Surgery Final Flashcards
(141 cards)
1
Q
In GDV what is the stomach rotating on?
A
The long axis
2
Q
What vein does the stomach compress venous flow through?
A
The vena cava and the portal vein
3
Q
What systemic signs of GDV will you see?
A
portal hypertension and systemic hypotensionand cariogenic shock
4
Q
What is the pathophysiology of a GDV?
A
Duodenum is displaced to the left, the funds moved ventrally and ends up in ventral abdomen, then the greater curvature is displaced ventral.
5
Q
What do you see in compensated shock?
A
injected mm, rapid pulses , increased heart rate, rapid CRT
6
Q
What do you see in decompensated shock?
A
pale mm, bradycardia, low CRT low temp
7
Q
What is the shock dose for dogs?
A
90ml/kg/hr , give 1/4 at a time
8
Q
What three parts make up the SI?
A
Duodenum, Jejunum, Illeum
9
Q
What are the three parts of the LA?
A
Ascending, Transverse, Descending
10
Q
What is the location of the duodenum? What attaches it to the body wall?
A
Proximal portion from pylorus to jejunum, it is attached to the colon via the duodenocolic ligament.
11
Q
What is the latin term for jejunum?
A
Jejunus meaning empty of food
12
Q
How many meters of intestine do dogs and cats have?
A
Dogs: 2-5
Cats: 1-1.5
13
Q
What demarcates the ileum?
A
antimesentartic band of vessles
14
Q
What is important about the ileums job?
A
absorbs folate, cobalamin and bile acids
15
Q
What are the major functions of the large intestine?
A
electrolyte and water transport and absorption also has GALT and produced short chain fatty acids.
16
Q
How do you know you have reached large intestine?
A
It is pale with a thinner wall
17
Q
In the SA what is a the cecum? Is it important?
A
Blind small dead end pouch between small and large intestine. It has very little purpose.
18
Q
What is the major blood supply to the small intestine?
A
Cranial mesenteric artery.
19
Q
What do you ligate in the small intestine?
A
The vasa recta not the main supply!
20
Q
What do the satellite veins of the SI drain into?
A
The portal vein.
21
Q
What are the three major blood supplies to the large intestine?
A
Cranial mesenteric artery, caudal mesenteric artery, cranial rectal artery.
22
Q
What are the four layers of the small and large intestine?
A
Mucosa
Submucosa
Muscularis
Serosa
23
Q
What is the holding layer for both the SI and LI?
A
Submucosa
24
Q
What is the difference in the SI and LI intestinal histology?
A
In the SI there are villi and crypts and lymphoid follicles in the SI. In the LA there are no villi and there are lymphoglandular complexes.
25
What are the three phases of intestinal healing? How long does each take?
1. ) Inflammation: First three days
2) Proliferative: 2-4 days up to 14 days
3. ) Maturation Phase
26
When is dehiscence most common?
First 3-5 days post surgery
27
How many layers should intestinal closure be? What suture patterns?
1 layer thick, simple interrupted is preferred.
28
What type of needle should you use in intestinal surgery?
Taper point
29
What do you see in a focal foreign body?
Dilation of loops oral to obstruction , can see pressure necrosis or perforation.
30
What do you see in a linear foreign body?
Bunches and scrunches of intestine can be anchored at tounge or pylorus.
31
What are the five factors that can negatively impact intestinal healing?
```
Hypoperfusion
Poor wound apposition
Wound tension
Infection
Distal obstruction
```
32
What is the normal intestinal height on radiograph?
2-3x rib width or 1-1.5x height of body of L2
33
Should jejunum be empty or full of food on radiograph?
empty
34
Should you incise tissue oral or aboral to the FB?
ABoral
35
What are the two clamps you use in intestinal surgery. What does each do?
Doyen; non- crushing goes on what you want to save.
Carmalt; crushing goes on what you want to take out
36
What are the 5 factors that determine if you are doing a resection or an anastomosis?
