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VM773 SA Med & Sx > Soft Tissue Surgery > Flashcards

Soft Tissue Surgery Flashcards

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1
Q

primary components of BOAS

A

stenotic nares
elongated soft palate
hypoplastic trachea
abberant nasal turbinates
macroglossia
redundant pharyngeal folds

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2
Q

what are the secondary components of BOAS and why they occur

A

negative pressure = edema, erythema, swelling
everted laryngeal saccules
everted tonsils
laryngeal collapse

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3
Q

why do dogs with BOAS have GI signs

A

primary or secondary inflam disease
regurg, sliding hiatal hernia, gastritis, esophagitis

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4
Q

what anatomic landmarks are used to assess the length of the soft palate?

A

the junction of the middle and caudal third of the palatine tonsils

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5
Q

stenotic nares treatment

A

vertical wedge resection
horizontal wedge resection
punch biopsy
nares amputation “traders”
alapexy

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6
Q

elongated soft palate treatment

A

staphylectomy
folded flap palatoplasty

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7
Q

compare and contrast laryngeal paralysis and laryngeal collapse, which one occurs as a result of BOAS and how is it addressed?

A

laryngeal paralysis - functional problem, laryngeal tieback

laryngeal collapse - secondary to BOAS, structural problem (cartilage integrity poor), prevention is best, +/- laryngeal tieback or permanent trach

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8
Q

causes of laryngeal paralysis in young animals

A

central neuro lesion
breed predisposition (husky)

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9
Q

causes of laryngeal paralysis in an old lab

A

peripheral neuro lesion
- most common being idiopathic polyneuropathy
- others: trauma, mass, iatrogenic, polyneuropathy from endocrine, infection, immune or hypothyroidism

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10
Q

what nerve is first to be affected in laryngeal paralysis? what does it innervate?

A

recurrent laryngeal n
innervates cricoarytenoideus dorsalis m (abducts arytenoid cartilage)

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11
Q

what are the two different clinical presentations for dogs with laryngeal paralysis?

A

acute on chronic - collapse, upper airway obstruction, pulmonary edema, heatstroke, aspiration pneumonia

chronic - exercise intolerance, bark change, cough, aspiration pneumonia

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12
Q

what is the most common surgical treatment for laryngeal paralysis and what is the goal?

A

Cricoarytenoid lateralization (“tie back”) - unilateral ONLY
goal is to increase diameter of rima glottis

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13
Q

what are the potential complications with a cricoarytenoid lateralization? what is the anticipated outcome?

A

aspiration pneumonia
suture failure
seromas

good-excellent, long term prognosis

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14
Q

what are the two types of congenital hernias?

A

PPDH
hiatal hernia

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15
Q

PPDH
connection between what?
organs displaced?
when do clinical signs arise?
what do animals often have with this?

A

peritoneal cavity and pericardium
liver > SI > stomach > GB > pancreas
usually incidental finding, asymptomatic for months/years
other concurrent congenital defects

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16
Q

hiatal hernia
what causes this?
organs displaced?

A

enlargement of esophageal hiatus allowing abdominal organs into the thorax
stomach most common

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17
Q

hiatal hernia treatment?

A

decrease size of esophageal hiatus (opened ventrally)
esophagopexy
left sided gastropexy (+/- G tube)

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18
Q

what should you avoid when doing surgery for hiatal hernia?

A

iatrogenic trauma to vagus n

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19
Q

complications with hiatal hernia surgery?

A

esophagitis, esophageal stricture, megaesophagus, failure to improve gastroesophageal reflux

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20
Q

diaphragmatic hernia
connection of what?
common cause?

A

peritoneal cavity and pleural space
trauma

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21
Q

Describe which clinical scenarios make a diaphragmatic hernia a surgical emergency

A

can’t stabilize or stomach is is herniated into the thorax

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22
Q

anatomy of the diaphragm

A

caval foramen
esophageal hiatus
aortic hiatus

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23
Q

complications associated with diaphragmatic hernias and their treatment

A

re-expansion pulmonary edema in CATS
recurrence
cardiac arrhythmias
cardiac arrest
pneumothorax
pleural effusion

