Flashcards in Surgery/Procedures Deck (103):
Risk factors for GDV
Relatives who had GDV
Higher thoracic depth to width ratio
Lean body condition
Eating quickly (large but not giant breeds)
Raised food bowl
Fed only dry food
Fed a single meal a day
Post prandial exercise association with GDV?
Several studies showed not a risk factor; one internet survey suggested beneficial.
% of dogs with GDV with pre-op aspiration pneumonia
What % of GDV have arrhythmias
Significance of elevated troponin with GDV?
Elevated in many dogs and associated with severity of ECG changes and with outcome
In what direction does the stomach typically rotate in GDV
pylorus rotates clockwise towards the left side of the body (i.e., ventrally and fundus goes dorsally).
Survival of dogs with GDV that require gastric resection
70-74%. Two studies do not agree as to whether need for gastric resection is prognostic indicator
What suture types are recommended for pexy
Polypropylene (prolene) or polydioxanone (PDS)
what are preoperative risk factors for mortality with GDV
Hypotension at any time during hospitalization
Combined splenectomy and partial gastrectomy
Findings on study evaluating keppra in PSS Dogs
Use of keppra was protective against development of PO seizures - rec starting at least 24 hours prior to surgery (Fryer)
What is goal portal pressure when occluding a PSS
Increase in portal pressure of no greater than 10 cm H2O
How do you convert mmHg to cmH2O
Multiply mmHg by 1.36
What is the normal portal venous pressure
approx 10-12 cmH2O (8-10 mmHg).
What are the 3 major complications of post-op PSS
Portal hypertension, coagulopathy, neurologic complications
Possible causes of post-op neurologic signs with PSS
Increased blood ammonia
Increased GI hemorrhage leading to increased NH3
Portal hypertension -> GI bleed -> increased NH3
Production of GABA, aromatic amino acids, and endogenous benzodiazepine receptor ligands by GI tract that are normally removed by the liver.
What factors predicted surgical mortality in patients with single EHPSS treated by aneroid ring constrictor?
occurrence of post-op complications
pre-operative white blood cell count
Perioperative mortality rate for EHPSS with slow attenuation, cellophane banding, or aneroid ring?
Mortality rate for IHPSS?
Predictors for short term outcome in dogs with intrahepatic PSS?
What recumbency is recommended for abdominocentesis
left lateral - allows spleen to fall away
At what point should a closed suction drain be removed
When drainage declines to 5-10mL/kg/24hours
Describe technique for intercostal nerve block
at least adjacent intercostal spaces should be blocked on both sides. Place needle at caudal border of rib near intervertebral foramen. Use approx 0.25 to 1 mL (based on size of dog) of 0.5% bupivacaine per site. Will maintain pain control 3-6 hours.
Which factors that regulate allograft rejection are inhibited by cyclosporine
Granulocyte-macrophage colony stimulating factor (GM-CSF).
prognosis for cats after kidney transplant
70-93% have been discharged from hospital with MST of 360-616 days.
According to one retrospective study, what abdominal organ is most injured secondary to motor vehicle accidents
What height are dogs more likely to experience abdominal injury when falling from
more than three stories (vs. falling from three or less)
What percentage of cats had thoracic trauma from high rise fall
What were most common injuries in cats falling from height
Pneumothorax and pulmonary contusions (60%, 40% of cats with thoracic trauma).
Survival of high rise falls in cats
In cats, falling from what height are they more likely to have thoracic trauma
Falling from seventh story or higher more likely to result in thoracic trauma
What three views are obtained for thoracic FAST exams
bilateral chest tube views, pericardial site views and diaphragmatic-hepatic view.
What % PCV Is necessary to diagnose hemorrhagic effusion?
PCV should be at least 10-25% of peripheral blood PCV.
What ratio of serum to abdominal fluid creatinine and potassium is needed for dogs versus cats to diagnose uroperitoneum
Creatinine and potassium serum/abdominal 1:2
Potassium: 1:1.4 (100% sensitive and specific)
Creatinine 1:2 (86% sensitive, 100% specific).
What bilirubin concentration needed to diagnose bile leakage
Greater than 2x serum concentration
Components of surgery for chylothorax
Thoracic duct ligation
Omentalization of thoracic cavity
Cisterna chyli ablation
What percentage of animals with pyothorax have a fever
Study on ionized hypocalcemia on outcome in dogs with trauma
More likely to require oxygen, colloids, blood products and vasopressors
Spent significantly longer in the hospital and ICU
Higher morality rate
Define each of the following wound types:
clean- surgically created
clean contaminated - minor break in ascetic technique, entrance into GI/urogenital/resp tracts
Contaminated- wound related to trauma with bacterial contamination, surgical wound with major breaks in asepsis
Dirty or infected- older wound with exudate or obvious infection. More than 10^5 organisms/gram of tissue
Describe classifications of open fractures (grade 1-3)
Grade 1- small break in skin caused by bone penetrating through
Grade 2- soft tissue trauma contiguous with the fracture, often caused by external trauma (bite, gunshot)
Grade 3- Extensive soft tissue injury, commonly in addition to high degree of comminution of the bone. (i.e., high velocity gun shot, distal extremity shear wounds)
What are the four phases of wound healing
Inflammation - first 5 days
Debridement- Simultaneous with inflammatory stage
Proliferative/Repair stage- Starts 3-5 days post injury and lasts 2-4 weeks
Maturation- starts 17-20 days post injury, may take years
What is the hallmark of the debridement phase
Entry of WBCs into wound. Neuts- 6 hours after injury; Monos- 12 hours after injury. Monocytes stimulate fibroblastic activity, collagen synthesis, and angiogenesis. They morph into Mps which remove necrotic tissue, bacteria and foreign material
What is hallmark of repair phase
Angiogenesis, granulation tissue formation, and epithelialization. Fibroblasts proliferate and start synthesizing collagen. Granulation tissue provides surface for epithelialization, source of myofibroblasts that play a role in wound contraction.