Color, blanching, thickness, peristalsis, bleeding pulses.
37
Can you ligate the arcuate vessles?
Yes.
38
When you anastomose bowel ends which side do you start on?
the mesenteric side
39
What is the most common cause of focal thickening in dogs and cats?
Neoplasia. In dogs adenocarcinoma in cats lymphoma
40
What is the consistant finding on radiograph for adenocarcinoma?
Applecore lesion
41
How large should your margins be in neoplasia removal?
3-5 cm
42
What is a serosal patch?
2 healthy loops of bowel in apposition with loop of concern.
43
What are the keys of medical management of focal intestinal neoplasia?
Gastro protectants, appetite stimulants, feeding tube, chemo(post healing time)
44
What are the two most common complications with focal neoplasia surgery?
Dehiscence, Pancreatitis
45
What is the portion that is telescoped into in an intussusception called?
Intussusceptum
46
What is the portion that is causing the telescoping caused?
Intussuscipiens
47
What are the two most common reasons for intussusception?
Parvo and Parasites
48
What is enteroplication?
Creating lasy loops of entire bowel with intermittent sutures between the loops to prevent future intussusception.
49
What is a mesenteric volvulus? What is the prognosis?
SI twists on its mesenteric axis, grave prognosis due to venous obstruction and pain.
50
What are the clinical signs of diseases of the cecum?
Tenesmus, weight loss, diarrhea, hematochezia, vomiting.
51
What is the treatment of choice for a cecal inversion in dogs? What about cecal impaction?
Typhlectomy: take it out
52
What is megacolon in cats?
End-stage obstipation with progressive, severe and irreversible colonic distention and flaccidity.
53
What are the causes of acquired megacolon?
Neurological disease, pelvic stensosi, tumor, perineal hernia, idopathic
54
What is the most common cause of megacolon?
Idiopathic
55
What is the ideal surgical treatment of megacolon?
Subtotal colectomy, transect ascending colon 1-2cm aboral to cecum then transect colon 2cm cranial to pelvic brim.
56
What type of enemas do you not use in cats?
phosphate enemas
57
What is the prokinetic drug of choice for megacolon?
Cisapride
58
What are the clinical signs of a colonic volvulus or entrapment in SA?
Abdominal distention, dehydration, abdominal pain, hematochezia.
59
What is the blood supply to the rectum and anus?
Crainal, middle and caudal recal arteries
60
What is the innervation to the rectum and anus?
PNS: Pelvic plexus
SNS; Hypogastric plexus
Somatic: Pudenal and caudal rectal nerve.
61
When do you use a ventral approach to the rectum and anus?
disease and masses involving the caudal colon cranial or intrapelvic rectum also a midline celiotomy
62
What are the two names for pubic splitting?
Symphysiotomy, Osteotomy
63
When is a dorsal approach to the rectum used? How is it done?
Lesions in middle of rectum,animal in sternal make a inverted U shaped incision. Be sure to repair muscle.
64
When is a rectal pull through used? What is it?
mid-caudal lesions, make a circular incision external to anus and pull rectum through opening.
65
What CBC sign do you see with an AGASACA?
Hypercalcemia
66
What are the two indications for an anal sacculectomy?
recurrent anal sacculitits or anal sac tumors.
67
What is the preferred technique for an anal sacculectomy?
Closed
68
What are the five complications of recto-anal surgery?
Infection, dehiscence, stricture, incontince(caudal rectal n.), bleeding
69
What are the best antibiotics post recto-anal surgery?
Cefoxitin, metro, en/ciprofloxacin.. want it against gram - an anerobic bacteria.
70
Why does perineal herniation happen?
Loss of strength of pelvic diaphragm, normally the levator ani muscle is what goes weak.
71
Are perineal herniations normally unilateral or bilateral?
Unilateral, right side most common
72
What is the sx for a perineal herniation?
Interal obturator transposition flap.
