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MOD (year 3) > SA soft tissue surgery > Flashcards

SA soft tissue surgery Flashcards

1
Q

what are halsteds principles of surgery?

A 
gentle tissue handling
meticulous haemostasis
preservation of blood supply
strict asepsis
minimal tension
accurate tissue apposition
obliteration of dead space
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2
Q

why is meticulous haemostasis important in surgery?

A

haemorrhage can obscure the surgical field and provide a medium for bacterial growth
can cause hypovolaemia, shock or death if not controlled

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3
Q

why is it important to not leave dead space in a cavity after surgery?

A

blood or tissue fluid can accumulate and form a haematoma or serum which provides a medium for bacterial growth increasing the chance of infection

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4
Q

what should always be used to attach a blade to a scalpel handle?

A

needed holders (avoid cutting yourself)

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5
Q

what are the ways of holding a scalpel?

A

pencil grip
fingertip grip
palm grip

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6
Q

what is the pencil grip on the scalpel used for?

A

short precise incisions due to small contact area

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7
Q

what is the fingertip grip on the scalpel used for?

A

for inactions over 3cm long (maximised blade/tissue contact)

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8
Q

when is the palm grip on a scalpel used?

A

rarely (allows substantial force but very imprecise)

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9
Q

what types of cutting can be done with a scalpel?

A

press cutting

slide cutting

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10
Q

how is press cutting done with a scalpel?

A

using the pencil grip and applying gradually increasing pressure in the direction of the motion of the blade (stab incision)

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11
Q

how is slide cutting done with a scalpel?

A

using any grip apply pressure at a right angle to the direction of motion of the blade while the other hand tenses the tissue laterally

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12
Q

why should slide cutting be done in a single motion?

A

creates less trauma and ensures smooth wound edges with less haemorrhage

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13
Q

what types of tissues are scissors very useful for cutting?

A

flaccid tissue that can’t be cut efficiently with a scalpel

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14
Q

what are metzenbaum scissors used for?

A

fine dissection

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15
Q

what are mayo scissors used for?

A

dissecting connective tissue/fascia

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16
Q

what are curved and straight scissors used for?

A

curved - dense tissue

straight - fine dissection

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17
Q

what forces are responsible for cutting when using scissors?

A

closing force - pushing blades together
shearing force - sliding blades over eachother
torque force - rolling leading edge of blade in to touch the other

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18
Q

what is the backhand thumb-third finger grip used for?

A

scissor cutting towards the dominant hand

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19
Q

what is the backhand thumb-index finger grip used for?

A

cutting across the table toward your body

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20
Q

what part of the scissors should be used for cutting?

A

tip (not the hinge)

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21
Q

what are the three ways of cutting with scissors?

A

scissor cutting
push cutting
blunt dissection

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22
Q

what is blunt dissection using scissors?

A

insert closed blades into tissue and open them then withdraw back

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23
Q

what are electrosurgical instruments used for?

A

coagulating or incising tissue

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24
Q

what are the types of electrosurgical instruments?

A

monopolar

unipolar

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25
Q

describe a monopolar electrosurgical instrument

A

electrode in the handpick and a ground plate

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26
Q

what can monopolar electrosurgical instruments be used for?

A

cutting

coagulation

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27
Q

what are bipolar electrosurgical instruments used for?

A

coagulation

haemostasis

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28
Q

why shouldn’t electrosurgery be used in excess?

A

causes more trauma to the surrounding tissues than using a scalpel or scissors

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29
Q

what should be remembered when using electrosurgery?

A

anaesthetised patients only
don’t use in presence of volatile gases/liquids
ground plate should be in complete contact with the animal
don’t wrap lead around towel clips (may induce burns)
keep electrode clean for proper function
keep power as low as possible

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30
Q

what are toothed forceps used for?

A

gripping tissue with minimal pressure (less traumatic)

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31
Q

what are two types of toothed forceps?

A

adson

debakey

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32
Q

describe the debakey forcep

A

fine atraumatic jaw pattern to the teeth

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33
Q

what should non-toothed forceps be used for?

A

handling inanimate objects (dressings…)

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34
Q

what are the types of tissue forceps?

A

allis
babcock
doyen

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35
Q

what are allis and babcock tissue forceps used for?

A

tissue that is going to be excised (they are traumatic)

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36
Q

what are doyen forceps used for?

A

holding and occluding the lumen of bowel (gap between the jaw avoids crushing tissue)

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37
Q

what are the types of retractors?

A

finger-held retractors
hand-held retractors
self-restraining retractors (balfour, gossett retractors, finochietto rib retractors, gulp retractors)

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38
Q

what are finger held retractors used for?

A

retraction of thin/delicate tissue

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39
Q

what are hand-held retractors used for?

A

retraction of thicker/robust tissue

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40
Q

what are balfour retractors used for?

A

abdominal wall retraction (used to lift the diploid process)

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41
Q

what are gossett retractors used for?

A

abdominal wall retraction

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42
Q

what are finochietto rib retractors used for?

A

separate ribs for intercostal thoracotomy

divide halves if sternum for median sternotomy

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43
Q

why is wound irrigation/lavage important?

A

avoid drying and trauma to tissue

role in asepsis

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44
Q

what are the types of suction tip?

A

frazier-ferguson
yankauer
poole

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45
Q

what is the frazier-ferguson suction tip good for?

A

removing haemorrhage during fine dissection

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46
Q

what is the yankauer suction tip good for?

A

removing large volumes of fluid fro body cavities

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47
Q

what is the advantage of the poole suction tip?

A

doesn’t block easily (multiple suction holes)

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48
Q

what are some complications of improper tissue handling?

A 
tissue ischaemia - delayed healing/necrosis
dead space formation
wound contamination
increased post-op pain
poorer cosmetic results
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49
Q

what is tensile strength of a suture material proportional to?

A

diameter of the suture

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50
Q

what should the tensile strength of a suture material be the same as?

A

strength of the tissue

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51
Q

what are the ideal properties of a suture material?

A

easy to handle
low tissue drag
resistant to contamination
good knot security

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52
Q

what are the two categories of suture material structure?

A

monofilament

multifilament

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53
Q

what are the advantages of monofilament suture material?

A

little tissue drag

withstand contamination well

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54
Q

what are the disadvantages of monofilament suture material?

A

prone to damage by instruments

high degree of memory - harder to handle and poor knot security

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55
Q

what are the advantages of multifilament suture material?

A

less memory - easy to handle and high knot security

higher surface friction - better knot security

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56
Q

what are the disadvantages of multifilament suture material?

A

can harbour bacteria (act as a wick)

increased tissue drag (reduced by coating)

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57
Q

what two ways can suture material be divided by chemical composition?

A

absorbable vs non-absorbable

synthetic vs natural

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58
Q

what are non-absorbable sutures mainly used for?

A

skin

hernia, ligament and tendon repair

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59
Q

how are absorbable synthetic sutures broken down? what does this cause?

A

hydrolysis - minimal tissue reaction

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60
Q

how are absorbable natural sutures broken down? what does this cause?

A

enzymatic reactions - inflammation and tissue reaction

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61
Q

what suture material should be used in contaminated/infected wounds?

A

smallest amount possible of synthetic monofilament suture material

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62
Q

what tissues can absorbable sutures be used on?

