Respiratory Surgery

Question 1

Laryngeal collapse: Cx

Answer 1

Stertor (expiratory); Stridor (Inspiratory); Exercise intolerance; Coughing; Regurg and vomiting

Question 2

Tracheal obstruction: Cx

Answer 2

Cough; Dyspnea; Cyanosis; Collapse

Question 3

Tracheal obstruction: Tx

Answer 3

Resection and anastomosis; Tracheostomy

Question 4

What is the main surgical treatment for lung lobe consolidation, bronchiectasis; lung lobe torsion or pulmonary neoplasia?

Answer 4

Partial or complete lung lobectomies

Question 5

What are the four main components of BOAS?

Answer 5

Stenotic nares; Elongated, thickened soft palate; Everted laryngeal saccules; Hypoplastic trachea; (also can have abherent turbinates; lorg tongue; tracheal collapse)

Question 6

List at least 3 clinical signs of BOAS

Answer 6

Stertor; Obstructive sleep apnea; Heat intolerance; Cyanosis and collapse; GI Signs (difficult swallowing, regurg, reflux, hiatal hernia)

Question 7

How do we diagnose BOAS?

Answer 7

Typical way is to evaluate the dog’s breathing at rest and exercise (walk), and do a sedated oral and laryngeal exam, based on these parameters we can assign a severity score; CT?radiology can be nice for issues like tracheal/bronchial hypoplasia, collapse, hiatal hernias, aspiration pneumonia

Question 8

Medical management of BOAS

Answer 8

Weight management; Avoid overheating

Question 9

List 5 surgical procedures we can do to manage BOAS

Answer 9

Rhinoplasty; Endoscope-guided turbinectomy; Shorten soft palate (e.g. Staphylectomy); Partial tonsillectomy; Laryngeal sacculectomy

Question 10

Prognosis of BOAS

Answer 10

The more severe, the worse the prognosis

Question 11

What does post-operative management look like for dogs with BOAS?

Answer 11

Susceptible to post-operative airway inflammation or pneumonia so address w/ supplemental oxygen, anti-inflammatories and possible a tracheostomy

Question 12

Pathomechanism of Laryngeal Paralysis (LarPar)

Answer 12

Idiopathic disorder typically in older large breed dogs (e.g. Labs and Goldens) where there is damage to the recurrent laryngeal nerve/caudal laryngeal nerve leading to failure of the cricoarytenoideus dorsalis muscle to abduct the arytenoids. Typically bilateral

Question 13

GOLPP

Answer 13

Geriatric Onset Laryngeal Paralysis and Polyneuropathy

Question 14

Three components of GOLPP

Answer 14

Laryngeal paralysis; Radial nerve dysfunction; Tibial nerve dysfunction

Question 15

Clinical signs of Laryngeal Paralysis

Answer 15

Change in phonation; Gagging; Exercise intolerance; Laryngeal stridor (during inspiration the arytenoids and vocal folds get pulled into the larynx closing the airway); Cyanosis; Dyspnea

Question 16

How is laryngeal paralysis diagnosed?

Answer 16

Radiographs to rule out other causes and look for supportive pathology such as aspiration pneumonia, non-cardiogenic pulmonary edema and megaesophagus); Laryngoscopy under light anaesthesia

Question 17

How would you address an emergency case of LarPar?

Answer 17

Cooling, oxygen therapy and anxiolytics +/- emergency intubation or tracheostomy

Question 18

For mild cases of LarPar, medical management solely tends to be appropriate. Describe medical management of this condition

Answer 18

Weight management, stress reduction, exercise restriction and avoiding heat. Warn owners that it will progress and can cause an emergency

Question 19

For moderate to severe cases of LarPar, how can we surgically manage the condition? What is a drawback?

Answer 19

Unilateral cricoarytenoid lateralization (“tie-back”); risk of aspiration (no swimmy :( )

Question 20

Prognosis of LarPar

Answer 20

Fair to poor (worsens as disease progresses)

Question 21

For tracheal collapse, which type of stenting is preferred, intraluminal or extraluminal?

