasia DX, TX
* DX * incidental finding of bumps on endoscopy * TX * rarely needed * rest and antiinflammatories (not really needed tho)
37
Pharynx Dorsal Displacement of the soft palate
* Intermittent \> persisten * intermittent: dynamic lesion * persistent * neuro cause? * **one lesion that causes noise on expiration**
38
DDSP DX
* Resting endoscopy * **exercising endoscopy** * +/- rads * +/- ultrasound
39
DDSP TX
* Conservative * tongue tie * figure 8 noseband * SX * Laryngeal tie-forward * gold standard * 80-9-% success * ST myectomy * ST tenectomy * Staphlectomy * Palatoplasty \* 60% success for other procedures
40
The Larynx Anatomy
* Epiglottis * Arytenoid cartilage * corniculate process * muscular process * Thyroid cartilage * Cricoid cartilage * Cricoarytenoideus dorsalis
41
Recurrent laryngeal neuropathy | (roarers, laryngeal hemiplasia)
* demyelination and axonopathy of RLN * Paresis to paralysis of intrinsic laryngeal muscles * CAD - ONLY ABDUCTOR * Inspiratory obstruction and noise at exercise * Mostly left side * large horses * TB, draft
42
Recurrent laryngeal neuropathy DX
* Laryngeal palpation * prominent Muscular Process * muscle atrophy * **Resting endoscopy is dx** * grading: 1 (normal) - 4 (complete paralysis) * **Laryngeal U/S** * +/- exercising endoscopy if not verified by other dxstics
43
Recurrent laryngeal neuropathy TX
* TX * **prosthetic laryngoplasty (tie-back)** * partial arytenoidectomy * last resort * Neuromuscular pedicle graft * takes like a year * ventriculectomy, vocalcordectomy, **ventriculocordectomy (usually done at same time as tie-back)**
44
Recurrent laryngeal neuropathy PX
* Tie-back * racehorses: 50-70% improved performance * performance horse: 85-95% improved performance
45
Guttural pouch Anatomy
* Paired extension of Eustachian tubes * Stylohyoid bone * medial and lateral compartments
46
Guttural pouch Lateral compartment
* smaller * structures * external carotic * maxillary a. * facial n.
47
Guttural Pouch Medial compartment
* Larger * structures * internal carotic a. * cranial cervical ganglion * sympathetic trunk * CN IX, X, XI, XII, pharyngeal branch of X * ventral straight muscles
48
Guttural Pouch mycosis about
* rare but life threatening * focal funcal infection with predilection for * arteries - ICA, ECA, MA * nerves - CN IX-XII, sympathetic trunk * aspergillus species (probs, usually)
49
Guttural pouch mycosis Clinical signs
* epistaxis * ddx: rupture of ventral straight muscles * dysphagia * horners * abnormal resp noise * nasal d/c
50
Guttural pouch mycosis DX
* **ENDOSCOPY**
51
Guttural pouch mycosis TX
* if in shock * blood transfusion/fluids * vascular occulsion if vessel involved * if nerve involved * nutritional support * treat topically
52
GPM Vascular occlusion
* Ligation Plus * balloon catheter * Detachable balloon * Microcoils * Nitnol plaque: under angiography (need fluorscopy) * ligating blood supply usually causes infection to regress on its own
53
GPM PX
* Guarded * 50% of horses that hemorrhaged will survive
54
Trachea anatomy
* incomplete hyaline cartilage rings * 4 layers of tissue * adventitia * musculocartilagenous layer * submucosa * mucosa
55
Tracheotomy
* Provide airway for horses with life-threatening upper airway obstruction * emergency or pre-emptive
56
Permanent trache**ostomy**
* Good prognosis
57
Tracheotomy procedure
* longitudinal incision at level of junction of prox and mid 1/3 of neck * transverse incision between tracheal rings * PUT YOUR FINGER IN THE HOLE TO SAVE YOUR PLACE * place temp trach tube
58
Tracheostomy procedure
2nd - 5th tracheal rings
59
Thorax indications for sx
* pleuritis * pleuropneumonia * pulmonary abscess * trauma * diaphragmatic hernia
60
Thoracic SX procedures
* Rib fracture repair (foals) * Rib resection and thoracotomy * Thoracoscopy

Surgery final (9 decks)

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