73
When you do an internal obturator transposition flap what other surgery must you do?
Castration
74
What is the procedure for an IOTF?
Flap internal obturator dorsally and suture to external anal sphincter ventromedially and coccygeus dorsolaterally.
75
In a double layer oronasla fistula repair what are the steps?
1. ) large semi-circular palatal mucoperiosteal flap created from the palatal side of the defect and folded over the defect.
2) make a second flap and pull over the intital flap and suture over palatal mucosa.
76
When are congenital palatal defects most common in development?
25 to 28 days
77
What are some causes of congenital palatal defects?
Trauma, Stress, Brachycephalics.
78
What are the three primary congenital palatal defects?
Cleft hard palate
Cleft soft palate
Hypoplastic soft palate
79
What are some of the clinical signs of a cleft palate?
Failure to thrive, nasal discharge, coughing, gagging, sneezing
80
When is the ideal time for a congenital palatal defect repair?
3-4 months of age
81
How many layers should a palate repair closure be?
Twi wil absorbable sutures
82
What is done in a medially reposititioned double flap technique?
Incisions are make a few millimeters from the dental arch
bilaterally, the palatal mucosa is subperiosteally elevated
and repositioned medially to appose the edges of palatal mucosa in
two layers
83
Bilateral Overlapping Mucosal Single-
| Pedicle Flap Technique
```
The overlapping flap
is performed by
creating a flap that
is hinged at the edge
of the palatal defect
and placed beneath
the other side of the
palatal mucosa and
sutured in place with
a vest-over-pants
type suture pattern.
```
84
Simple Double Layer Appositional
| Soft Palate Repair
A: An incision is made on each side of the soft palatal
defect to separate the soft palate into two layers
B: Each layer is apposed separately with simple interrupted
sutures to close the midline soft palatal defect.
85
Buccal flaps
large marginal palatal defects in endentuous regions
86
Rotation flaps
small circular defects later to midline
87
Advancement flaps
For caudal defects that cross midline
88
Tongue flaps
For large rostral defects
89
Axial Pattern Flap
Use orbicularis oris for large defects
90
What are the three indications for a ventral approach to the nasal cavity?
Removal of foreign bodies, biopsy of nasal tumors, nasopharyngeal stenosis and choanal atresia
91
What are the most common nasal tumors in cats?
Squamous cell carcinoma followed by fibrosarcoma
92
What are the most common nasal tumors in dogs?
1. ) malignant melanoma
2. ) Squamous cell carcinoma
3. ) Fibrosarcoma
93
What are the types of partial mandibulectomies?
bilateral rostral,
unilateral rostral, segmental, complete unilateral,
vertical ramus
94
What are the types of partial maxillectomies?
bilateral rostral,
| unilateral rostral, lateral, bilateral and caudal
95
What are some cardiac signs you can see with GDV?
myocardial ischemia, VPC's , tachycardia
96
What is the signalment for GDV?
Deep chested large breed dogs
97
What is the radiographic view you need for GDV?
Right lateral
98
What are the principles of fluid therapy in a GDV?
Large bore catheters with Crystalloid and Colloids
99
What is the preferred method of gastric decompression?
Orogastric tube
100
What is the best way to derotate the stomach?
Pull pylorus with right hand ventrally toward right, push stomach with left hand dorsally toward left.
101
How many layers should you close the stomach with? What pattern?
2 layers, simple interrupted/cont. followed by an inverting
102
If you need to use a stapler for gastric resection which one do you use?
90mm thoracoabdomial
103
What are the four pairs of salivary glands?
Parotid, Mandibular, Sublingual, Zygomatic
104
What is the location of the Parotid gland?
base of the auricular cartilage and duct opens on mucosa apical to distal aspect of 4th premolar
105
What is the location of the mandibular salivary gland?
between maxillary and linguofacial veins
106
What are the four major diseases of salivary glands?
Mucoceles, Sialoiths, Sialoadenitis, neoplasia
107
How do salivary mucoceles happen?