A

visceral wounds (heal quicker)

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63
Q

name a natural absorbable suture material

A

catgut

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64
Q

is catgut monofilament or multifilament?

A

multifilament

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65
Q

name some synthetic absorbable suture material

A 
dexon
vicryl
polysorb
monocryl
biosyn
PDS
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66
Q

which synthetic absorbable suture material is monofilament?

A

monocryl
biosyn
PDS

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67
Q

which synthetic absorbable suture materials multifilament?

A

dexon
vicryl
polysorb

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68
Q

name some synthetic non-absorbable suture material

A

nylon
supramid
prolene (surgilene)

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69
Q

what are the two methods suture material is attached to a needle?

A

swaged-on

eyed needle

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70
Q

what are the advantages of swaged-on needles?

A

less traumatic to tissue as you get a new sharp needle each time
easier to use

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71
Q

what is the advantages of eyed needles?

A

they are cheap and reusable

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72
Q

what are the two shapes of needles?

A

straight

curved

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73
Q

what are straight needles used for?

A

suturing near body surface or the skin

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74
Q

what are curved needles used for?

A

(most sutures)

narrow wounds deep in body cavities

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75
Q

what are the two types of point profiles of needles?

A

round bodied

cutting needles

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76
Q

what are round bodied needles used for suturing?

A

easily penetrated tissue such as fat, viscera or muscle

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77
Q

what are the three types of cutting needle?

A

conventional cutting needle
reverse cutting needle
taper-cut needles

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78
Q

describe conventional cutting needles

A

cutting edge on concave surface (can cause suture material to cut towards the edge of the incision)

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79
Q

describe reverse cutting needles

A

cutting edge on convex surface (less likely for suture to cut towards the incision)

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80
Q

what is the difference between mayo-hear and olsen-hegar needle holders?

A

Olsen-hegar have scissors built into them

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81
Q

what are the three effects sutures can have on tissue alignment?

A

appositional
inverting
everting

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82
Q

what does an appositional suture do?

A

brings wound edges into direct contact (most widely used)

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83
Q

what to inverting sutures do?

A

turn the suture edges inwards

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84
Q

what do everting sutures do?

A

turn the suture edges outwards

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85
Q

what are the types of interrupted suture pattern?

A

simple
cruciate mattress
vertical mattress
horizontal mattress

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86
Q

what are the advantages of simple interrupted suture patterns?

A

minimal interference with blood supply
allows tension to be easily adjusted across the wound
accurate apposition

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87
Q

what are the advantages of the cruciate mattress suture pattern?

A

tension relieving

doesn’t interfere with wound healing

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88
Q

what is the cruciate mattress pattern used for?

A

skin closure

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89
Q

what is the main advantage of the vertical mattress suture pattern?

A

doesn’t interfere with blood supply around the wound edge

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90
Q

what are the disadvantages of the horizontal mattress pattern?

A

can cause skin eversion
poor stability to wound edges
interfere with blood supply

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91
Q

what are some continuous suture patterns?

A

simple continuous
continuous horizontal mattress
ford interlocking

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92
Q

what is the disadvantage of continuous suture patterns?

A

breakage will cause the whole suture to fail

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93
Q

what are the advantages of the simple continuous pattern?

A

good tissue apposition

spreads tension evenly across the wound

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94
Q

what are the advantages of intradermal sutures?

A

no sutures to remove
no sutures passing through the skin surface to cause irritation or infection
minimal scar formation

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95
Q

what are subcutaneous sutures used for?

A

decrease tension across wound before placing skin sutures

reduce dead space

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96
Q

what type of pattern is used for subcutaneous tissue sutures?

A

simple continuous

continuous horizontal mattress

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97
Q

what suture patterns are used for the skin?

A

simple interrupted
cruciate mattress
continuous intradermal

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98
Q

what wounds are staples not suitable for?

A

wounds under tension
wound with irregular edges
less than 6mm depth of tissue separating them from bone/viscera

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99
Q

what is the name of tissue adhesives?

A

cyanoacrylate

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100
Q

what wounds are tissue adhesives used on?

A

small skin wounds under low tension

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101
Q

what wounds are tissue adhesives not suitable for?

A 
mucous membranes (don't adhere well on moist surfaces)
larger wounds under tension
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102
Q

define -tomy

A

to incise into

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103
Q

define -ectomy

A

to remove

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104
Q

define -centesis

A

introduction of a needle into a cavity to aspirate fluid/gas

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105
Q

define -pexy

A

surgical fixation of an organ/structure

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106
Q

define -rraphy

A

act of suturing

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107
Q

define -stomy

A

surgically creating an opening

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108
Q

define -desis

A

secure fixation by surgical methods

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109
Q

define -plasty

A

surgical shaping/moulding of a structure

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110
Q

what are the phases of wound healing?

A

lag/inflammatory
repair
remodelling

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111
Q

how long does the lag phase of wound healing last?

A

1-5 days

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112
Q

what is the immediate response to injury that initiates the lag phase?

A

haemostasis

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113
Q

what happens during haemostasis?

A

cells/fluid exit blood vessels and platelets trigger the formation of fibrin clots to form the provisional extracellular matrix and stabilise the wounds edges

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114
Q

during the lag phase what are the first cells attracted to the wound?

A

neutrophils

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115
Q

what are neutrophils attracted to the wound by?

A

chemotaxis

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116
Q

what is the role of neutrophils in the lag phase of wound healing?

A

degrade necrotic tissue and control infection by destroying bacteria

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117
Q

what cells enter the wound after the neutrophils?

A

monocytes

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118
Q

what do monocytes differentiate into once they have entered the wound?

A

macrophages

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119
Q

what is the role of macrophages in the wound?

A

remove degenerate neutrophils, necrotic tissue and debris by phagocytosis

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120
Q

how long does the repair phase of wound healing last?

A

6-16 days

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121
Q

what are the three overlapping parts of the repair phase of wound healing?

A

connective tissue repair
wound contraction
epithelialisation

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122
Q

what do mesenchymal cells differentiate into during connective tissue repair?

A

fibroblasts

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123
Q

what do the fibroblasts create during connective tissue repair?

A

new collagenous extracellular matrix

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124
Q

what allows fibroblast migration into the wound?

A

angiogenesis (capillary ingrowth)

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125
Q

what happens towards the end of the connective tissue repair stage of wound healing?

A

fibroblasts and new capillaries undergo apoptosis resulting in granulation tissue becoming acellular (paler scarring)

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126
Q

in full thickness skin wounds, how long does it take for wound contraction to start?

A

5-9 days

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127
Q

what causes wound contraction?

A

specialised myofibroblasts proliferate in the wound, attach to the wound matrix and each other then begin to contract

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128
Q

when does epithelialisation begin in partial thickness skin wounds?

A

immediately

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129
Q

when does epithelialisation begin in full thickness skin wounds?

A

4-5 days post injury

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130
Q

what is required in full thickness skin wounds before epithelialisation can occur?

A

a granulation tissue bed

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131
Q

describe the process of epithelialisation of wounds

A

epithelial cells from wound edges migrate across the wound to form a monolayer, they then begin to proliferate to increase the epithelial thickness
they become firmly attached to the dermis and over time stratifies

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132
Q

what can be mistaken for infection during suture wound healing?

