Respiratory Flashcards
(160 cards)
1
Q
Surgically speaking, where does the upper airway start and where does it end?
A
Nares to Larynx
2
Q
What are the neoplasias of the nasal cavity?
A
Adenocarcinoma, SCC, lymphoma, MCT
3
Q
What is the best imaging tool for nasal disease?
A
CT
4
Q
T/F: Always perform rhinoscopy and nasopharyngoscopy after imaging the nose.
A
True
5
Q
What is the most common nasal neoplasia indicated for surgery?
A
SCC
6
Q
What are some complications seen with nasal surgery?
A
Hemorrhage, flap necrosis, fistula, dehiscence, stenosis
7
Q
What are the primary disease components of brachycephalic airway syndrome?
A
Stenotic nares, elongated soft palate, everted laryngeal saccules, hypoplastic trachea
8
Q
What is the pathophysiology of upper airway obstructive disease?
A
Higher negative pressures that overcome obstruction, secondary soft tissue changes, decreased air flow with increased obstruction
9
Q
What is the most common component of BAS, and what does it lead to?
A
Elongated soft palate - leads to stertor.
10
Q
How much of the airway resistance in BAS does stenotic nares make up?
A
77% of the airway obstruction
11
Q
What are the 3 stages of laryngeal collapse?
A
Stage 1 - everted laryngeal saccules
Stage 2 - collapse of cuniform cartilage
Stage 3 - collapse of corniculate cartilage
12
Q
Which dog breed most commonly has hypoplastic tracheas?
A
English Bulldogs
13
Q
What are some GI comorbidities that go along with BAS, and what is a potential, more important complication they can lead to?
A
Regurgitation, vomiting, hiatal hernias, ulceration
These can lead to aspiration pneumonia
14
Q
How does BAS affect the cardiovascular system?
A
The chronic decrease in Pa02 from the airway obstruction leads to pulmonary vasoconstriction, V/Q mismatch, and then CV hypertenson
15
Q
What gender is more commonly affected by BAS?
A
Males
16
Q
T/F: Aspiration pneumonia is associated with severe BAS
A
True
17
Q
What are some space occupying masses that can occur in the upper airway?
A
Neoplasia, abscess, granuloma, foreign body, epiglottic retroversion
18
Q
What are the preferred methods of examining and diagnosing BAS?
A
Examination of upper airway under light anesthesia, thoracic radiographs
19
Q
What drug is a general CNS stimulant and used to improve the rate and strength of respiration?
A
Doxapram
20
Q
What are the indications for surgery in a case of BAS?
A
Any presence of the components or clinical signs of BAS, also to prevent secondary changes of BAS
21
Q
What are the surgical procedures used to treat BAS?
A
Wedge resection, soft palate resection, excision of everted laryngeal saccules
Spay/neuter
22
Q
What anti-inflammatory would you give as a pre-op therapy for BAS?
A
Dexamethasone
23
Q
What tools are used for soft palate resection?
A
CO2 laser, bipolar sealing device, sharp dissection with stay sutures on the soft palate
24
Q
What surgical techniques are performed to treat stenotic nares?
A
Wedge resection, allapexy, trader’s technique
25
T/F: Tonsillectomies are not recommended because the swelling will usually resolve after the treatment of other tissues
True
26
What must you distinguish before performing a unilateral arytenoid lateralization?
The presence of laryngeal paralysis (do procedure) and laryngeal collapse (do not do procedure)
27
What are some post-op therapies for BAS?
Prolonged intubation, analgesia, NPO, e-collar
28
What are some post-op complications with BAS?
ASPIRATION PNEUMONIA
rhinitis, swelling, bleeding
29
What CxS does epiglottic retroversion cause?
Extreme inspiratory effort
30
How do you treat epiglottic retroversion?
pexy of the ventral epiglottis and dorsal base of tongue
31
What is the muscle and nerve responsible for the larynx to abduct?
Muscle: crycoarytenoideus dorsalis
Nerve: caudal laryngeal nerve
32
What are the 3 functions of the larynx?
Swallowing, abduction for breathing, voice production
33
What are the two big diseases of the larynx?
Paralysis, trauma
34
What are the CxS seen with laryngeal disease?
Stridor, exercise intolerance, dysphagia, coughing
35
What is the pathophysiology of laryngeal paralysis?
Dysfunction to the vagus nerve that branches to the recurrent laryngeal and caudal laryngeal nerves
36
What is the most common cause of laryngeal paralysis?
Idiopathic
37
How do you surgically treat laryngeal paralysis?