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24
Q

Explain the prognosis and outcomes for diaphragmatic hernias

A

79-89% survival for diaphragmatic hernias

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25
pelvic diaphragm anatomy
External anal sphincter muscle Levator ani muscle Coccygeus muscle
26
where is the most common location of a perineal hernia?
between levator ani and external anal sphincter muscles “caudal hernia”
27
predisposing factors for a perineal hernia?
breed - small dogs (e.g. mini poodles, boston terriers) older intact male dogs - prostatic disease or relaxin hormone
28
causes of perineal hernia?
unknown etiology, but anything that causes increased abdominal pressure
29
what is the treatment of choice for a perineal hernia?
muscle replacement w/ internal obturator m
30
why is a herniorrhaphy a poor surgical option for perineal hernias?
the levator ani m will barely exist so closure of pelvic diaphragm is a poor choice
31
Describe a clinical scenario when a perineal hernia is an emergency
urinary obstruction
32
complications with a perineal hernia?
incisional complications tenesmus rectal prolapse sciatic n entrapment fecal incontinence (bilateral n damage) urinary abnormalities
33
indication for cystotomy
stones in the lower urinary tract (bladder or if retropulsed into the bladder from urethra)
34
indication for urethrotomy
if stone cannot be retropulsed 1st time offender NOT in cats -- too small
35
indication for urethrostomy
if stone cannot be retropulsed if has had multiple obstructions
36
preferred location for a urethrostomy in dog?
scrotal location - urethra is the largest - superficial (tension free, limited hemorrhage) - minimizes urine scald
37
preferred location for a urethrostomy in cat?
perineal urethrostomy (PU) (dissect to level of bulbourethral gland)
38
Explain how to perform retropulsion of urethroliths in a dog
general anesthesia large rigid catheter gauze to grip penis lube and saline extra finger for rectal PRN post procedure rads
39
do you perform the cystotomy on the ventral or dorsal aspect? why?
ventral - less anatomy
40
in male does what approach is done for cystotomy?
caudal midline and parapreputial approach due to narrow urethra
41
holding layer of the bladder?
submucosa
42
for a cystotomy - full thickness defects gain 100% of normal strength in ___ days?
14-21 days
43
complications associated with a cystotomy beginning with the most common
self resolving hematuria and dysuria incomplete removal superficial incisional complications uroabdomen
44
what is the difference between a skin graft and skin flap?
skin flap maintains bloody supply skin graft has no vascular attachment and must reestablish blood supply
45
what is the difference between a subdermal plexus flap and axial pattern flap?
subdermal plexus flap - terminal branches of direct cutaneous aa, associated with cutaneous m (panniculus m layer) axial pattern flap - known a and v that perfuse a tissue; mapped throughout the body
46
what are the 4 general principles of a skin flap surgery?
1. limit flap length to size required to cover recipient bed w/o tension 2. atraumatic tissue 3. undermine deep to the cutaneous m 4. healthy recipient bed
47
what are the 4 types of local subdermal skin flaps?
advancement rotational transposition skin fold (inguinal or axillary)
48
what are the most common axial pattern flaps?
caudal superficial epigastric thoracodorsal
49
what are the most common complications with a laparascopy?
insufflation of SQ tissue splenic laceration
50
Describe different techniques for creating a capnoperitoneum (aka pneumoperitoneum)
veress needle hasson technique SILS port
51
Describe reasons for conversion from a laparoscopic procedure to an open procedure
hemorrhage equipment malfunction organ trauma unanticipated findings anesthetic complication time
52
describe the surgical treatment for an aural hematoma
S shape or linear incision (parallel to blood supply) multiple staggered rows of full thickness sutures monofilament non-abs suture knots on concave side
53
difference in dog and cat external ear canal neoplasia
dogs - epithelial, 60% malignant, unilateral cats - 88% malignant, bilateral, SCC and anaplastic carcinomas
54
what are the indications of a lateral wall resection?
otitis externa reversible small tumor of tragus or lateral wall not extending into horizontal canal patent horizontal canal
55
contraindications of a lateral wall resection?
cocker spaniels
56
what are the indications of a vertical ear canal resection
vertical canal severely disease horizontal canal normal neoplasia or otitis externa of the vertical canal only (rare)
57
what are the indications of a TECA-LBO
chronic end stage external ear dz narrow horizontal canal neoplasia extensive middle ear disease
58
complications associated with aural hematoma
anesthesia scar/deformity
59
complications associated with lateral wall resection +/- ventral bulla osteotomy
failure dehiscence stenosis of horizontal canal self trauma (ecollar)
60
complications associated with vertical ear canal resection +/- ventral bulla osteotomy
stenosis
61
complications associated with TECA-LBO
hemorrhage facial n paralysis (usually improves 2-4 weeks) fistula inner ear infection (vestibular signs) horners syndrome (cat >dog) loss of hearing
62
complications associated with a ventral bulla osteotomy
horners syndrome vestibular signs
63
what the most common route of bacterial otitis media?
tympanic membrane (otitis externa)
64
what is the difference between a cat and dog bulla on CT?
cats have a septum dividing their bulla into two compartments

VM773 SA Med & Sx (15 decks)

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