A

epithelial proliferation causing an inflammatory response a keratinising epithelial cells contact connective tissue

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133
Q

when does the remodelling stage of wound healing begin?

A

14-16 days post injury

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134
Q

what happens during the remodelling phase of wound healing?

A

cellular content of the granulation tissue reduces and collagen bundles reorganise by thickening, cross linking and reorientation along tension lines

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135
Q

what local factors can effect wound healing?

A 
wound perfusion
tissue viability
wound fluid accumulation
infection
mechanical factors
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136
Q

why is wound perfusion so important to healing?

A

dividing cells require a lot of oxygen to be able to divide

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137
Q

what is the rate limiting step of wound perfusion?

A

new capillary formation in the granulation tissue bed

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138
Q

what effect does tissue viability have on wound healing?

A

devitalised/necrotic tissue and debris will prolong the inflammatory phase and delay healing

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139
Q

how does fluid accumulation in wounds slow healing?

A

physically separates the tissue and puts pressure on surrounding tissue which reduces perfusion

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140
Q

what effect does bacterial infection have on wound healing?

A

prolongs inflammatory phase
reduces chemotaxis
increases tissue damage
reduces fibroblast activity and collagen synthesis (decreases wound strength)

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141
Q

what are some systemic factors that can effect wound healing?

A

immunosuppression

neoplasia

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142
Q

why does neoplasia effect wound healing?

A

cancer cachexia due to increased cytokine level

cytotoxic drugs/radiotherapy can kill rapidly dividing cells

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143
Q

what is the specific response of the intestine to a wound?

A

collagenase activity decreases the wound strength

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144
Q

what is crucial to successful intestinal wound healing?

A

avoiding infection
preservation of blood supply
avoiding tension

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145
Q

how does skeletal muscle heal from small wounds?

A

regeneration with minimal fibrous tissue formation (if held in close apposition)

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146
Q

what are the specific responses to a wound to a peripheral nerve?

A

severed ends retract
cell body swells
nucleus becomes eccentrically placed
axon undergoes Wallerian degeneration

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147
Q

what is significant about wound healing of the liver?

A

regenerate up to 80% of its volume in 6 weeks by proliferation and hypertrophy

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148
Q

what are the two ways in which wounds can be classified?

A

degree of contamination

aetiology

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149
Q

what are the degrees of wound contamination?

A

clean
clean contaminated
contaminated
dirty

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150
Q

describe a clean wound

A

elective surgical wounds not entering respiratory, urogenital or GI tracts with no break in asepsis and primary closure

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151
Q

describe a clean contaminated wound

A

surgical wounds involving respiratory, urogenital or GI tract without significant contamination or minor breaks in asepsis

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152
Q

describe a contaminated wound

A

fresh traumatic would less than 6 hours old
surgical wounds involving respiratory, urogenital or GI tract with significant contamination
surgery in presence of inflammation
major breaks in asepsis

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153
Q

describe a dirty wound

A

traumatic wound greater than 6 hours old
traumatic wounds contaminated with foreign material/significantly devitalised tissue present
surgery in presence of abscessation

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154
Q

what are the categories of etiologically classifying a wound?

A 
abrasion
avulsion
degloving
incision
laceration
puncture
burn
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155
Q

what is an abrasion?

A

partial thickness wound with loss of epidermis and part of dermis

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156
Q

what is an avulsion?

A

tearing of tissue from its attachments

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157
Q

what is a devolving injury?

A

low-velocity avulsion of skin due to rotational force

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158
Q

what is an incision wound?

A

sharp trauma resulting in smooth edged wound

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159
Q

what is a laceration?

A

sharp trauma resulting in irregular wound with tearing of tissue

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160
Q

what is a puncture wound?

A

penetration by a sharp object

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161
Q

why must care be taken with puncture wounds?

A

often minimal superficial damage but infection and damage to deeper structure (especially abdomen/thorax)

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162
Q

what is the first stage on preparing a wound for closure?

A

take a swab for bacteriology

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163
Q

how should a wound be prepared for treatment?

A

cover with sterile ointment (KY jelly) or sterile swabs then clip the edges working away from the wound
surgically scrub around d the wound (do not allow detergents to come into contact with the wound)

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164
Q

what are the ways a wound can be debrided?

A

hydrodynamic
hydromechanical
surgical

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165
Q

what is hydrodynamic debridement also known as?

A

lavage

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166
Q

what are the aims of lavage?

A

decrease bacteria in wound
remove debris
prevent further contamination

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167
Q

how should grossly contained wounds be lavaged?

A

tap water

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168
Q

what is used to lavage a wound?

A

large volume of isotonic solution

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169
Q

what can be added to the final lavage?

A

antiseptics

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170
Q

what antiseptic can be used at the end of lavage?

A

chlorhexidine

povidone iodine

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171
Q

what is used for hydromechanical debridement?

A

amorphous hydrogel dressings

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172
Q

what functions do amorphous hydrogel dressings have?

A 
promote hydration and autolysis of necrotic tissue
absorb sloughing tissue
moisten the wound
prevent eschar formation
allow cell migration/proliferation
bacteriostatic
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173
Q

what do amorphous hydrogel dressings contain to make them bacteriostatic?

A

propylene glycol

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174
Q

when should amorphous hydrogel dressings be removed?

A

when dressing is changed (by lavage)

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175
Q

what should hydrogel be covered with when in wounds containing necrotic tissue?

A

non-adherent semi-occlusive primary layer (fenestrated polyester film)

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176
Q

what should wounds with lots of exudate be covered with?

A

hydrocellular foam dressing - won’t absorb gel but will wick away excess moisture

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177
Q

how should tissue viability be evaluated when deciding on surgical debridement?

A

tissue colour, pulse and bleeding

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178
Q

if in doubt about whether to surgically decried a wound, what should be done?

A

manage as an open wound until obvious demarcation of devitalised tissue occurs

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179
Q

what are the types of wound closure?

A

primary
delayed primary
secondary
secondary intention healing

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180
Q

what is primary closure of a wound?

A

immediate suture closure without tension

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181
Q

what is delayed primary closure of a wound?

A

closure of wound 1-5 days after injury before granulation bed forms

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182
Q

what is secondary closure of a wound?

A

closure of a wound 5 days after injury once the granulation bed has formed

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183
Q

what must be done just before closing a wound by secondary closure?

A

excise around wound edge or granulation tissue margin then close

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184
Q

what are the layers of dressing?

A

primary (contact)
secondary (intermediate)
tertiary (outer)

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185
Q

what are the two types of primary dressing layer?

A

adherent

non-adherent

186
Q

why do adherent dressing layers adhere to the wound?

A

fibrinous material, granulation tissue or exudate penetrates their structure and dries

187
Q

why are adherent primary dressing layer not commonly used?

A

slow healing
painful to remove
can cause tissue maceration

188
Q

what factors determine which type of non-adherent dressing to use?

A

what you want the dressing to do
how much exudate is being produced
if the wound is infected

189
Q

what dressing should be used to deride necrotic tissue?

A

non-adherent with hydrogel

190
Q

what dressing should be used used for a wound in the repair phase of healing?

A

non-adherent dressing for protection (to speed up granulation tissue formation)

191
Q

what are the most absorbent/permeable non-adherent dressings?