Unilateral arytenoid lateralization (yes, I said it already)
38
What are some post-op therapies for surgical treatment of laryngeal paralysis?
Keep ET tube in until patient is awake, NPO for 24 hours, avoid heavy sedation, check for aspiration pneumonia
39
What lobe of the lung is most commonly affected by aspiration pneumonia?
Right middle lung lobe
40
What are the chances that laryngeal paralysis may reoccur after surgical intervention?
33% due to suture failure, progression of disease, or contralateral issues
41
When performing a ventriculocordectomy, how much of the ventral cord do you want to leave in tact and why?
1-2 mm to decrease the risk of webbing
42
Surgically speaking, what part of the trachea becomes apart of the lower respiratory tract?
Cricoid cartilage to the carina
43
Where does the trachealis muscle connect to on the trachea?
Dorsally
44
What are the layers of the trachea?
Mucosa, submucosa, mucociliary elevator
45
What are some surgical approaches to reach the trachea?
Cervical ventral midline, median sternotomy, intercostal thoracotomy
46
Name some big surgical tracheal diseases
Tracheal collapse, foreign bodies, tracheal rupture (from ET tube), trauma
47
T/F: Tracheal collapses are reversible degenerations of the upper airway.
False. Progressive, irreversible degeneration of the LOWER airway
48
What is the cause behind tracheal collapse?
Weakness of the tracheal cartilage from decreased water retention
49
What are some factors that lead to tracheal collapse?
Obesity, environmental allergens, respiratory irritants, kennel cough
50
What is the typical signalment for tracheal collapse?
Small/toy breed dogs, middle aged.
51
What does a tracheal collapse sound like?
Goose honk. waxing and waning
52
What is the gold standard diagnostic technique for tracheal collapse?
Tracheoscopy
53
What % of the trachea is affected with Grade I-IV tracheal collapse?
Grade I - 25%
Grade II - 50%
Grade III - 75%
Grade IV - almost 100%
54
When is surgery indication for tracheal collapse?
When medical management fails
55
What portion of the trachea are external prosthetic tracheal rings placed on?
Cervical portion
56
What are some surgical complications that can occur with surgery on the trachea?
Laryngeal paralysis, tracheal necrosis, pneumothorax
57
What is the surgical method of treating tracheal collapse?
Intraluminal stent
58
How do you determine the size of the surgical stent for tracheal collapse?
Imaging using an esophageal measurement probe
59
What are the pros and cons of an intraluminal stent to treat tracheal collapse?
Pro: not invasive, fast procedure, used on all portions of trachea, immediate improvement
Cons: expensive, uses scope, short-lifespan of stent, complications
60
What are some complications with an intraluminal stent placement?
Stent fracture, stent migration, tracheitis, extended collapse, granulation formation leading to obstruction, tracheal rupture
61
How can the trachea have internal trauma?
Foreign body, ETT
62
What is the primary method of treating tracheal trauma?
Medically
63
When is surgical treatment of tracheal trauma indicated?
When dyspnea persists, pneumothorax, or trauma is severe
64
What are the ways to surgically treat tracheal trauma?
Primary tear closure, resection & anastomosis
65
What are some complications of surgical treatment of tracheal trauma?
Stricture, pneuothorax/mediastinum, infection
66
When would you perform a permanent tracheostomy?
as a salvage procedure when you cannot treat an upper airway obstruction
67
What are some complications associated with permanent tracheostomies?
Infection, bleeding, stenosis, foreign bodies, pneumonia,
68
What kinds of dogs are best suited for permanent tracheostomies?
Indoor dogs with diligent owners
69
T/F: Permanent tracheostomies are also indicated for cats!
False. poor prognosis
70
What are some key things to do when performing a median sternotomy and opening the thoracic cavity? How do you close it?
Leave the manubrium and xiphoid intact
Close the cavity with a figure of 8 polypropylene suture or orthopedic wire
71
Besides the median sternotomy, what is another approach to access the thoracic cavity? When is this indicated? How do you perform this approach?
Lateral/intercostal thoracotomy
Used to approach a specific structure in the cavity
Incise layer by layer
Close with circumcostal suture
72
T/F: Median sternotomy is less painful than lateral thoracotomy
False.
73
Which is the most minimally invasive technique to access the thoracic cavity?
Thoracoscopy
74
What approach to the thoracic cavity is used to access the thorax during a celiotomy, and is used to ligate the thoracic duct, caudal esophagus, or intra-operative CPR?
