Soft Tissue Surgery (1-19) Flashcards
(390 cards)
1
Q
name the 3 phases of wound healing
A
- inflammation
- proliferation
- maturation
2
Q
name the 3 goals of the inflammatory phase of wound healing
A
- haemorrhage + clot formation
- incr. blood flow
- start control bacterial infection
3
Q
what is the role of neutrophils in the inflammatory phase of wound healing
A
phagocytose bacteria & die
4
Q
name the 3 roles of macrophages in the inflammatory phase of wound healing
A
- phagocytosis of debris
- produce proteases
- release cytokines
5
Q
name 2 roles of exudate during the inflammatory phase of wound healing
A
- sloughing tissue, cells, and bacteria
- debridement phase of wound management
6
Q
name the 2 parts of the proliferative phase of wound healing
A
- granulation tissue forms
- epithelialisation
7
Q
name the 3 steps of granulation tissue formation during the proliferative phase of wound healing
A
- macrophages promote fibroplasia and angiogenesis
- vessels migrate into fibrin clot
- collagen matrix is laid down
8
Q
name 3 features of an unhealthy granulation bed during wound healing
A
- pale
- not progressing
- usually necrotic debris or infection
9
Q
name 3 features of a healthy granulation bed during wound healing
A
- highly resistant to infection
- nutrient and oxygen supply
- lattice for scar formation (red, moist, flat)
10
Q
name 5 factors that promote epithelialisation during the proliferative phase of wound healing
A
- healthy granulation bed
- absence of infection
- absence of necrotic debris
- oxygen at wound surface (vessels)
- moist wound environment
11
Q
name the 2 parts of the maturation phase of wound healing
A
- scar contracts
- collagen remodels (increasing strength)
12
Q
what is the endpoint goal of initial open wound management
A
granulation tissue with epithelialisation
13
Q
name 2 types of factors affecting wound healing
A
- host factors
- local factors
14
Q
name 5 host factors that may delay wound healing
A
- old age
- hypoalbuminaemia
- endocrine disease
- metabolic disease
- medication
15
Q
name 5 local factors detrimental to wound healing
A
- foreign material
- infection
- trauma
- desiccation
- hypoxia
16
Q
name 6 ways to promote wound healing
A
- removal of non-viable tissue
- control infection
- good tissue oxygenation
- moist surface
- avoid trauma
- control host factors where possible
17
Q
name 4 wound closure options
A
- primary closure
- delayed primary closure
- secondary closure
- second intention healing
18
Q
what type of wound is able to be closed by primary closure
(immediately)
A
clean or clean-contaminated with aseptic technique
19
Q
what type of wound is able to be closed by delayed primary closure
(2-5 days)
A
clean contaminated, contaminated
20
Q
what type of wound is able to be closed by secondary closure
(>5 days)
A
contaminated, dirty
21
Q
name the type of wound closure
closure after bacteria and debris have been eliminated but before granulation starts;
moderate tissue trauma;
grossly contaminated;
caused by dirty objects
A
delayed primary closure
22
Q
name the type of wound closure
closure once granulation tissue has formed;
healthy granulation - implies no infection or necrotic debris
A
secondary closure
23
Q
name the 3 steps of open wound management
A
- initial assessment and preparation
- debridement (inflamm. phase)
- granulation (proliferation phase)
24
Q
name 4 steps to prevent further contamination during hair clipping for preparation of an open wound
A
- pack wound with sterile K-Y jelly
- clip widely
- gel traps hair
- lavage gel off
25
name 3 ways to debride an open wound for initial debridement
1. sharp dissection
2. scraping with blade
3. rub with dry swab
26
name 4 signs of devitalised tissue that should be debrided
1. white, green black
2. does not bleed when nicked
3. loss of skin pliability
4. thinning of skin
27
name 3 options for continued debridement of an open wound
1. adhesive dressing (wet-to-dry dressing)
2. autolytic
3. surgical
28
how often should a wet-to-dry dressing for debridement be changed
min. 24 h;
usually 12-24h
29
how long should an adherent dressing be used for continued debridement of an open wound
48-72 h
(during exudative period)
30
when should you change the debridement method of an open wound to non-adherent?
| (3 features present)
1. all necrotic tissue removed
2. exudate reduces
3. granulation starts
31
name 3 surgical options for continued debridement of an open wound
1. en bloc
2. layered debridement
3. combination
32
name 2 autolytic options for continued debridement of an open wound
1. hydrogel
2. honey dressing
33
what are the 3 goals of autolytic debridement
1. encourage enzyme activity
2. liquefy exudate
3. remove exudate
| (physiological slough)
34
name 4 features of honey dressings for an open wound debridement
1. autolytic debridement
2. osmotic effect
3. antibacterial effect
4. accelerate wound healing
35
name 4 visual features of healthy granulation tissue
1. red
2. uniform
3. minimal exudate
4. progressing daily
36
name the 3 layers of a bandage
1. primary (contact) layer
2. intermediary layer
3. tertiary layer
37
name 3 functions of the intermediary layer of a bandage for an open wound
1. hold contact layer in place
2. absorb exudate passing through contact layer
3. provide padding + support
38
name the 2 parts of the tertiary layer of a bandage
1. conforming layer
2. cohesive layer
39
name the 3 functions of the tertiaru layer of a bandage
1. hold intermediary layer in place
2. protect environmental contamination
3. apply pressure to dressing
40
# name the topical antimicrobial
bactericidal broad spectrum;
apply early to prevent bacterial colonization;
burn therapy
silver sulfadiazine
41
# name the topical antimicrobial
Ag+ ions;
bactericidal;
independent of culture and sensitivity
silver dressings
42
# name the topical antimicrobial
oxidase activity generates H2O2;
acidic pH;
anti-oxidants;
modifies host response;
osmotic effect
honey dressings
43
name the 4 layers of the skin
1. epidermis
2. dermis
3. hypodermis
4. panniculus muscle
44
name the 4 levels of vasculature in the skin
(superficial to deep)
1. papillary/superficial plexus
2. middle plexus
3. subdermal plexus
4. direct cutaneous vessels
45
name the 7 Halsted Principles
1. aseptic technique
2. gentle tissue handling
3. meticulous haemostasis
4. preservation of blood supply
5. obliteration of dead space
6. accurate apposition of tissue
7. minimise tension
46
what kind of suture material should you use for the skin
synthetic, monofilament, small diameter
47
what kind of needle should you use for suturing skin
swaged-on reverse cutting needles
48
what type of forceps are the most traumatic to skin?