A

calcium aginate
polyurethane foam dressings
fenestrated polyester film

192
Q

what is the least absorbent/permeable non-adherent dressing type?

A

polyethylene film dressing

193
Q

how often does the dressing of infected wounds need to be changed?

A

at least once a day

194
Q

what are the type of non-adherent dressings?

A 
calcium aginate
fenestrated polyester film
hydrocellular foam
hydrocolloid
polyethylene
petrolatum-impregnated gauze
hyperosmolar agents
maggots
silver dressing
195
Q

what is calcium aginate dressing indicated for?

A

full/partial thickness wounds at any stage of healing with moderate/heavy exudation

196
Q

what are fenestrated polyester film dressings mainly used for?

A

protecting wounds with an intact epithelial surface

197
Q

what type of lesions are hydrocellular foam dressing good for?

A

ulcers

198
Q

what does silver dressing do?

A

release bacteriocidal silver ions into the wound

199
Q

what do maggots do?

A

debridement (difficult to keep them in the right place) - useful as antibacterial resistance increases

200
Q

what is an example of a hyperosmolar agent that can be used in dressings?

A

honey

201
Q

what are the actions of honey when used as a hyperosmolar dressing?

A

dehydrate bacteria to impair growth

low pH reduces bacterial growth

202
Q

what is the function of the secondary layer of a dressing?

A 
draws away and absorbs excess fluid 
keep primary layer in contact with wound
obliterate dead space
protect wound (padding)
support and immobilisation
203
Q

what are some types of secondary layers of dressings?

A

cast paddings
disposable nappies
cotton wool

204
Q

what is the function of the tertiary layer of dressing?

A

support

keep other layers clean

205
Q

what are the haemostat techniques?

A 
pressure
haemostatic forceps
electrosurgery
ligatures
vascular clips
topical haemostat agents
206
Q

what types of haemorrhage should pressure be used to control?

A

low-pressure haemorrhage

temporarily to high-pressure haemorrhage to allow time to select a better technique

207
Q

how should pressure be applied to haemorrhage?

A

for 5 minutes with a saline moistened swab (take care when removing not to remove clot)

208
Q

what vessels should haemostatic forceps be used on?

A

ones that are going to be sacrificed rather than repaired

209
Q

what are the methods of clamping using haemostatic forceps?

A

tip clamping

jaw clamping

210
Q

what is tip clamping? and what is it used for?

A

apply tip of smaller haemostat to tissue to occlude small vessels

211
Q

describe the features of monopolar cautery

A

current flows from single hand electrode to a ground plate under the patient

212
Q

what are the types of electrosurgery?

A

radiofrequency instruments

vessel sealing devices

213
Q

what are the two radio frequency devices used for haemostasis?

A

monpolar cautery

bipolar cautery

214
Q

what are the advantages of bipolar cautery?

A

more precise
requires less current
works better in a wet field

215
Q

what are the two types of vessel sealing devices?

A

elecrtrothermal bipolar vessel sealers

harmonic scalpels

216
Q

how do harmonic scalpels work?

A

ultrasonic vibrations of the instruments tip cause heating and coagulation of tissue

217
Q

what are the two types of ligatures used for haemostasis?

A

simple/circumferential

transfixing

218
Q

describe a circumferential ligature

A

simple loop placed a few mm from the end of the cut vessel

219
Q

how should large vessels (arteries) be ligated?

A

circumferential and a distal transfixing ligature

220
Q

what is a transfixing ligature?

A

penetrates the vessel and then encircles it in a figure of eight pattern

221
Q

what are the advantages of vascular clips?

A

rapid and convenient (but more expensive than ligatures)

222
Q

what are examples of topical haemostatic agents?

A

granules, powder or sheets of collagen or fibrin

223
Q

how do topical haemostatic agents work?

A

act as a scaffold for fibrin clot formation

224
Q

what are used for?

A

persistent capillary haemorrhage

225
Q

what are risk factors for increased wound infection?

A 
type/number of bacteria
clipping surgical site
anaesthesia/surgical time
propofol use
endocrinopathies
number of people in operating room
sex of patient
local wound environment
226
Q

how does the clipping of a surgical site effect the risk of wound infection?

A

causes microtrauma to the skin the can increase bacterial growth

227
Q

when should skin be clipped relative to surgery?

A

immediately before to avoid bacterial growth due to microtrauma

228
Q

why does increased anaesthetic time and surgical time increase the risk of wound infection?

A

immunosuppression
increased tissue handling
longer exposure of bacteria

229
Q

why can propofol use increase the risk of wound infection?

A

it is suspended in lipid that can support bacterial growth (if contaminated and injected it can cause infection)

230
Q

why do endocrinopathies increase the risk of wound infection?

A

many of them can cause immunosuppression

231
Q

what sex are more at risk of wound infection?

A

males

232
Q

why are male patients more at risk of wound infection?

A

due to the immunomodulatory effects of androgens

233
Q

what can impair tissue response to an infection?

A 
trauma
foreign material
ischaemia
poor nutrition 
chemotherapy
systemic disease
234
Q

what ways can surgical infections be prevented?

A 
patient selection/prep
surgical team prep
sterilisation of equipment
operating theatre prep
wound lavage 
post-op care
antibacterial
235
Q

what patients should elective surgery be postponed in?

A

those with pre-existing disease/infections

236
Q

what should be used on a regular basis in autoclave machines to ensure the sterilisation is efficient?

A

biological indicators

237
Q

should prophylactic antibacterials be used for clean surgeries?

A

only if they last longer than 90 minutes or if the animal is at risk due to other factors

238
Q

should prophylactic antibacterials be used for clean contaminated surgeries?

A

yes

239
Q

should prophylactic antibacterials be used for dirty surgeries?

A

no the wound is already infected, use therapeutic antibacterials

240
Q

define antisepsis

A

use of germicidal substances on living tissue

241
Q

define disinfection

A

use of germicidal substances on inanimate objects

242
Q

define nosocomial infections

A

hospita; enquired infections often caused by highly antibacterial resistant strains of bacteria

243
Q

define sterilisation

A

process of destroying all micro-organisms

244
Q

define a surgical infection

A

infection developing at the site of a surgery within 30 days of the surgery (1 year if its an implant)

245
Q

what are the main clinical signs of nasal disease?

A 
sneezing
increased respiratory noise
nasal discharge
epistaxis
facial pain
246
Q

what are the common causes of acute nasal disease?

A

nasal foreign body
viral URT infection
allergic/irritant rhinitis
tooth root abscess

247
Q

what are the two usual clinical signs of acute nasal disease?

A

snoring

serous nasal discharge

248
Q

what are the common causes of chronic nasal disease?

A

progression of acute disease
feline rhinotracheitis
fungal rhinitis (aspergillosis)
lymphocytic/plasmacytic rhinitis

249
Q

what would be examined on a clinical exam of a patient with suspected nasal disease?

A

symmetry of the head
nasal discharge, crusting, ulceration, depigmentation
pain and swellings
retropulse both globes
assess airflow (place hair by nares)
oral cavity - dental disease, fistulae, palate defects
palpate submandibular lymph node

250
Q

what are some possible diagnostic tests that can be carried out to diagnose nasal disease?