Transdiaphragmatic approach
75
T/F: Positive pressure ventilation is mandatory when performing thoracic surgery
True
76
How would you access the thoacic cavity when performing a total or partial lung lobectomy? (2 answers)
Lateral thoracotomy, thoracoscopy
77
What is the name of the procedure where you remove all lobes of one lung?
Pneumonectomy
78
What is the maximum lung mass that can be acutely removed without being fatal?
65%
79
When is a pneumonectomy indicated?
When disease is diffuse through multiple lung lobes
80
What surgical instrument is used with complete or partial lung lobetomies?
Thoracoabdominal stapler (TA)
81
T/F: The thoracoabdominal stapler is too large for small patients
True
82
What can the thoracoabdominal stapler be used to do?
Isolate hilus of lobe or portion of it so it can be excised
83
T/F: When suturing a partial lobectomy, you want to suture distal to the clamps.
False. Proximal
84
What type of suture pattern is used for small peripheral masses?
Guillotine.
85
How do you suture for a complete lobectomy?
Triple ligate the vessels, pre-place horizontal sutures and tie before cutting, close bronchus with sutures
86
Why should you isolate affected lung tissue with moistened laparotomy sponges when performing pulmonary surgery?
Decreases the risk of contamination
87
What are some things to check before closing up the surgery?
Hemorrhage, air leaking, chest tube placement
88
What are some surgical diseases of the lungs?
Cysts, fistulas, abscesses, lacerations, torsions, neoplasia
89
What is a bleb?
localized collection of air between internal and external layers of the visceral pleura
90
What is a bullae?
Cavity in the lung not separated by epithelium or viscera
91
What are some complications that can occur with cysts, bullae, and blebs?
Abscessation, rupture, spontaneous pneumothorax
92
What is the problem with treating cysts, bullae, and blebs conservatively?
high recurrence rate
93
What are the surgical methods of treating cysts, bullae, and blebs?
Partial or complete lung lobectomy
94
What types of dogs are most commonly affected by lung lobe torsion?
Large, deep chested dogs and pugs
95
What CxS will you find with lung lobe torsion?
Dyspnea, tachycardia, cough, exercise intolerance, hemoptysis
96
What PE findings are reported with lung lobe torsion?
Pyrexia, pale mucous membranes, decreased ventral lung sounds
97
How can you diagnose lung lobe torsion?
Thoracocentesis - serosanguinous/chylous effusion
Imaging - rads/CT
98
What will happen if you untorse a lung lobe torsion?
It will release cytokines and endotoxins - reperfusion injury
99
What surgical treatment do you use for lung lobe torsion?
Lung lobectomy
100
What do you want to do to treat lung lobe torsion before performing the lung lobectomy?
patient stabilization - thoracocentesis, O2, fluids
101
Which dog, large or pug, has a better prognosis with lung lobe torsion?
Pug
102
What are the two most common types of primary pulmonary neoplasias?
Bronchiolar and alveolar carcinomas
103
How do you treat primary lung neoplasias?
Lung lobectomy for peripheral tumors not involving the hilus
104
What is the most common cause of thoracic wall trauma?
Hit by car
105
T/F: Most thoracic wall traumas do not require surgery
True
106
How do you treat a patient with a penetrated chest wound?
Stabilize, cover wound with dressing until patient is stable enough for surgery (may not need it if mild wounds)
107
What should you NOT do with an object that is penetrating the chest wall?
Remove it before fully accessing and preparing the area for removal
108
What is the most common cause for chylothorax?
Idiopathic
109
How do you diagnose chylothorax? What will you see?
Cytology of pleural effusion.
Modified transudate, lymphocytic effusion, triglycerides more in fluid, cholesterol less in fluid
110
How do you surgically treat chylothorax?
Thoracic duct ligation, cysterna chyli ablation, subtotal pericardiectomy
111
How can you better visualize the lymphatic structures when performing surgery on the chylothorax?
Injection of methlyene blue
Lymphangiography
112
Where on the dog do you approach the chylothorax surgery? Cat?
Dog: Right 10th IC space
Cat: Left 10th IC space
113
Where do you ligate and clip the thoracic duct when performing the thoracic duct ligation?
Close to the diaphragm as possible
114
How can you approach a subtotal pericardectomy?
Intercostal, median sternotomy or transdiaphragmatic approach
115
Where do you excise the pericardium for a subtotal pericardiectomy with a chylothorax?
Ventral to the phrenic nerve
116
What does a cisterna chyli ablation do
Re-routes the abdominal lymphatic drainage to major abdominal vessels
117
Which pet, dog or cat, has a better outcome with thoracic duct surgery?
Dog
118
What are some complications with thoracic duct ligation surgery?
