Soft tissue surgery (respiratory)

Question 1

what are some possible effusions that can occur in the thorax?

Answer 1

pyothorax
chylothorax
haemothorax
serosanguinous effusions
neoplastic effusions

Question 2

what are some contraindications for draining the thorax?

Answer 2

if patient isn’t stable
ongoing haemothorax (trauma/coagulopathy)
clinically insignificant volume

Question 3

what are the features of a normal pleural cavity?

Answer 3

mesothelial lining
potential space in thoracic cavity
small volume of pleural fluid (lubrication)

Question 4

what is lung collapse also known as?

Answer 4

atelectasis

Question 5

what are the clinical signs of a pleural effusion?

Answer 5

restrictive/paradoxical breathing
tachypnoea, dyspnoea, cyanosis
orthopnoic posture
diminished cardiac sounds

Question 6

what will happen if a pleural effusion if percussed?

Answer 6

lung sounds decrease dorsally due to fluid

Question 7

what are the possible ways to drain the thoracic cavity?

Answer 7

needle thoracocentesis
trocar thoracostomy tube
wire guided multi-fenestrated thoracostomy

Question 8

where is needle thoracocentesis carried out?

Answer 8

7th to 9th intercostal space (dorsal for air and ventral for fluid)
cranial aspect of rib

Question 9

should the three tap be on or off when inserting for needle thoracocentesis?

Answer 9

off

Question 10

what are some possible complications of needle thoracocentesis?

Answer 10

lung lacerations
pneumothorax
haemorrhage
iatrogenic infection

Question 11

what angle should the needle be inserted for needle thoracocentesis?

Answer 11

parallel to chest wall once through it (reduce risk of lung laceration)

Question 12

how can you test if blood from needle thoracocentesis is due to iatrogenic haemorrhage or haemothorax?

Answer 12

it will clot if its from iatrogenic haemorrhage

Question 13

when are thoracostomy tubes placed?

Answer 13

if repeated thoracocentesis is required
following thoracic surgery
to medically manage pyothorax

Question 14

what recumbency is best for inserting a thoracostomy tube?

Answer 14

lateral

Question 15

where is a thoracostomy tube inserted?

Answer 15

through 7th/8th intercostal space on cranial border of rib

Question 16

where is an incision madd when placing a trocar type chest drain?

Answer 16

over 10th/11th intercostal space and then inserted between the 7th or 8th intercostal space

Question 17

what post-placement care is needed for thoracostomy tubes?

Answer 17

close monitoring (respiratory rate, effort, insertion site…)
hard elizabethan collar and body vest
analgesia

Question 18

what are some possible complications associated with thoracostomy tubes?

Answer 18

discharge around tube site
damage/removal - pneumothorax
tube blocking/kinking
pain
intra-thoracic structure damage

Question 19

when should a thoracostomy tube be removed?

Answer 19

when draining <2ml/kg/day of fluid
depending on patient status, disease and diagnostic imaging

Question 20

how would the blood supply of the trachea be described?

Answer 20

segmental from thyroid and bronchoesophageal artery

Question 21

what nerve innervates the trachea?

Answer 21

right vagus nerve

Question 22

how is the cervical trachea approached for surgery?

Answer 22

patient in dorsal recumbency with the neck straight
ventral midline incision from caudal to the larynx
separate sternohyoideus muscle on the midline

Question 23

why may patients undergoing tracheal surgery have post-surgical laryngeal paralysis?

Answer 23

recurrent laryngeal nerves run very close to the trachea

Question 24

what suture material is used to close the trachea?

Answer 24

absorbable monofilament

Question 25

what suture pattern is used to close the trachea?

Answer 25

simple interrupted pattern with knots placed extraluminally

Question 26

what are the indications for a temporary tracheostomy tube?

Answer 26

life threatening upper airway obstruction - BOAS, laryngeal paralysis, laryngeal foreign bodies, neoplasia GA for intra-oral surgery

Question 27

how do temporary tracheostomy tubes need to be managed?

Answer 27

ICU (24 hour monitoring) replace tube twice daily keep tubes clean (fill with mucous)

Question 28

what are the possible complications of temporary tracheostomy?

Answer 28

plugging of tube accidental removal gagging/coughing infection stenosis pneumothorax/pneumomediastinum

Question 29

how do you determine if you can remove the temporary tracheostomy tube?

Answer 29

occlude before removal to see how they cope

Question 30

what ate the indications for tracheal resections and anastomosis?

Answer 30

trauma, stenosis, neoplasia, avulsion

Question 31

what is the maximum length you can remove for trachea resection/anastomosis?

Answer 31

5-6 rings

Question 32

what does tracheal collapse result from?

Answer 32

laxity of the trachealis muscle causing weakness of the trachea rings leading to collapse of the lumen

Question 33

what dogs are predisposed to tracheal collapse?

Answer 33

middle aged small/toy breeds

Question 34

what are the clinical signs of tracheal collapse?

Answer 34

goose-honk cough dyspnoea exercise intolerance cyanosis

Question 35

what is a grade 1 tracheal collapse?

Answer 35

laxity of dorsal tracheal membrane leading to 25% luminal collapse

Question 36

what is a grade 2 tracheal collapse?

Answer 36

loss of cartilage rigidity and further laxity leading to 50% collapse

Question 37

what is a grade 3 tracheal collapse?

Answer 37

flattening of the carriage leading to 75% collapse

Question 38

what is a grade 4 tracheal collapse?

Answer 38

100% loss of luminal integrity

Question 39

what is used to medically manage tracheal collapse?

Answer 39

corticosteroids (anti-inflammatory) anti-tussives bronchodilators antimicrobials (if infected) weight loss exercise control (use harness)

Question 40

how can tracheal collapse be treated surgically?

Answer 40

extraluminal prosthetic tracheal rings intraluminal stenting (continue medically management)

Question 41

what is the disadvantage of an intercostal thoracostomy?

Answer 41

can only access one side of the trachea

Question 42

how is a median sternotomy carried out?

Answer 42

position in dorsal recumbency and approach through cutting through the sternum

Question 43

what are the indications for a lung lobectomy?

Answer 43

lung lobe torsion localised pulmonary abscess, cyst, neoplasia... severe lung trauma broncho-oesophageal fistula

Question 44

how are rib fractures treated?

Answer 44

usually incidental - analgesia and oxygen

Question 45

what is flail chest?

Answer 45

segment of one or more ribs is fractured in two places so this segment moves independently from the chest 9causes paradoxical moving)

Question 46

how is flail chest treated?

Answer 46

stabilising surgically (external brace) - only if respiratory function is compromised

Question 47

where do tears of the diaphragm most commonly occur?

Answer 47

ventrolateral part of the diaphragm

Question 48

how are diaphragmatic hernias treated?

Answer 48

surgery when patient is stable (ASAP if stomach has herniated) midline coeliotomy and close with absorbable monofilament