A 
blood tests
virology
radiography/imaging 
rhinos copy
nasal biopsy
forced flush
FNA
swabs
251
Q

what blood tests can be carried out for suspected nasal disease?

A

haematology/biochemistry
clotting profile
serology

252
Q

why may clotting profiles be carried out for suspected nasal disease?

A

if epistaxis is the only clinical sign

253
Q

what species is virology used for in suspected nasal disease?

A

cats

254
Q

what are the most useful radiographs for detecting nasal disease?

A

lateral of the skull
dorsoventral intramural of nasal cavity
rostrocaudal of frontal sinuses

255
Q

if nasal neoplasia is suspected, what diagnostic test should be carried out?

A

thoracic radiography to look for metastasis

256
Q

what should be done if haemorrhage after a nasal biopsy doesn’t stop after a few minutes?

A

flush nasal cavity with ice cold saline and place ice pack on the maxilla to cause vasoconstriction

257
Q

where in the nasal cavity should not be biopsied blind?

A

caudal to medial canthus of the eye

258
Q

why should you not blind biopsy caudal to medial canthus of the eye?

A

because you may damage he cribriform plate

259
Q

how is a forced nasal flush carried out?

A

cuffed endotracheal tube is placed and abdominal swabs packed into the common pharynx
the nasal cavities are then flushed under pressure to dislodge any foreign bodies or tissue fragments which will then be collected in the pharyngeal swabs

260
Q

what can you do an FNA of to help diagnose nasal disease?

A

mandibular or retropharyngeal lymph nodes (if enlarged or firm)

261
Q

what is fungal rhinosinusitis usually due to in dogs?

A

Aspergillus fumigatus

262
Q

what is fungal rhinosinusitis usually due to in cats?

A

Cryptococcus neoformans (rare)

263
Q

what dogs most commonly get fungal rhinosinusitis?

A

young/middle aged medium/large breed dogs

264
Q

what can fungal rhinitis cause extensive damage to?

A

turbinates

265
Q

what are the clinical signs of fungal rhinitis?

A 
nasal discharge 
epistaxis
facial pain
ulceration/depigemented nares
dullness/depression
266
Q

what type of nasal discharge is associated with final rhinitis?

A

mucopurulent

267
Q

how can be used to diagnose fungal rhinitis?

A 
history/clinical signs 
serology
radiography
rhinoscopy
histopathology
268
Q

what is seen on radiographs of animals with fungal rhinitis?

A

turbinate bone destruction

increased fluid density in the cavity

269
Q

what will rhinoscopy of dogs with fungal rhinitis reveal?

A

fungal plaques

turbinate destruction

270
Q

what is the gold standard of diagnosing fungal rhinitis?

A

histopathology

271
Q

what can be used to treat fungal rhinitis?

A

topical antifungals

272
Q

how are topical fungals used to treat fungal rhinitis?

A

trephination of frontal sinus and flush with sterile saline followed by packing of the sinus and nasal cavity with clotrimazole cream
soaking of nasal cavity with cltrimazole solutions using foley catheters

273
Q

are tumours of the nasal cavity usually benign or malignant?

A

malignant

274
Q

what neoplasias can effect the nasal cavity?

A 
adenocarcinoma
osteosarcoma
chondrosarcoma
squamous cell carcinoma
fibrosarcoma
lymphoma
275
Q

what are the clinical signs of nasal neoplasia?

A 
reduced airflow
nasal discharge (with epistaxis)
facial swelling/distortion
palate swelling/distortion
exophthalmos 
neurological signs
276
Q

when may neurological signs be a clinical sign of nasal neoplasia?

A

if it extends through the cribriform plate

277
Q

when may exophthalmos be a clinical sign of nasal neoplasia?

A

if there is invasion of the retrobulbar space

278
Q

what can be used to diagnose nasal neoplasia?

A

history/clinical signs
diagnostic imaging
rhinoscopy (biopsy)

279
Q

when taking a biopsy of a nasal mass, what must you be careful of?

A

not taking too smaller sample - will only contain normal nasal mucosa overlying neoplasia

280
Q

what can be done to treat nasal lymphomas?

A

chemotherapy

281
Q

what is the most effective treatment of nasal neoplasms?

A

radiation therapy (not usually curative)

282
Q

what palliative treatments can be used for nasal neoplasias?

A

antibacterials
analgesics
anti-inflammatories

283
Q

what is non-infectious inflammatory rhinitis also known as?

A

lymphocytic/plasmacytic rhinitis

284
Q

what are the clinical signs of non-infectious inflammatory rhinitis?

A

bilateral serous/mucopurulent nasal discharge
sneezing
snorting

285
Q

what can be used to diagnose non-infectious inflammatory rhinitis?

A

history/clinical signs
diagnostic imaging
rhinoscopy and biopsy

286
Q

what will be the findings on diagnostic imaging of animals with non-infectious inflammatory rhinitis?

A

mild loss of turbinate detail

increased soft tissue density (due to discharge)

287
Q

how can biopsy help to diagnose non-infectious inflammatory rhinitis?

A

histopathology to view lymphocytic/plasmocytic infiltration of the mucosa with possible secondary bacterial infection and neutrophilic inflammation

288
Q

how effective is treatment of non-infectious inflammatory rhinitis?

A

rarely curative and will often require longterm treatment

289
Q

what are the options for treating non-infectious inflammatory rhinitis?

A 
environmental modification
saline in nares to liquefy/clear discharge
nasal flushes
NSAIDs
antibacterials
mucolytics
test/eliminate allergens
290
Q

what effect does doxycycline have on the nares?

A

anti-inflammatory on nasal mucosa

antibacterial

291
Q

how can the environment be modified to treat non-infectious inflammatory rhinitis?

A

minimise exposure to irritants/allergens through ventilation, cleaning and humidification

292
Q

what are the clinical signs of nasal foreign bodies?

A

sudden onset
sneezing
distress/face pawing
purulent nasal discharge (unilateral)

293
Q

what can be used to diagnose nasal foreign bodies?

A

history/clinical signs
rhinoscopy
diagnostic imaging
exploratory rhinotomy (last resort)

294
Q

how are nasal foreign bodies treated?

A

nasal flushing
endoscopic removal
rostral retraction of the soft palate and retrieval
rhinotomy (last resort)

295
Q

what are some less common causes of nasal discharge?

A 
dental disease
bacterial rhinitis
cleft palate
ciliary dyskinesis
parasites (rare)
dysphagia causing nasopharyngeal reflux
296
Q

what is a major risk of rhinotomy?

A

haemorrhage - apply tourniquet around common carotid artery (whole blood should be available for transfusion)

297
Q

what has caused brachycephalic obstructive syndrome (BOS)?

A

selective breeding leading to shortening of the skull but without the same reduction of volume of connective tissue

298
Q

what are the primary components of BOS?

A

overlong soft palate
stenotic nares
tracheal /laryngeal hypoplasia

299
Q

what secondary change can occur as BOS progresses?

A

tonsillar enlargement and protrusion
laryngeal collapse
tracheal collapse

300
Q

describe the laryngeal collapse associated with BOS

A

eversion of the laryngeal saccules and progressive medial deviation of the corniculate and cuneiform processes of the arytenoid cartilage

301
Q

what are the clinical signs of brachycephalic obstructive syndrome?