plain thumb forceps
(crushing injury)
49
name 3 surgical techniques for eliminating dead space
1. drains
2. sutures
3. bandages
50
what is the surgical technique to preserve blood supply if the panniculus is present
dissect below
51
what is the surgical technique to preserve blood supply if the panniculus is absent?
dissect off underlying fascia
52
name 3 surgical techniques for meticulous haemostasis
1. vessel ligation
2. electrosurgical devices
3. tourniquets
53
name 4 ways to reduce tension during surgery closure
1. distribute tension evenly through all layers of the wound
2. follow tension lines
3. tension-relieving suture patterns
4. reconstructive techniques
54
this is the primary holding layer of the wound
subcutaneous layer
55
should you close wounds parallel to OR perpendicular to tension lines
parallel
56
# name the tension relieving technique
this is the main form of tension relief during surgery;
should be done below the panniculus muscle or below the subcutaneous tissue when the panniculus is absent;
use blunt or sharp technique
undermining
57
# name the tension relieving technique
this follows undermining;
distributes tension throughout wound;
reduces tension at primary suture line;
staggered rows of simple interrupted sutures (absorbable)
walking sutures
58
name the 4 types of mattress sutures
1. cruciate mattress
2. vertical mattress
3. horizontal mattress
4. near-far-far-near
59
# name the tension relieving technique
close one wound by creating a second, adjacent wound;
used to shift wound away from pressure point or into an area where there is more available skin
relaxing incisions
60
name 3 types of relaxing incisions that can be made to relieve tension
1. mesh expansion
2. bipedicle advancement flap
3. V-Y plasty
61
name two types of pedicle flaps
1. subdermal plexus flap
2. axial pattern flap
62
# name the type of pedicle flap
incorporate a large direct cutaneous vessel;
larger flap possible;
anatomical landmarks determined by angiosome
axial pattern flaps
63
name the 4 most commonly used vessels for axial pattern flaps
1. deep circumflex iliac
2. caudal superficial epigastric
3. thoracodorsal
4. omocervical
64
name the 3 key principles of a free skin graft
(full thickness meshed graft)
1. intolerant of movement
2. require healthy granulation tissue bed
3. must stay in close contact with bed
65
# name the term
removal of part of the upper jaw
usually to remove oral neoplasms
maxillectomy
66
# name the term
removal of part of the lower jaw
mandibulectomy
67
# name the term
removal of part of the toungue;
usually to remove a tumour
glossectomy
68
# name the term
plastic surgery to repair lip defects
cheiloplasty
69
name 4 important surgical principles for oral surgery
1. atraumatic tissue handling
2. haemorrhage
3. tension-free, supported closure
4. appositional suture patterns
70
name 6 general clinical signs that may be seen with oral disease
1. drooling
2. oral bleeding
3. dysphagia
4. anorexia
5. pain
6. halitosis
71
name 3 postoperative concerns of oral surgery
1. eating
2. preventing wound dehiscence
3. pain relief
72
name the 4 major pairs of salivary glands in dogs and cats
1. Parotid gland
2. Zygomatic gland
3. subLingual gland
4. Mandibular gland
73
# name the term
submucosal or subcutaneous collection of saliva;
leakage of saliva from gland or duct;
submandibular, cervical, sublingual
sialocoele
(aka salivary mucocoele )
74
name 3 common locations of sialocoeles (aka salivary mucocoele)
1. submandibular
2. cervical
3. sublingual (ranula)
75
name 6 possible causes of salocoele
1. idiopathic (most common)
2. trauma
3. inflammation
4. neoplasia
5. sialolithiasis
6. foreign body
76
what duct is most commonly the cause for a sialocoele
sublingual gland
77
name 5 clinical signs of a sialocoele
1. fluctuating swelling
2. dysphagia
3. oral bleeding
4. hypersalivation
5. respiratory obstruction
78
name 3 features of aspirate from a sialocoele to help with diagnosis
1. honey coloured
2. viscous
3. mucin
79
what is the treatment for a subcutaneous sialocoele?
sialoadenectomy
(removal of the salivary gland)
80
what is the treatment for a ranula (caused by a sialocoele)
marsupialisation
+/- sialoadenectomy
81
# name the term
abnormal communication between the oral and nasal cavity
oronasal fistula
82
name 4 clinical signs of an oronasal fistula
1. chronic rhinitis
2. nasal regurgitation of food
3. aspiration pneumonia
4. malnutrition
83
name 3 possible causes of an oronasal fistula
1. dental disease
2. trauma
3. neoplasia
84
name 3 features of acute presentation of penetrating oropharyngeal injuries
1. oral signs (dysphagia, blood-tinged saliva, pain)
2. pyrexia
3. pyothorax + mediastinitis
85
name 2 features of chronic presentation of penetrating oropharyngeal injuries
1. swelling/abscess
2. sinus tract
86
# name the term
any incision into abdominal cavity
coeliotomy
87
# name the term
incision through muscle into abdomen;
flank incision or paracostal approach
laparotomy
88
# name the term
sudden onset abdominal pain;
catastrophic abdominal pathology
acute abdomen
89
name 5 possible characteristics of acute abdomen
1. acute severe abdominal pain
2. shock
3. +/- abdo distension
4. +/- vomiting
5. +/- diarrhea
90
# name the term
fibrous band running from xiphoid to prepubic tendon;
located between paired rectus abdominus
linea alba
91
the aponeuroses of what muscles forms the linea alba
1. external oblique
2. internal oblique
3. transversus abdominus
92
this is the primary holding layer for abdominal closure
external rectus sheath
93
which 3 muscles contribute to the external rectus sheath
1. external abdominal oblique
2. internal abdominal oblique
3. transversus abdominus
94
name the 3 possible approaches to abdominal surgery
1. ventral midline coeliotomy
2. flank laparotomy
3. paracostal laparotomy
95
name two advantages of an organ centered approach for ventral midline coeliotomy
1. quicker
2. lower morbidity
96
name three advantages of a full exploratory approach for ventral midline coeliotomy