Persistent chylous/non-chylous effusion, lung lobe torsion, pneumothorax
119
What is the most common cause of diaphragmatic hernias?
traumatic
120
What part of the thorax is most susceptible to tears from blunt force?
Muscle
121
What diagnostic imaging technique is the most accurate for diaphragmatic hernias?
Ultrasound
122
What CxS are seen with DH?
muffled heart sounds, borborygmi heard in thoracic cavity, tachycardia, tachypnea
123
What should you do to treat a patient with a diaphragmatic hernia before surgery?
Stabilize, look for other conditions, O2 therapy, prop patient at angle to drop organs down
124
How do you approach a diaphragmatic herniorrhaphy?
Ventral midline abdominal
125
What organ is most commonly herniated?
Liver
126
What suture pattern do you use to repair the hernia? Material?
Simple continuous suture pattern with PDS or Prolene
127
T/F: Re-expansion pulmonary edemas associated with rapid expansion of previously atelectic lungs are most commonly caused from acute hernias
False. Chronic hernias
128
What pressure ventilation must you keep at all times during a diaphragmatic herniorrhaphy?
< 15 cm H2O
129
How do you treat re-expansion pulmonary edema?
You can't. It's fatal
130
What is the prognosis for diaphragmatic hernias?
Good if patient survives 24 hours after surgery. 90%
131
What are some factors that decrease prognosis with DH?
Chronicity, age, concurrent injuries
132
T/F: Peritoneopericardial diaphragmatic hernias are congenital
True
133
What occurs with PPDH?
There is a communication with the pericardium and peritoneal cavity
134
What other congenital defects are seen with PPDH?
Polycystic kidneys, ventricular septal defects, sternal deformation
135
What PE findings are noticed with PPDH?
Muffled heart sounds, ascites, murmur
136
How do you diagnose PPDH?
Rads, U/S
137
What will you see on rads with PPDH?
Enlarged cardiac silhouette, dorsal elevation of trachea, overlap of heart and diaphragm borders, gas in pericardial sac
138
How do you treat PPDH?
Surgery with ventral midline abdominal approach asap, antibiotics
139
How do you suture close the surgery of PPDH?
Simple continuous pattern
140
What is the most common congenital cardiac defect in dogs?
Patent Ductus Arteriosis
141
What happens with PDA?
Blood is shunted from left to the right side of the heart causing severe volume overload progressing to heart failure of the left side
142
What do you see with reverse PDA?
Right to left shunt - severe pulmonary hyppertension
143
How can you treat PDA?
Coil embolization, ductal occluder
Surgical ligation - indicated with top two don't work
144
What are some complications of surgical ligation with PDA?
Severe hemorrhage due to PDA rupture, bradycardia (reflex), recanalization
145
What is the prognosis for PDA? Reverse PDA?
PDA - excellent if younger.
Reverse PDA - grave
146
T/F: Mitral regurgitation and myocardial insufficiency from PDA is likely to resolve after surgery.
True
147
What is the most common cardiac neoplasia in the dog?
Hemangiosarcoma of the right auricle
148
How do you treat hemangiosarcoma of the right auricle?
Emergency pericardiocentesis due to acute cardiac tamponade.
Chemotherapy
149
What are the functions of the pericardium?
Prevents over-distension of the heart, a gliding surface, and protection from spread of infection from thoracic cavity
150
What cardiac signs will you see with cardiac tamponade?
Increase intra-cardiac diastolic pressure, decreased stroke volume, decreased cardiac output, increased systemic venous pressure
151
List some pericardial diseases.
Rupture, effusion, inflammation, herniation
152
What CxS will you see in animals with pericardial disease?
Muffled heart sounds, weak femoral pulses, weakness, lethargy, dyspnea, exercise intolerance
153
What is both therapeutic and diagnostic for pericardial diseases?
Pericardiocentesis
154
What imaging tool will give you instantaneous information on fluid present in the pericardium?
Ultrasound
155
What types of surgeries are used to treat pericardial disease? What is the difference?
Total pericardiectomy - phrenic nerves dissected from pericardium
Subtotal pericardiectomy - all pericardium ventral to phrenic nerves are removed
156
What is the most common cause of vascular ring anomaly?
Persistent right aortic arch
157
What breed of dog is most commonly reported to have PRAA?
German shepards
158
What signs are seen with PRAA?
Regurgitation, unthrifty, respiratory signs
159
How do you treat PRAA?
Surgically via left intercostal thoracotomy (5-7 IC space), isolation of the ligament, double ligate and transect
160
What is the prognosis for PRAA with surgery?
Good to excellent