A 
marked inspiratory noise
dyspnoea
snoring
sleep apnoea
exercise intolerance
cyanosis
fainting/collapse
gagging
dysphagia
regurgitation
coughing
302
Q

is starter or stridor associated with brachycephalic obstructive syndrome?

A

stertor

303
Q

what can exacerbate the clinical signs of BOS?

A

heat, excitement, exercise

304
Q

what can be used to diagnose BOS?

A

breed, history, clinical signs
examination of upper airway
radiography

305
Q

what is assessed in BOS cases by examination of the airway under light anaesthesia?

A

tonsillar size/protrusion from the crypts
soft palate - should just overlap the epiglottis
larynx - look for collapse

306
Q

why does care need to be taken when assessing the soft palate length of BOS patients?

A

don’t pull the tongue forward as this will displace the larynx/epiglottis and cause an overestimation of palate length

307
Q

what is assessed on radiographs of suspected BOS patients?

A

pharyngeal airway
tracheal diameter
signs of aspiration pneumonia
other causes of upper airway obstruction (masses…)

308
Q

what are the options for treatment of brachycephalic obstructive syndrome?

A

rhinoplasty
palatoplasty
laryngeal sacculectomy
tonsillectomy

309
Q

when should you intervene surgically with BOS cases?

A

if indicated by severity of clinical signs and impact on quality of life
as soon as possible before there is extensive secondary changes
wait until animal is skeletally mature so the tissue is less delicate and there is more room

310
Q

what should be done to stabilise severe BOS cases?

A 
cool, quiet environment
supplementary oxygen
sedation
IV corticosteroids
intubate to bypass obstruction
311
Q

describe the rhinoplasty performed on BOS cases

A

lateral, vertical or horizontal wedge resection of the dorso-lateral nasal cartilages

312
Q

how is haemorrhage controlled when performing rhinoplasty in BOS cases?

A

2 absorbable sutures placed in the defects

313
Q

what is given to patients undergoing palatoplasty? and why?

A

IV corticosteroid to reduce post-op airway swelling

314
Q

describe the procedure of a palatoplasty for BOS patients

A

resect the excess soft palate to it just overlaps the epiglottis

315
Q

what is the limit for resection of the soft palate?

A

caudal border of tonsillar crypts

316
Q

why should you not resect further than the caudal border of the tonsillar crypts?

A

will allow nasopharyngeal reflux of food/fluid leading to a chronic rhinitis

317
Q

describe the process of laryngeal sacculectomy for BOS patients

A

grasp the everted laryngeal saccule mucosa and amputate level with the laryngeal mucosa

318
Q

what usually causes laryngeal collapse?

A

secondary to chronic upper airway obstruction leading to increase resistance and hence increase negative pressure and turbulence

319
Q

what are the stages of laryngeal collapse?

A

1 - eversion of laryngeal saccules
2 - eversion of laryngeal saccules and medial deviation of the cuneiform process of the arytenoids
3 - eversion of laryngeal saccules and medial deviation of the cuneiform and corniculate processes of the arytenoid cartilages

320
Q

how is stage 1 laryngeal collapse treated?

A

laryngeal sacculectomy

321
Q

how are stage 2/3 laryngeal collapse treated?

A

laryngeal sacculectomy with/without arytenoid caudolateralisation

322
Q

what is an alternative treatment for laryngeal collapse if laryngeal sacculectomy fails?

A

permanent tracheostomy

323
Q

describe the procedure of arytenoid caudolateralisation for patients with laryngeal collapse

A

arytenoid cartilage is pulled further caudal than normal so it is medially supported by the cricoid cartilage preventing the medial deviation

324
Q

what can cause laryngeal paralysis?

A

congenital dysfunction of the recurrent laryngeal nerve
idiopathic degeneration of the recurrent laryngeal nerve
neuropathy due to metabolic disease
myopathies
trauma/neoplasia effecting the recurrent laryngeal nerve

325
Q

what can paralysis of the dorsal cricoarytenoid result in?

A

reduced size of the glottis and increased airway resistance during inspiration

326
Q

what breeds are predisposed to acquired laryngeal paralysis?

A

golden retrievers
labradors
irish setters

327
Q

what breeds are predisposed to congenital laryngeal paralysis?

A

Bouvier des Flandres

white German shepherds

328
Q

what are the clinical signs of laryngeal paralysis?

A 
inspiratory stridor
exercise intolerance
fainting/collapse
altered phonation
coughing/gagging during swallowing 
dysphagia
329
Q

what can be used to diagnose laryngeal paralysis?

A 
history/clinical signs
laryngoscopy
thoracic/cervical radiographs
haematology/biochemistry
electromyography
330
Q

what is being observed during a laryngoscopy off patients with suspected laryngeal collapse?

A

arytenoid cartilages should abduct during inspiration and adduct during expiration - take care with paradoxical movements caused by turbulence

331
Q

what is cervical/thoracic radiography used for when examining for suspected laryngeal disease?

A

mass lesions and concurrent aspiration pneumonia

332
Q

what is haematology/biochemistry used for in cases of suspected laryngeal paralysis?

A

to rule out metabolic disease

333
Q

what is the most common treatment of laryngeal paralysis?

A

arytenoid lateralisation (laryngeal tieback)

334
Q

describe the procedure of arytenoid lateralisation (tie back)

A

sutures permanently placed to permanently abduct the arytenoid cartilage and open the glottis
usually unilaterally on the left

335
Q

why is arytenoid lateralisation done unilaterally on the left side?

A

surgery on the left is easier for right handed surgeon

unilateral provided adequate airway for most cases but also minimises postoperative aspiration pneumonia

336
Q

what are some possible complications associated with arytenoid lateralisation (tie back)?

A

aspiration pneumonia
suture/cartilage breakage
serum development

337
Q

what techniques can be used to investigate tracheal disease?

A 
clinical exam
diagnostic imagery
tracheobronchoscopy 
biopsy
tracheal wash
338
Q

how can tracheal disease be investigated on a clinical examination?

A

auscultation of larynx, cervical trachea and thorax to localise respiratory noise
palpation of cervical trachea - changes in shape (collapse, neoplasia..)

339
Q

why are many tracheal abnormalities visible on radiographs?

A

high contrast between air filled lumen and surrounding soft tissues

340
Q

what diagnostic imagining can be used to visualise dynamic tracheal abnormalities?

A

fluoroscopy

341
Q

what are tracheal washes and bronchioaveolar lavage useful for?

A

bacterial culture

cytology

342
Q

what can cause tracheal tears?

A

sharp penetrating objects
blunt trauma
overinflation of cuffed ET tube in cats

343
Q

what can large tears of the trachea cause?

A

subcutaneous emphysema

pneumothorax

344
Q

what can be done to treat tracheal tears?

A

cage rest if not dyspneic

tracheoscopy - expose, decried and suture

345
Q

where does tracheal avulsion usually occur?

A

in the intrathoracic trachea caudal to the bifurcation

346
Q

how can tracheal avulsion be diagnosed?

A

history of trauma and progressive dyspnoea
tracheoscopy
toracic radiography

347
Q

what will tracheoscopy reveal in patients with tracheal avulsion?

A

circumferential tracheal ring disruption or tracheal stenosis

348
Q

what will thoracic radiography reveal in patients with tracheal avulsion?