1. better exposure
2. evaluate entire abdomen
3. easier to deal with complications
97
how should an animal be clipped for an abdominal surgery
for full abdomen approach
(mid-sternum to beyond pubis + up to flank folds)
98
what two additional structures must be transected/ligated in a male doge for full ventral midline coeliotomy
1. cranial preputial muscle
2. preputial branches of caudal and superficial epigastric artery and vein
99
name 2 surgical approaches to maximize exposure during ventral midline coeliotomy
1. excise falciform fat
2. use abdominal retractors
100
name 2 types of abdominal retractors
1. Balfour
2. Gosset
101
name 2 surgical approaches to prevent tissues from desiccating during abdominal surgical
1. moistened swabs
2. saline lavage + suction
102
what 4 organs should be looked at in the cranial quadrant of the abdomen
1. diaphragm
2. liver
3. gall bladder
4. stomach
103
what 7 structures should be inspected in the right gutter of the abdomen
1. R limb pancreas
2. kidney
3. adrenal
4. portal vein
5. vena cava
6. ureter
7. ovary
104
what maneuver must be done in order to see into the R gutter of the abdomen
mesoduodenal sling
105
what maneuver must be done in order to see the left gutter of the abdomen
mesocolic sling
106
what 4 structures should be looked at in the left gutter of the abdomen
1. kidney
2. ureter
3. ovary
4. adrenal
107
what 3 structures should be looked at in the central abdomen quandrant
1. omentum
2. spleen
3. left limb of pancreas
108
what 6 structures should be inspected in the caudal quadrant of the abdomen
1. colon
2. repro tract
3. bladder
4. urethra
5. prostate
6. inguinal rings
109
what suture type should be used to close the first layer from a coeliotomy, the linea alba (external rectus sheath)
monofilament, synthetic absorbable suture material
110
what suture pattern should be used to close the first layer from a coeliotomy, the linea alba (external rectus sheath)
simple interrupted or continuous patterns
111
if using PDS for closure of the ecternal rectus sheath, how many throws should be at the start and finish of the continuous pattern
7 throws start + finish
112
what type of suture should be used for coeliotomy closure of the second layer, the subcutaneous tissue
monofilament, absorbable suture
113
what type of suture should be used for intradermal skin apposition
monofilament, absorbable suture
114
what type of suture should be used for external skin apposition
non-absorbable
115
name the 3 layers that must be sutured for coeliotomy closure in a dog
1. linea alba (external rectus sheath)
2. subcutaneous tissue
3. skin apposition
116
# name the term
enlargement of the stomch associated with rotation on its mesenteric axis
gastric dilation-volvulus (GDV)
117
# name the term
stomach that is engorged with air or froth but not malpositioned
simple dilatation
118
name 3 types of fluid that may fill the dilated stomach in GDV
1. food + gastric secretions
2. transudate from mural venous congestion
3. blood + mucosal slough as stomach necrosis develops
119
what direction will the stomach typically rotate in a GDV
clockwise rotation
120
where will the spleen be displaced to with GDV
right dorsal
(via gastrosplenic ligament)
121
name 4 possible cardiovascular effects of GDV
1. reduced venous return to heart
2. reduced circulating blood volume
3. cardiac arrhythmias
4. shock (endotoxic + septic)
122
how can GDV cause respiratory compromise?
diaphragmatic compression
123
name 3 intrinsic factors that may incr. risk for GDV
1. breed (deep-chested)
2. conformation
3. genetics
124
name 3 diets that may be risk factors for GDV
1. single source diet
2. one daily feeding
3. processed dry (cereal or soya based)
125
name 6 recommendations to try and prevent GDV for high-risk dogs
1. several small meals rather than 1 large
2. avoid stress during feeding
3. restrict exercise before and after meals
4. no elevated feed bowl
5. don't breed dogs with first-degree relative with GDV history
6. consider prophylactic gastropexy
126
how to confirm GDV diagnosis
radiography:
1. compartmentalisation
2. cannot identify pylorus on R lateral
127
what 2 things for patient stabilisation must start immediately for a dog with GDV
1. fluid resuscitation
2. gastric decompression
128
what 2 veins should you use for IV fluid resuscitation for a dog with GDV (one of the 2)
1. Jugular
2. Cephalic
129
what type of fluid and at what rate should be given to a dog with GDV for fluid resuscitation
crystalloids
90+ mL/kg per hour
| (squeeze a full bag into them)
130
name 3 reasons for decompressing a patient with GDV
1. prevents necrosis
2. stabilize systemically/cardiovascularly
3. easier to de-rotate
131
name 2 methods for decompression of a patient with GDV
1. orogastric intubation
2. percutaneous decompression
132
where should the large bore tube be premeasured to for orogastric intubation for decompression of GDV
to last rib
133
name 3 goals of GDV surgery
1. decompress and reposition stomach
2. assess stomach and spleen for necrosis
3. prevent recurrence
134
what is the most common site for necrosis from a GDV
greater curvature
135
name 3 indications for a splenectomy from GDV
1. persistent congestion aftr 10 min of repositioning
2. avulsion or infarction of vessels
3. gross necrosis
| (rarely necessary)
136
name 4 gastropexy techniques
1. incisional
2. belt loop
3. circumcostal
4. tube
137
# name the gastropexy technique
strong;
technically easiest;
adhesion formation between pyloric antrum and R body wall just behind last rib
incisional
138
where do you put the stomach tube for GDV tube gastropexy
tube in pylorus
139
where do you put the stomach tube for feeding
in fundus
140
what is the minimum time a gastrostomy tube must be maintained/kept in
7 days
141
name 3 possible early post op complication of a GDV surgery
1. cardiac arrhythmias
2. gastric wall necrosis
3. peritonitis
142
name 2 possible longer term post op complications of a GDV surgery