Answer 21

Intraluminal (easier, and less severe complications especially in dogs where sx approach could be difficult)

Question 22

Does stenting a tracheal collapse stop the dog from coughing?

Answer 22

Naur

Question 23

Provide at least three causes of a spontaneous pneumothorax

Answer 23

Pulmonary emphysema; Pulmonary neoplasia; Chronic pneumonia; Migrating plant material; Asthma; Lungworm; Heartworm

Question 24

Clinical signs of spontaneous pneumothorax

Answer 24

In moderate to severe cases, we get restrictive breathing, hypoventilation, diminished lung sounds and respiratory distress

Question 25

Diagnosis of pneumothorax

Answer 25

US and PE to confirm presence of pneumothorax

Question 26

Four treatments for spontaneous pneumothorax

Answer 26

Thoracocentesis; Thoracotomy + continuous suction; Autologous blood patch (basically using animal's own blood, injecting it into the pleural space, and incuding the formation of a fibrin clot); Surgery

Question 27

Pathomechanism of pyothorax

Answer 27

Accumulation of septic purulent fluid in the pleural space

Question 28

Clinical signs of pyothorax

Answer 28

(May not be evident): tachypnea; dyspnea; cough; lethargy; weight loss; anorexia; restrictive breathing pattern

Question 29

Treatment of pyothorax

Answer 29

Typically, thoracocentesis or chest tube to drain +/- lavage + antibiotics (Fluoroquinolone and penicillin or clindamycin)

Question 30

Diagnosis of a pyothorax

Answer 30

Thoracocentesis; Cytology and culture

Question 31

When would surgical management of a pyothorax be indicated? What does this involve?

Answer 31

If you have failure of medical management (3-7d) or complications with the thoracostomy tube; remove inciting cause of pyothorax

Question 32

Prognosis of pyothorax

Answer 32

Guarded to good; Dogs tend to do better than cats with surgery

Question 33

Pathomechanism of a diaphragmatic hernia

Answer 33

Trauma leads to deatchment/rupture of part of the diaphragm from the body wall, allowing abdominal organs (liver most often) to enter the thoracic cavity

Question 34

Clinical signs of a Diaphragmatic hernia

Answer 34

Respiratory distress; Exercise intoelrance; Muffled heart and lung sounds: +/- borborygmi

Question 35

Diagnosis of a diaphragmatic hernia

Answer 35

radiographs; Ultrasound

Question 36

How are patients with diaphragmatic hernias treated?

Answer 36

Taken into surgery ASAP once stabilized; hernia is reduced via an abdominal approach while patient is on ventilatory support

Question 37

Briefly describe diaphragmatic hernia reduction surgery

Answer 37

Gently reduce the abdominal contents back into the abdomen, breaking adhesions where possible; Close opening dorsal to ventral using a continuous pattern +/- surgical mesh if chronic; Place thoracostomy tubes

Question 38

Prognosis of diaphragmatic hernia patients that receive surgeru

Answer 38

80-90% survival to discharge

Question 39

True or false. Death w/in 24 h of DH reduction is typically due to issues related to the GI tract.

Answer 39

False. Death w/in 24 h of DH reduction tends to be due to either pulmonary or cardiac dysfunction. Following 24hj, death typically due to GI damage or an unrelated issue

Question 40

True or false. Diaphragmatic hernias and peritoneopericardial diaphragmatic hernia are acquired.

Answer 40

False. PPDH are congenital while DH are acquired

Question 41

PPDH

Answer 41

Opening in the ventral diaphragm which allows the pericardial sac and peritoneal cavity to interact

Question 42

Clinical signs of PPDH

Answer 42

Muffled heart sounds, Boroborygmi in the thoracic cavity; Dyspnea; Cardiac dysnfunction

Question 43

Diagnosis of PPDH

Answer 43

radiographs; Ultrasound

Question 44

Surgery used to correct PPDH

Answer 44

Midline celliotomy (may have to enter pleural space and pericardium)