A

intrathoracic pseudo trachea (area of gas density in line with the trachea)

349
Q

how is tracheal avulsion treated?

A

decried and anastomose avulsed ends

350
Q

what causes tracheal collapse?

A

laxity of the tracheal muscle

chondromalacia of the tracheal rings

351
Q

how is the severity of tracheal collapse catagorised?

A

grade I-IV

352
Q

describe a grade I tracheal collapse

A

laxity of the dorsal tracheal membrane resulting in 25% collapse of the lumen

353
Q

describe a grade II tracheal collapse

A

loss of cartilage rigidity and further laxity of the membrane resulting in 50% collapse of the lumen

354
Q

describe a grade III tracheal collapse

A

flattening of the tracheal cartilage resulting in 75% collapse of the lumen

355
Q

describe a grade IV tracheal collapse

A

collapse of the rings resulting in 100% loss of luminal integrity

356
Q

tracheal collapse is a dynamic process, describe this

A

cervical trachea collapses on inspiration and the intrathoracic trachea collapses on expiration

357
Q

what animals is tracheal collapse usually seen in?

A

small/toy dog breeds

358
Q

what are the clinical signs of tracheal collapse?

A

cough (goose honk) - elicited by tracheal pressure
waxing/waning dyspnoea
exercise intolerance
cyanosis
flattening of cervical trachea on palpation

359
Q

what can be used to diagnose tracheal collapse?

A

signalment, clinical signs, history
endoscopy
fluoroscopy
radiography

360
Q

what can fluoroscopy be used for when diagnosing tracheal collapse?

A

can reveal changes in the lumen diameter during inspiration/expiration

361
Q

how is tracheoscopy used when diagnosing tracheal collapse?

A

determine the location and grade of the collapse

362
Q

what can be done in most cases to treat tracheal collapse?

A

medical management - most dogs respond for more than 12 months

363
Q

what medical management techniques can be used in the treatment of tracheal collapse?

A 
weight loss (if required)
avoid stress, heat, excitement...
use harness instead of collar
address any other airway disease
corticosteroids
antitussives
bronchodilators
antibacterials for concurrent infections
364
Q

what are possible surgical treatments of tracheal collapse?

A

intraluminal stent

extraluminal stent

365
Q

what are some complications of intraluminal stenting to treat tracheal collapse?

A

stent migration
stent fracture
failure to integrate into mucosa

366
Q

what will failure of an intraluminal stent to integrate into the tracheal mucosa result in?

A

reduced mucociliary clearance
granulation tissue formation
tracheal stenosis
collapse of unstented trachea/bronchi

367
Q

what is used for extraluminal stenting of the trachea?

A

prosthetic rings

368
Q

what are some complications of extraluminal stenting for treating tracheal collapse?

A

iatrogenic damage to laryngeal nerves
tracheal necrosis (disrupted blood flow)
persistent cough
further collapse

369
Q

what is done to reduce the complication of laryngeal collapse due to damaged nerves caused by extraluminal stenting?

A

concurrent arytenoid lateralisation

370
Q

what animals is tracheal hypoplasia most commonly seen in?

A

tracheal hypoplasia

371
Q

how is tracheal hypoplasia diagnosed?

A

lateral cervical/thoracic radiographs

372
Q

how is tracheal hypoplasia treated?

A

management of other airway abnormalities (stenotic nares, long soft palate…)
symptomatic treatment to improve mucociliary clearance

373
Q

what is tracheal necrosis?

A

abnormal narrowing due to trauma and excessive granulation tissue formation

374
Q

what are the clinical signs of tracheal stenosis?

A

progressive cough
exercise intolerance
dyspnoea

375
Q

what can be used to diagnose tracheal stenosis?

A

history/clinical signs
diagnostic imaging
tracheoscopy and biopsy

376
Q

what can be done to treat tracheal stenosis?

A

tracheal resection and anastomosis

377
Q

what can be done to treat tracheal neoplasia?

A

excision and anastomosis for small minimally invasive neoplasms
chemotherapy
radiotherapy for lymphoma

378
Q

how is the cervical trachea accessed for surgery?

A

ventral midline incision, separating the sternohyoideus muscles along the midline to reveal the trachea

379
Q

how is the thoracic trachea accessed for surgery?

A

3rd to 5th intercostal space thoracotomy on the level of the lesion

380
Q

what type of blood supply does the trachea have?

A

segmental

381
Q

why does care need to be taken with tracheal surgery?

A

close to many important structures - recurrent laryngeal, carotid arteries, thyroid gland

382
Q

what should be used to close tracheal injuries?

A

monofilament absorbable suture material with knots placed extraluminally

383
Q

what is temporary tracheostomy used for?

A

release potentially life threatening URT obstruction
assist ventilation
removal of secretion or aspirated materials
inhalation anaesthetic agents

384
Q

describe the technique for placing a temporary tracheostomy tube

A

incise skin and separate right/left sternothyroid and sternohyoid
make a transverse incision between the 4th/5th tracheal rings
place a suture loop cranial and caudal to the incision
place a non-cuffed tracheostomy tube into the lumen
suture skin around the tube leaving an open wound for replacing the tube
place a light bandage

385
Q

how does a tracheostomy tube have to be maintained?

A

change at least twice a week
clean/disinfect
suction airway when required
moisten airway every 1-4 hours

386
Q

what are some common complications associated with tracheostomy tubes?

A 
tube obstruction/removal
gagging/coughing
SC emphysema 
pneumothorax
infection
tracheal stenosis
387
Q

what should be done before removing a tracheostomy tube?

A

occlude the tube for 15-20 minutes to ensure no respiratory distress

388
Q

how is the stoma of tracheostomy tube placement allowed to heal?

A

secondary intention

389
Q

how are permanent tracheostomy tubes managed?

A 
cleaning opening
keep hair short
maintain good BCS
cover when outside
restrict patient from swimming
390
Q

what is tracheal resection indicated for?

A

congenital or acquired tracheal strictures
localised tracheal neoplasia
tracheal granuloma

391
Q

what is the maximum number of tracheal rings you can remove?

A

5-6

392
Q

what are some developmental abnormalities of the kidneys?

A

renal agenesis
renal dysplasia
renal ectopia
polycystic kidney disease

393
Q

what species are predisposed to polycystic kidney disease?

A

Persians

Bull terriers

394
Q

what is renal agenesis?

A

when the kidney and ureter aren’t present

395
Q

what is renal dysplasia?

A

disorganisation of the parenchyma

396
Q

what are the indications for a renal biopsy?

A 
renal mass (most common)
haematuria of UUT origin
renal cortical disease
renal failure of unknown cause
evaluate severity of renal disease
397
Q

what tests should be carried out before a renal biopsy?

A 
haematology
serum biochemistry
urinalysis
diagnostic imaging
coagulation profile
398
Q

what are the contraindications for a renal biopsy?

A 
anaemia 
coagulopathy
oliguria/anuria/severe azotaemia
hypertension
urinary obstruction
hydronephrosis
renal abscess 
solitary functioning kidney
399
Q

what are some potential complications of renal biopsies?

A 
haemarrhage 
haematuria
hydronephrosis
renal infarction
damage to renal vasculature
infection
fibrosis
400
Q

what are the methods of taking a renal biopsy?