1. gastric hypomotility
2. recurrence 5 to 10%
143
# name the term
incision into the intestine
enterotomy
144
# name the term
removal of a segment of intestine
enterectomy
145
# name the term
eneterostomy with reestablishment of continuity between the divided ends
intestinal resection and anastomosis
146
# name the term
surgical fixation of one intestinal segment to another
enteroplication
147
name 2 ways to reduce contamination during intestinal surgery
1. isolate intestine
2. lavage and suction
148
name 2 ways to minimize tissue trauma during intestinal surgery
1. gentle handling
2. use correct instruments
149
what is the holding layer of the intestines that MUST be engaged in EVERY suture or staple
submucosa
150
what is the best choice of forceps to handle the intestines with during surgery
Debakey forceps
151
what type of forceps should NEVER be used with the intestines during surgery
rat-toothed forceps
152
name 3 clinical signs of an intestinal foreign body
1. vomiting
2. loss of appetite
3. abdominal discomfort
| (+/- diarrhea +/- melaena)
153
name 3 possible systemic effects of an intestinal foreign body
1. dehydration
2. electrolyte loss
3. weight loss (chronic)
154
name 3 possible local effects of an intestinal foreign body
1. pressure necrosis
2. perforation
3. peritonitis
155
name the 2 surgical options for an intestinal foreign body
1. enterotomy
2. enterectomy
156
where should the incision be made for an enterotomy for an intestinal foreign body
distally (healthy bowel) to foreign body on antimesenteric surface
157
how to perform a leak test following closure of an enterotomy
1. occlude intestine with fingers
2. 25g needle + syringe
3. slight pressure but no more
158
where should sutures 1 and 2 be placed for anastomosis following intestinal resection
1. mesenteric border
2. antimesenteric border
159
how to manage luminal disparity during intestinal resection + anastomosis
cut smaller diameter end more obliquely
160
at least how big must an intestinal biopsy be
5mm in length,
2mm in width
161
where is intussusception of the intestine most common
jejunocolic at ileocaecocolic junction
162
what are the 2 options for resolving intussusception of the intestines
1. reduce intussusception
2. intestinal resection and anastomosis
163
name 3 indications for intestinal rection and anastomosis as treatment for intussusception
1. adhesions prevent reduction
2. tissue non-viable
3. tissue tears
164
# name the term
incising the stomach
gastrotomy
165
# name the term
excising a portion of the stomach
gastrectomy
166
# name the term
creating a stoma (opening) in the stomach usually using a tube
gastrostomy
167
# name the term
fixing the stomach to body wall
gastropexy
168
why are animals fasted prior to ANY general anaesthetic
minimize reflux of gastric contents into oesophagus
169
what 2 things can be caused by reflux of gastric contents into oesophagus (esp. during anaesthetic)
1. reflex oesophagitis
2. aspiration pneumonia
170
name 4 specific risks of gastrointestinal surgery
1. intra-operative contamination
2. postoperative dehiscence and leakage
3. peritonitis
4. iatrogenic blockage
171
name 3 ways to isolate the stomach to control contamination during GI surgery
1. stay sutures
2. Babcock forceps
3. packing around site
172
name 3 ways to reduce risk of dehiscence during GI surgery
1. atraumatic tissue handling
2. omental wrap
3. serosal seal
173
name 3 benefits of an omental wrap during GI surgery to reduce risk of dehiscence
1. blood supply
2. physically blocks holes
3. walls off/protects
174
what are the 2 main indications for a gastrotomy
1. foreign body removal
2. biopsy
175
name the 6 steps of a gastrotomy
1. expose stomach
2. pick avascular area away from pylorus
3. place stay suturs on either side of site
4. tent stomach up and isolate with swabs
5. stab incision with no.10/11 scalpel
6. extend with scalpel or Metzenbaum scissors
176
what suture pattern should be used for a one layer closure of stomach
simple appositional
(interruptes or continuous)
177
what tissues make up each layer in a two layer closure of the stomach
1. mucosa and submucosa
2. muscularis and serosa
178
what suture pattern should be used for each layer in a two layer closure of the stomach
1. simple appositional / simple continuous
2. appositional/inverting pattern
179
how long after GI surgery should you wait before feeding?
feed ASAP!
| (fasting delays healing of GI trac)
180
name 5 signs of gastric disease
1. vomiting, haematemesis
2. melena
3. dehydration, hypokalaemia
4. loss of appetite
5. weight loss
181
how big should a normal fundus of stomach be?
less than 3 intercostal spaces
182
name 2 options for stomach foreign body treatment
1. endoscopic removal
2. gastrotomy
183
name 4 examples of pre-existing abdominal pathology that may lead to secondary generalized peritonitis
1. rupture of GIT
2. urine leakage
3. penetrating trauma
4. bile leakage following trauma
184
what is the most common cause of secondary peritonitis in dogs?
infectious
185
what two things may be seen on radiography to indicate septic peritonitis
1. loss of serosal detail - fluid
2. free abdominal gas
186
what 2 things may be seen on ultrasound to indicate septic peritonitis
1. turbid abdominal fluid
2. identification of underlying pathology
187
what would neutrophils with intracellular bacteria found in an abdominal fluid analysis indicate
septic peritonitis
188
what is the treatment for septic peritonitis
emergency surgery!
189
name 3 indications for colonic surgery
1. colonic biopsy
2. neoplasia
3. severe constipation (obstipation)
190
which part of the GI tract has the highest bacterial flora and has gram negative anaerobes
-perioperative antibiotics indicated
colon
191
name 3 common large intestine pathologies
1. megacolon
2. anal sac disease
3. rectal prolapse
192
# name the term
large intestinal enlargement and hypomotility with severe contipation/obstipation
megacolon
193
# finish the phrase:
maybe she's born with it,
maybe its...