Result from damage to the duct or gland with leakage of saliva into surrounding tissues.
108
What are salivary mucoceles lined by?
Inflammatory connective tissue
109
Where are ranulas located?
sublingual tissues on one side of the tongue
110
What are the clinical signs of animals with pharyngeal mucocele?
difficulty breathing or swallowing, fluid filled mass.
111
What are the clinical signs of animals with zygomatic mucoceles?
exophthalmos, divergent strabismus, non painful swelling of orbit
112
What two things are the diagnosis of mucoceles based on?
Palpation and aspiration of clear viscous blood tinged to light brown fluid.
113
What is the recommended treatment for mucoceles?
surgical excision of involved glands and drainage of mucocele
114
What is the ideal treatment for an Aural hematoma?
Incision and drainage combined with suturing the skin to the cartilage
115
What is important in aural hematomas for cats?
delay opening of hematoma for 5-6 days to allow hemostasis.
116
How should the mattress sutures in the pinna be placed?
parallel to the skin incision to not disrupt blood supply.
117
What is the purpose of a lateral ear canal resection?
Increases drainage of the external ear canal and improves ventilation of the canal.
118
What are the indications for a lateral ear canal resection?
Chronic otitis media without significant changes that are causing obstruction.
119
When do you do a total ear canal ablation with lateral bulla osteotomy?
irreversible hyperplastic ear canal dz, hyperplastic otitis externa, neoplasia of the horizontal ear canal.
120
When do you do a vertical ear canal resection?
tumors confined to vertical ear canal, stenosis or trauma
121
What are the possible complications with a TECA-LBO
Facial nerve injuries, vestibular injury, infection, pain
122
Why would you do a ventral bulla osteotomy?
treatment of otitis media that has not responded to appropriate medical therapy or less invasion surgical therapy.
123
What are some less common indications for a ventral bulla osteotomy?
exploration of tympanic cavity in animals with polyps, neoplasia, osteomyelitis
124
What are three things that horses with a small intestinal strangulating obstruction usually have?
Severe abdominal pain, increased heart rate and PCV, hypo perfusion and metabolic acidosis
125
If you get large amount of reflux what is the number one possible diagnosis?
Duodenitits-proximal jejunitis aka proximal enteritis
126
What part of the intestine is normally involved in an epiploic foramen entrapment?
Ileum and Jejunum
127
What are the typical presenting complaints for urinary problems in horses?
low grade abdominal pain, weightless, stranguria, dysuria, hematuria, oliguria, incontinence
128
What is important to remember about your suture choice for equine urinary surgery?
never use non-absorbable suture
129
What is one of the most important organs in pharmacology?
Kidney. Drugs can have nephrotoxic effects and are sensitive to hypo perfusion and hypotension.
130
What is the vast majority of stones in equines? How do they present?
Calcium carbonate. Weight loss, colic, anorexia.
131
What is the treatment of choice for unilateral diseases of the kidney in horses?
Nephrectomy
132
What is different if you decide to do a nephrotomy in a horse?
You have to do capsular sutures, for this reason it is not recommended to do. Nephrectomy is better.
133
What clinical abnormalities do you see in a uroperitoneum in horses?
Uremia, severe electrolyte and acid base abnormalities.
134
What is the number one rule to remember in uroperitoneum?
Medically stabilize before surgery. They are medical nor surgical emergencies
135
What should you remember to check in a patent urachus?
They are normally systemically sick.
136
How long should you wait to fix a patent urachus before surgery?
5 to 7 days max
137
What is the most common location for stones in horses?
Bladder
138
What is the indicated surgery for bladder rupture?
Cystorrhaphy.
139
What is the indicated surgery for a patent urachus?
Cystoplasty
140
What is the indicated surgery in horses for urinary calculi?
Cystotomy
141
In urethral obstruction which drug should you avoid?
Xylazine, it has diuretic effects