A

FNA
tru-cut needle
surgical

401
Q

what does tru-cut or FNA take a renal sample of??

A 
the cortex 
(don't go in medulla - causes problems)
402
Q

why are FNA and tru-cut renal biopsies taken under ultrasound guidance?

A

to make sure you don’t put the needle in the medulla

403
Q

what are the ways of approaching the kidney for a biopsy?

A

ultrasound guided
keyhole (flank)
laparoscopic
ventral midline coeliotomy

404
Q

how do you expose the right kidney when doing a midline coeliotomy?

A

retract descending duodenum to the midline

405
Q

how do you expose the left kidney when doing a midline coeliotomy?

A

retract the colon to the midline

406
Q

which kidney has multiple arteries?

A

left

407
Q

what is a nephrotomy?

A

an incision into the kidney

408
Q

what are the indications for a nephrotomy?

A

wedge biopsy

removal of nephroliths

409
Q

how should haemostasis be carried out during a nephrotomy?

A

using assistants fingers or vascular clamps for no longer than 20 minutes

410
Q

what is bisectional removal of calculi from the kidney?

A

incisioin made from pole to pole of the kidney

411
Q

after removing the nephroliths from the kidney, what must you do?

A

check for patency of the ureter

412
Q

what must be done at the end of a nephrotomy?

A

fix the kidney back onto the body wall

413
Q

what are the two types of neophrotomy to remove calculi?

A

bisectional

intersegmental

414
Q

what are the clinical signs of nephroliths?

A

lumbar/abdominal pain
haematuria
recurrent UTI
azotaemia

415
Q

how can nephroliths be treated?

A

medical management - specific diets

surgery

416
Q

what type of nephroliths don’t respond to medical management?

A

calcium oxalate

417
Q

what is ureteronephrectomy?

A

removal of the kidney and associated ureter

418
Q

what are the indications for ureteronephrectomy?

A

trauma
hydronephrosis
renal masses
harvest for transplant

419
Q

what is a key aspect that must be taken into account before carrying out a ureteronephrectomy?

A

animals must have two functioning kidneys

420
Q

what is the only indication for partial nephrectomy?

A

if patient has lost other kidney and need to do surgery on the other kidney

421
Q

what is the most common renal neoplasm in cats?

A

lymphoma

422
Q

what is the most common neoplasm in dogs?

A

renal cell carcinoma

423
Q

are primary or metastatic renal neoplasms more common?

A

metastatic

424
Q

what are the clinical signs of renal neoplasia?

A 
(slow onset)
haematuria
weight loss
depression/lethargy
inappetance
pyrexia
lameness
abdominal distension
425
Q

how are renal neoplasms investigated?

A 
abdominal palpation
haematology/biochemistry
radiography
computed tomography
ultrasound
biopsy
(check for metastasis)
426
Q

is renal lymphoma in cats usually bilateral or unilateral?

A

bilateral

427
Q

how can renal neoplasms be treated?

A

lymphoma - chemotherapy

ureteronephrectomy

428
Q

why is surgery to remove renal neoplasms often challenging?

A

can be metastasis and extensive neovascularisation (high risk of haemorrhage)

429
Q

what are some possible congenital abnormalities of the bladder?

A

patent urachus

vesicourachal diverticulum

430
Q

what does the urachus connect?

A

bladder and allantoic sac

431
Q

what s vesicourachal diverticulum?

A

when the external opening of the rachis closes but the blind ending diverticulum remains open

432
Q

where on the bladder should be avoided during surgery?

A

trigone

433
Q

what is cystotomy?

A

opening of the bladder

434
Q

what are the indications for cystotomy?

A 
removal of calculi
repair bladder trauma
biopsy/resection of bladder mass
biopsy of bladder wall
repair ectopic ureters
435
Q

what is the surgical approach for cystotomy?

A

ventral midline coeliotomy from umbilicus to the pubis
isolate the bladder and place stay sutures
make incision and suction urine

436
Q

why is gentle tissue manipulation of the bladder very important?

A

the urothelium quickly becomes congested and oedematous

437
Q

what suture material is used to close the bladder?

A

monofilament - monocryl

438
Q

what two patterns of suture can be used to close the bladder?

A

single layer of simple interrupted/continuous

double layer using inverting continuous pattern

439
Q

how fast does the bladder heal?

A

rapidly - 100% strength in 2-3 weeks

440
Q

what is the postoperative management after cystotomy?

A

hospitalisation to monitor urination

don’t palpate abdomen

441
Q

what are possible complications associated with cystotomy?

A

haematuria
dysuria
uroabdomen (uncommon)

442
Q

what are the main types of bladder calculi?

A

struvite

calcium oxalate

443
Q

what are the clinical signs of bladder calculi?

A

haematuria
pollakuria
stranguria
dysuria

444
Q

how are baldder calculi diagnosed?

A 
radiography
pneumocystography
double contrast cystography
ultrasound
CT
445
Q

what are the possible causes of bladder rupture?

A

trauma
neoplasia
urethral obstruction
iatrogenic

446
Q

what are the clinical signs of bladder rupture?

A

haematuria, dysuria
abdominal bruising
abdominal distention
depression, vomiting, shock

447
Q

how can bladder rupture be diagnosed?

A 
history/clinical exam
abscence of urine on catheterisation
urethral obstruction
azotaemia, dehydration, metabolic acidosis
abdominocentesis
ultrasound
positive contrast study
448
Q

what differences will be seen in the fluid from abdominocentesis of patients with bladder rupture?

A

increased creatinine and potassium (higher than serum)

449
Q

how is bladder rupture treated?

A

fluid therapy and urine drainage

closure of rupture (same as cystotomy) after exploratory laparotomy to identify the defect

450
Q

what does cystostomy tubes allow?

A

urinary diversion and avoid bladder distention

451
Q

what are the indications for a cystostomy tube?

A

bladder or urethral surgery
obstructed bladder neck or urethral neoplasia
neurogenic bladder atony

452
Q

what is the most common bladder neoplasia of dogs/cats?

A

transitional cell carcinoma

453
Q

how can bladder neoplasias be treated?

A 
chemotherapy
NSAIDs
cystostomy tubes
urethral stenting 
partial cystectomy
454
Q

what is the difference between male and female urethras?

A

female - shorter and wider

males - divided into pelvic, membranous and penile urethra

455
Q

what are the possible clinical signs of patients with urinary tract disease?

A 
haematuria
polyuria/polydipsia
dysuria
pollakiuria
stranguria
oliguria
anuria
nocturia
incontinence
lethargy
collapse
pyrexia
weight loss
vomiting/diarrhoea
abdominal/lumbar pain
456
Q

what is dysuria?

A

pain on urination

457
Q

what is polydipsia defined by?

A

water intake exceeding 100ml/kg/day

458
Q

what is polyuria define by?

A

urine output higher than 50ml/kg/day

459
Q

what is oliguria?

A

lower than normal urine output

460
Q

what is pollackiuria?

A

frequent small amounts of urination

461
Q

what vital parameters are assessed in patients with urinary tract disease?

A

HR, RR, hydration, MM colour, mentation, temperature

462
Q

what is assessed on abdominal palpation in patients with urinary tract disease?

A

pain

changes in kidney size

MOD (year 3) (45 decks)

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