megacolon
| (congenital, primary)
194
this is the commonest form of megacolon;
acquired disorder;
uncertain aetiology (environment, stress, obesity, primary colonic inertia)
feline idiopathic megacolon
195
name 2 causes of an acquired functional megacolon
1. acquired dysautonomias
2. neurological injury
196
name 3 causes of intramural and mural acquired secondary megacolon
1. foreign body
2. neoplasia
3. stricture
197
what type of acquired megacolon will a pelvic fracture cause
extramural
198
what is the diameter of a megacolon
greater than 1.5 times the length of L7
199
this is when 90-95% of the colon is removed to treat megacolon in CATS only;
+/- removal of ileocaecal junction
subtotal colectomy
200
name 3 complications of subtotal colectomy
1. postop diarrhea (inevitable)
2. faecal incontinence
3. recurrence
201
name the 3 most common anal sac diseases
1. anal sacculitis (impaction and infection)
2. anal sac abscess + rupture
3. apocrine gland adenocarcinoma
202
name 3 indications for a liver biopsy
1. substantially/persistently incr. liver enzymes
2. diffuse changes in hepatic echogenicity
3. isolated liver lesions
203
name 3 techniques for taking a liver biopsy
1. percutaneously (U/S-guided)
2. laparoscopic
3. open surgical technique
204
# name the liver biopsy technique
least invasive;
small specimen size;
U/S guidance;
not possible to observe haemorrhage directly;
relatively cheap and readily available
percutaneous
205
# name the liver biopsy technique
general anaesthesia required;
medium specimen size;
direct visualization;
haemorrhage can be directly observed;
more expensive, specialized equipment and training required
laparoscopic
206
# name the liver biopsy technique
most invasive, GA required;
large specimen size;
direct visualisation;
haemorrhage can be directly observed;
variable cost & availability depending on clinic
open surgical
207
this is when anomalous vessels enable portal blood to bypass the liver so portal blood passes directly into the systemic circulation
portosystemic shunt
208
name 6 systemic effects of a portosystemic shunt
1. failure to thrive
2. hypoalbuminaemia
3. hepatic encephalopathy
4. hypoglycaemia
5. urinary tract signs
6. coagulopathy
209
what is the goal of medical management of portosystemic shunt
manage hepatic encephalopathy
210
name 4 commonly used medical managements for a portosystemic shunt
1. hepatic diet
2. lactulose
3. antibiotics
4. SAMe
211
what is the goal of surgical management of a portosystemic shunt
increase hepatic blood flow by closing anomalous vessel
212
name 3 techniques for surgical management of a portosystemic shunt
1. ameroid constrictor
2. cellophane banding
3. ligation
213
name 5 possible post-operative complications of surgical management of a portosystemic shunt
1. hypoglycaemia
2. haemorrhage/anaemia
3. portal hypertension
4. seizures and encephalopathy
5. recurrence of clinical signs
214
name 4 surgical procedures for the biliary tree
1. cholecystectomy
2. cholecystojejunostomy
3. choledochal stenting
4. choledochotomy
215
name 4 surgical indications of the spleen
1. splenic trauma
2. splenic torsion
3. splenic neoplasia
4. benign splenic mass
216
name 2 possible causes of splenic torsion
1. spontaneous torsion
2. secondary to GDV
217
# name the term
Protrusion of a structure through a defect in the wall of its normal anatomical cavity
Hernia
218
# name the term
herniation of organ out of the abdomen through a defect in the external wall of the abdomen;
usually traumatic
external abdominal hernia
219
# name the term
occur through a ring of tissue confined within the abdomen or thorax
internal abdominal hernias
220
# name the type of hernia
enclosed in a peritoneal sac
true hernia
221
# name the term
protrusion of organs outside a normal abdominal opening;
not enclosed in a peritoneal sac
false hernias
222
name 3 examples of external abdominal hernias
1. ventral
2. paracostal
3. prepubic
223
name 3 physical findings of external abdominal hernias
1. asymmetry of body contour
2. palpable organs in subcutaneous location
3. hernia ring (body wall defect)
224
# name the type of hernia
avulsion of cranial pubic (prepubic) tendon;
usually caused by RTA;
often associated pelvic fractures
prepubic hernia
225
name the 4 principles of hernia repair
1. access hernia
2. assess viability contents
3. reduce contents
4. repair hernia defect
226
name the 2 options for hernia repair
1. autologous repair
2. non-autologous repair
227
# name the hernia repair option
muscular flaps;
anchor structures through bone tunnels
autologous repair
228
# name the hernia repair option
synthetic mesh
non-autologous repair
229
# name the type of hernia
herniation through inguinal canal;
contents adjacent to vaginal process;
may be congenital or acquired;
may be unilateral or bilateral
inguinal hernia
230
what can make the repair of an inguinal hernia in male dogs easier?
neutering
231
# name the type of hernia
rare, unilateral;
organs herniate into the vaginal process adjacent to the spermatic cord in the scrotum;
organ strangulation is common
scrotal hernia
232
# name the type of hernia
usually traumatic;
herniation of organs through femoral canal;
femoral artery, vein + nerve (repair difficult);
refer for repair
femoral hernia
| (usually misdiagnosed as inguinal hernias)
233
# name the type of hernia
pelvic diaphragm (levator ani muscle) degenerates;
rectum, prostate + abdominal organs herniate
perineal hernia
234
name the 4 muscles involved with the pelvic diaphragm and perineal hernias
1. external anal sphincter
2. lavator ani muscle
3. coccygeal muscle
4. internal obturator muscle
235
name 3 typical presentations (clinical signs) of a perineal hernia
1. faecal tenesmus
2. perineal swelling
3. constipation
236
name 2 clinical signs of a retroflexed bladder, associated with a perineal hernia
1. dysuria
2. systemic collapse/acute renal failure
237
what is the best treatment option to repair a perineal hernia
internal obturator muscle transposition flap
238
how long does it take for the bladder wall to regain 100% strength
14-21 days
239
name 5 indications for a cystotomy
1. remove bladder/urethral stones
2. biopsy/resection masses
3. repair of ectopic ureters
4. biopsy/culture bladder wall (severe cystitis)
5. repair bladder trauma
240
name 3 advantages of a ventral cystotomy
1. readily accessible
2. visualise the trigone well
3. no increased risk of leakage
241
name 3 disadvantages of a dorsal cystotomy
1. potential damage to neurovascular structures
2. less easy to visualise
3. ureters enter dorsally
242
what procedure allows bladder drainage whilst bypassing the urethra
cystostomy
243
name 3 indications for urethral surgery
1. urethral obstruction
2. penile/urethral trauma or disease
3. urethral prolapse
244
name 4 consequences of a urethral obstruction
1. postrenal azotaemia
2. hyperkalaemia
3. hydronephrosis
4. bladder damage
245
name 3 options for management of urethral obstruction by urolithiasis
1. push stones into bladder
2. remove stones from urethra
3. create new stoma into urethra above the obstruction
246
what is the preferred method for pushing uroliths out of the urethra and into the bladder?
retrograde urohydropropulsion
| (then remove stones by medical dissolution or cystotomy)
247
name the 7 steps of a prescrotal urethrotomy in a male dog to remove uroliths
1. place urinary catheter
2. incise skin behind os penis
3. reflect retractor penis muscle
4. incise urethra
5. remove stones
6. flush to ensure all stones removed
7. suture or leave open to heal by second intention
248
at what location should a urethrostomy be performed in a male dog?
scrotal urethrostomy
249
at what location should a urethrostomy be performed in a male cat?
perineal urethrostomy
250
name 4 possible complications of a urethrostomy
1. haematuria
2. stenosis
3. incontinence
4. urinary tract infection
251
name 3 tests used to diagnose uroabdomen
1. serum biochemistry + urinalysis
2. Abdominal fluid analysis
3. urinary tract imaging
252
name 3 methods for abdominal fluid collection
1. abdominocentesis
2. POCUS scan
3. diagnostic peritoneal lavage
253
# urea or creatinine?
small molecule, equilibrates quickly
urea
254
# urea or creatinine?
large molecule; does not equilibrate
creatinine
255
how is uroabdomen confirmed usuing creatinine and/or potassium values?
[Creatinine (ascites)] > [Creatinine (serum)]
[Potassium (ascites)] > [Potassium (serum)]
256
name 3 treatment options for nephrolithiasis
1. shock wave lithotripsy
2. nephrotomy
3. uretero-nephrectomy
257
name 5 causes of urinary incontinence
1. congenital abnormalities
2. urethral sphincter mechanism incompetence (USMI)
3. inflammation
4. neurogenic abnormalities
5. behavioural problems
258
name the 2 types of ectopic ureters
1. extramural
2. intramural
259
name 3 surgical treatment options for an intramural ectopic ureter
1. laser ablation
2. neoureterostomy
3. ureteroneocystotomy
260
what is the surgical treatment option for an extramural ectopic ureter
ureteroneocystostomy
261
name 3 goals of colposuspension
1. increase urethral length
2. relocate bladder neck to intraabdominal position
3. increase pressure at bladder neck
262
name 5 surgical management options for Urethral Sphincter Mechanism Incompetence (USMI)
1. colposuspension
2. pexy techniques
3. submucosal urethral bulking agent injections
4. artificial urethral sphincter
5. transobturator vaginal tape
263
# name the USMI surgical management option
pexy bladder more cranial to abdominal wall;
suture ventral wall of proximal urethra to prepubic tendon
(cysto)urethropexy
264
# name the USMI surgical management option
goal: increase urethral resistance;
endoscopic submucosal injections of collagen
bulking agents
265
# name the USMI surgical management option
goal: increase urethral resistance;
cuff placed around proximal urethra;
urethral compression can be increased by injecting saline into subcutaneous port
artificial urethral sphincter
266
what is the treatment for USMI in cats?
excision of the caudoventral portion of the bladder
267
# name the procedure
removal of ovaries and uterus
ovariohysterectomy
268
# name the procedure
removal of ovaries only
ovariectomy
269
# name the procedure
minimally invasive ovariectomy
laparoscopic spay
270
# name the procedure
surgical removal of testicles
orchiectomy
| (aka castration)
271
# name the procedure
surgical excision of mammary gland(s)
mastectomy
272
# name the procedure
incision of the vulvular orifice to expose the vulva & vagina;
access to vaginal and vestibular lesions
episiotomy
273
# name the procedure
reconstruction of the vulva;
excision of extra folds around the vulva (obesity/breed-related)
episioplasty
274
name 5 indications for an ovariohysterectomy (spay)
1. prevent uncontrolled breeding/population control
2. prevent/reduction of diseases
3. control of oestrus-associated behaviour
4. management of disease of reproductive organs
5. termination of pregnancy
275
name 4 diseases of reproductive disorders that can be managed with an ovariohysterectomy (spay)
1. pyometra
2. dystocia
3. pseudopregnancy
4. vaginal hypertrophy/prolapse
276
what are 2 negatives of spaying a cat
1. obesity
2. diabetes mellitus
277
name 3 negatives of spaying a dog
1. obesity
2. orthopaedic conditions
3. certain neoplastic diseases
278
when are bitches traditionally spayed
from 6 months of age
(before first season OR after first season)
279
when are queens traditionally spayed
5-6 months of age
280
name 4 pros of early spaying (6-16 weeks)
1. prevent mammary tumours
2. usually faster/more simple surgery
3. smaller incision
4. quicker anaesthetic recovery
281
name 4 cons of early spaying (6-16 weeks)
1. incr. risk of hypothermia/hypoglycaemia under GA
2. more risk for developing urinary incontinence
3. incr risk of orthopaedic diseases (CCLR, HD, ED)
4. vulva may remain small and immature
282
name 3 disadvantages for spaying a bitch during pro-oestrus and oestrus
1. highly vascular/more friable tissue
2. reduced coagulation
3. incr. risk of haemorrhage
283
name a risk of spaying a bitch during diaoestrus (luteal phase)
pseudopregnancy
284
what is the standard practice/method for spaying a bitch
midline ovariohysterectomy
285
what is the standard practice/method for spaying a cat
flank ovariohysterectomy
286
should you give perioperative antibiotics during an elective neutering/spay?
no
(short, clean procedure)
287
how long should food be withheld before a midline ovariohysterectomy
12h
(4h for paediatric)
288
where should the incision be made for a midline ovariohysterectomy
from umbilicus to midway to pubic brim
| (large enough for you to do it safely)
289
which ovary is more caudal?
left
290
# name the structure
consists of: ovarian artery from aorta, mesovarium and suspensory ligament + fat
ovarian pedicle
291
# name the structure
continuous with the uterine artery and lies within the broad ligament (mesometrium)
ovarian artery
292
# name the structure
sits between bladder and colon;
'Y' shaped body
uterus
293
# name the structure
most lateral structure in abdomen;
ovary at proximal end;
linear blood supply
uterine horn
294
what ligament must be broken in order to exteriorise the ovary
suspensory ligament
295
what technique should be used to ligate the ovarian artery
triple clamp technique
296
what forceps should be used for the triple clamp technique to ligate the ovarian artery
Rochester-Carmalt forceps
297
where should the first ligature be placed when ligating the ovarian artery using the triple clamp technique
circumferential in proximal crush line
298
where should the second ligature be placed when ligating the ovarian artery using the triple clamp technique
transfixing between proximal suture and middle clamp
299
what type of suture material should be used for ligating the ovarian artery during a spay
synthetic, absorbable, secure knots, monofilament
(PDS)
300
where should you transect the ovarian artery after ligating
just distal to middle clamp
301
where should the 3 clamps be placed in order to ligate the ovarian artery using the triple clamp technique
1. proper ligament clamp above ovary
2. 2 clamps across pedicl, proximal (deep) to ovary
302
what type of suture material should be used for closure of a spay (for the linea alba/external rectus sheath)
synthetic, long lasting
(PDS, Prolene)
303
name the 2 landmarks for a flank ovariohysterectomy of a cat
triangle between:
1. wing of ilium
2. greater trochanter
304
name 2 possible intraoperative complications of an ovariohysterectomy
1. haemorrhage
2. ureter ligation/trauma
305
name 2 possible early post-operative complications of an ovariohysterectomy
1. wound healing problems (infection, dehiscence, seroma)
2. glossypyboma
306
name 5 possible late post-operative complications of an ovariohysterectomy
1. ovarian remnant syndrome
2. stump granulomas
3. weight gain
4. acquired incontinence
5. associations with certain neoplasia/ortho conditions
307
what is it called when a surgical swab is accidentally left in the abdomen during surgery
glossypyboma
308
name 3 advantages of a laparoscopic ovariectomy
1. improved visualisation & magnification
2. 2 or 3 small incisions (portals)
3. less post op pain & faster recovery
309
name 3 possible complications of a laparoscopic ovariectomy
1. haemorrhage (spleen/pedicle)
2. bladder perforation
3. ovarian remnant/SSI/hernia
310
name 4 indications for a caesarean
1. dystocia
2. maternal origin (uterine inertia)
3. foetal origin (over-sized/malpositioned/dead)
4. previous dystocia
311
name 2 causes of secondary uterine inertia leading to needing a caesarean
1. small pelvic canal
2. previous pelvic fracture
312
how long should your incision be for a caesarean
halfway between xiphoid and umbilicus → the pubis
313
what bacteria is the most common cause of pyometra
E. coli
314
name 2 reasons why pyometra is rare in cats
1. induced ovulators
2. usually sterile
315
what 3 issues may need stabilised in a patient prior to pyometra surgery
1. dehydration/hypovolaemia
2. azotaemia
3. SIRS/shock
316
# name the term
surgical removal of testicles
orchiectomy (castration)
317
name 4 reasons for an orchiectomy
1. prevents breeding
2. reduces aggression and roaming
3. prevents/treats testosterone driven diseases
4. removes risk of testicular neoplasia
318
name 3 testosterone driven diseases that can be prevented/treated by an orchiectomy
1. benign prostatic hyperplasia
2. perianal adenoma
3. perineal hernia
319
name 3 castration approaches possible in dogs
1. pre-scrotal (routinely)
2. scrotal ablation
3. perineal castration
320
what approach is used for castration in cats
scrotal
321
name 2 risks of an open technique for castration
1. evisceration
2. peritonitis
322
name a benefit of the open technique of castration
better haemostasis
323
name 2 benefits of the closed technique for castration
1. no risk of evisceration
2. no risk of peritonitis
324
what suture material should be used on the spermatic cord ligation for a closed castration
synthetic
long lasting
absorbable
monofilament
| (PDS II)
325
what suture material should be used for pre-scrotal closure of a castration
1. synthetic
2. monofilament
| (monocryl)
326
what is the difference between an open and closed castration
open castration enters the parietal vaginal tunic
327
what two structures should be ligated separately in an open pre-scrotal castration of a dog
1. ductus
2. vessels
328
name a possible intraoperative complication of a castration
haemorrhage
329
name 3 possible early post-operative complications of a castration
1. scrotal haematoma
2. wound healing problems
3. herniation
330
name 2 possible late post operative complications after a castration
1. potential association with some orthopaedic conditions and some cancers
2. weight gain
331
# name the term
congenital failure of testicles to descen into scrotum (unilateral or bilateral)
cryptorchidism
332
name 3 reasons a cat/dog with cryptorchidism should be castrated
1. heritable
2. neoplastic transformation
3. more prone to torsion
333
at what age can cryptorchidism definitively be diagnosed
6 months
334
name 3 possible locations of a cryptorchid testicle
1. abdominal
2. in inguinal canal
3. pre-scrotal
335
name 6 common differential diagnoses for prostatic disease
1. benign prostatic hyperplasia (BPH)
2. prostatitis
3. prostatic abscess
4. prostatic cysts
5. para-prostatic cysts
6. neoplasis
336
# name the prostatic disease
diffuse enlargement due to chronic androgenic stimulation;
common in older castrated males
benign prostatic hyperplasia (BPH)
337
what is the treatment of choice for BPH (benign prostatic hyperplasia)
castration
| (curative)
338
# name the type of prostatic cyst
within the capsule
prostatic cyst
339
# name the type of prostatic cyst
attached to capsule but do not communicate with parenchyma
paraprostatic cyst
340
what is the best way to diagnose a prostatic cyst
abdominal ultrasound
('double bladder')
341
what is the medical management for prostatic cysts
repeated aspiration
| (+ castration)
342
name 2 options of surgical management for prostatic cysts
1. complete resection
2. partial resection and omentalisation
| (+ castration)
343
name 2 predisposing factors of prostatic abscesses
1. entire, middle aged/older dogs
2. BPH
344
what is the treatment of choice for a stable prostatic abscess
trial medical treatment
(analgesia, antibiosis)
| (+ castration)
345
what is the treatment of choice for a prostatic abscess with sepsis
surgical intervention
(drain abscess + omentalisation + castration)
| (aggresive IVFT, analgesia, antibiosis)
346
what is the most common neoplasia of the prostate
adenocarcinoma
347
name the 3 locations of rapid metastasis of a prostate adenocarcinoma
1. regional LNs
2. lungs
3. skeleton
348
name the 3 treatment options for prostate neoplasia (adenocarcinoma)
1. often palliative/euthanasia
2. stenting
3. partial/complete prostatectomy & radiation therapy
349
name 4 presentations of moderate to severe respiratory distress
1. open-mouth breathing
2. abducted forelimbs
3. laboured breathing
4. restlessness
350
name 3 sedation options for emergency management of a patient in respiratory distress
1. Acepromazine
2. Dexmedetomidine
3. Butorphanol
351
# name the sedative
slower onset;
vasodilation
acepromazine
352
# name the sedative
quicker onset;
blood pressure alterations and bradycardia
dexmedetomidine
353
name 3 ways to cool a patient in respiratory distress
1. fan
2. clip hair if heavy undercoat
3. pour cool water over patient
354
# name the syndrome
skull has normal width but reduced length;
soft tissues of head not proportionately reduced;
so soft tissue obstruction of nasal and pharyngeal cavities
Brachycephalic Obstructive Airway Syndrome (BOAS)
355
name 4 primary disorders that brachycephalics are born with
1. stenotic nares
2. aberrant nasal turbinates
3. elongated soft palate
4. tracheal hypoplasia
356
name the 3 stages of progressive laryngeal collapse in a brachycephalic
1. everted laryngeal saccules
2. cuneiform processes contact
3. corniculate processes contact
357
name 3 ways to diagnose Brachycephalic Obstructive Airway Syndrome (BOAS)
1. cervical and throacic radiographs
2. CT-scan
3. laryngoscopy under general anaesthesia
358
name 4 surgeries to help correct Brachycephalic Obstructive Airway Syndrome (BOAS)
1. rhinoplasty
2. staphlectomy (soft palate)
3. folded flap palatoplasty (soft palate, more traumatic)
4. excision of everted laryngeal saccules
359
name 2 surgeries to manage laryngeal collapse stage 2-3
1. crico-arytenoid lateralisation
2. permanent tracheotomy
360
what nerve innervates the dorsal cricoarytenoid muscle?
recurrent laryngeal nerve
361
name 3 ways to diagnose laryngeal paralysis
1. thoracic radiographs
2. blood work: T4
3. laryngoscopy
362
name 3 types of pneumothorax
1. traumatic
2. spontaneous
3. iatrogenic
363
name 4 features of pneumothorax that can be seen on thoracic radiographs
1. elevation cardiac sillhouette from sternum
2. atelectatic lung lobes are radiopaque
3. air-filled pleural space
4. vascular pattern lungs does not extend to chest wall
364
what is the most common type of pneumothorax?
closed traumatic pneumothorax
365
# name the type of pneumothorax
caused by blunt impact with closed glottis;
bronchial tree/lung parenchyma can rupture;
fractured rib
closed traumatic pneumothorax
366
# name the type of pneumothorax
caused by bite/stab/gun wound
open traumatic pneumothorax
367
# name the type of pneumothorax
non-traumatic leakage of air:
bullae, blebs, abscess, neoplasia, severe pneumonia
spontaneous pneumothorax
368
name the management for closed traumatic pneumothorax
intermittent thoracocentesis
369
name the management for spontaneous pneumothorax & tension pneumothorax
thoracostomy tube placement
370
name 4 reasons to take a pneumothorax to surgery for management
1. not resolving after 72h
2. open traumatic pneumothorax
3. spontaneous pneumothorax
4. rapid large volume accumulation
371
name 2 indications for thoracic drainage
1. pneumothorax (therapeutic)
2. pleural effusion (diagnostic & therapeutic)
372
where to insert needle for thoracocentesis
6th-8th intercostal space
373
name the 4 pieces of equipment necessary for thoracocentesis
1. butterfly needle
2. extension set
3. 3-way tap
4. syringe
374
name 3 indications for a thoracostomy tube placement
1. repeated thoracocentesis
2. continuous suction required
3. pre-emptive following thoracic surgery
375
name 2 approaches to thoracic surgery
1. intercostal thoracotomy
2. median sternotomy
376
name the 6 steps/landmarks of the intercostal thoracotomy approach to thoracic surgery
| (muscle sparing approach)
1. incise skin and SC tissue
2. cut latissimus dorsi muscle (or reflect dorsally)
3. visualise/incise scalenus & serratus ventralis muscles
4. incise intercostal muscles
5. open pleural space
6. Finochietto rib retractors
377
name 2 indications for a temporary thracheotomy
1. relief of upper respiratory tract obstruction
2. elective prior to upper airway surgery
378
name 5 upper respiratory tract obstructions that can be relieved via a temporary tracheotomy
1. laryngeal foreign body
2. cervical trauma
3. neoplasia
4. laryngeal oedema
5. laryngeal paralysis
379
name the 7 steps of a temporary tracheotomy
1. ventral midline skin incision behind larynx
2. separate bluntly sternohyoideus muscles
3. incise between tracheal rings
4. incision ~1/3 of circumference
5. place stay suture around tracheal rings
6. lift up distal stay suture and push tube in
7. partly close skin incision & bandage in place
380
name the 4 components of post-operative care of temporary tracheotomy tubes
1. clean tube every 4-6h
2. use stay sutures to remove and replace
3. humidify airway
4. remove tube ASAP
381
name 4 risks of temporary tracheotomy tubes that must be intensively monitored for
1. risk of obstruction if tube dislodges
2. risk of emphysema
3. risk of laryngeal paralysis
4. risk of tracheal stenosis
382
name the 3 openings of the diaphragm
1. caval foramen
2. oesophageal hiatus
3. aortic hiatus
383
name 4 signs that may be present on physical exam indicating diaphragmatic rupture
1. dyspnoea +orthopnoea
2. dull on percussion
3. muffled heart
4. auscultation of gut sounds in thorax
384
name 3 signs of diaphragmatic rupture that can be seen on radiographs
1. loss of diaphragmatic and cardiac contours
2. displacement of abdominal organs
3. abdominal organ 'loss'
385
name 3 indications for immediate surgery of diaphragmatic rupture
(most will be delayed for stabilisation)
1. deterioration despite supportive care
2. gastrothorax
3. ongoing haemorrhage
386
what pattern(s) can be used to suture the defect in a diaphragmatic rupture?
simple interrupted or continuous
387
what direction should the defect in a diaphragmatic rupture be sutured?
dorsal to ventral
(radial component first)
388
why is a chest drain necessary following surgery to repair a diaphragmatic rupture (esp. in cats)
to re-establish negative pressure safely
(forced re-expansion highly dangerous and kills cats)
389
name 3 possible complications of surgery to repair diaphragmatic rupture
1. pleural effusion reforming
2. pneumothorax
3. re-expansion pulmonary oedema
390
# name the condition
congenital defect;
pericardial + peritoneal cavities communicate;
often not identified before adulthood;
often clinically silent, possible GI signs
Peritoneo-Pericardial Diaphragmatic Hernia (PPDH)