What were the findings of the in vitro study investigating normal saline vs. LRS for wound lavage
Saline and tap water caused mild (saline) and severe (water) cytotoxic effects on fibroblasts, whereas LRS did not cause significant fibroblast injury.
What size needle/syringe for lavage
60 mL syringe, 18 g needle.
Healing properties of honey
accelerates sloughing of necrotic tissue
provides cellular energy source
promotes healthy granulation bed
antibacterial properties (from high osmolarity, acidity, and hydrogen peroxide content).
Can be used in debridement phase and over infected granulation tissue.
Benefits of negative pressure wound therapy
early generation of granulation tissue
reduction in size of wound and volume
fewer bandage changes
possibly decrease bacteria and edema in wounds- not proven. If left on too long (7 days), may result in higher bacterial load, decreased epithelialization and decreased wound contraction.
Define delayed primary closure
Closure of a wound 2-5 days after injury
Define secondary closure
Closure of a wound 5 or more days after the inciting injury
What pressure should the VAC be set at
Contraindications of negative pressure wound therapy?
necrotic tissue with eschar
nonenteric and unexplored fistulas
exposed vasculature, nerves, organs, or anastomotic site
Benefits of hyperbaric oxygen in wound healing
promotion of angiogenesis
increased proliferation of fibroblasts
Increased leukocyte oxidative killing of bacteria
What wounds/injuries most likely to benefit from HBOT?
Compromised skin grafts
Infections with anaerobic organisms
What is the MOA of low level laser light therapy aka "cold" laser
Low levels of red and near-infrared light penetrate tissue and increase ATP production in the mitochondria of chromophores
Promotes healing via activation of fibroblasts.
Proposed benefit of vitamin A in wound healing?
Antagonize the effect of corticosteroids on wound healing (steroids decrease the inflammatory phase and the rate of protein synthesis)
Where do the internal thoracic arteries run
Along ventral thorax a few cm to either side of sternum
What is the normal pressure difference between pleural pressure and intra-alveolar pressure, and what does that translate to in terms of mL of vacuum in a syringe
4-8 mmHg; equivalent to 5-10 mL of vacuum in a syringe
At what point should chest tubes be removed
When fluid production is less than 2 mL/kg/day.
What is cullens sign
Periumbilical ecchymoses, may indicate hemorrhage in the peritoneum or retroperitoneum.
What volume of fluid should be administered for DPL
What was the finding of the 2003 study evaluating blood to abdominal fluid glucose and lactate.
A blood-to-fluid glucose (BFG) difference > 20 mg/dL was 100% sensitive and 100% specific for the diagnosis of septic peritoneal effusion in dogs. In 7 dogs in which it was evaluated, a blood-to-fluid lactate (BFL) difference < -2.0 mmol/L was also 100% sensitive and specific for a diagnosis of septic peritoneal effusion.
Compare vertical vs. horizontal mattress sutures
Horizontal - for areas of tension but my cause tissue eversion
Vertical- stronger than horizontal when used in areas of tension. Eversion of skin is less than horizontal.
What is Gambee pattern and what is its benefit?
Used in intestinal surgery to reduce mucosal eversion.
Suture introduced through from serosa through muscular to and mucosa into lumen (as in simple interrupted); the needle is then reintroduced from lumen through mucosa to muscular before it crosses the incision. After crossing incision, it is introduced in the muscular and continued through mucosa to lumen. Needle then reintroduced through mucosa and musclaris to exit from serial surface and suture tied.
Characteristics of Lembert suture pattern
vertical mattress pattern in continuous fashion - inverting pattern, does not enter lumen.
What are the characteristics of cushing and connell patterns
Connell- enters lumen.
Both are inverting patterns. Seldom used because they cause excessive tissue inversion.
Findings of "Closed Suction Drainage for Treatment of Septic Peritonitis of Confirmed Gastrointestinal Origin in 20 Dogs"
- most common source of contamination
- length of time drains in
- survival %
- most common complication
Dehiscence of a previous anastomosis was the most common source of contamination (80%).
Drains (JP) remained in place for a median of 6 days
85% survival to discharge.
Postoperative hypoproteinemia was the most commonly documented complication (90%)
Findings: "Evaluation of Pharyngeal Function in Dogs with Laryngeal Paralysis Before and After Unilateral Arytenoid Lateralization"
Topical pharyngeal and laryngeal sensitivity testing was decreased in LP dogs compared with age-matched healthy control dogs.
Esophagram showed dysmotility in the cranial and caudal esophagus.
Gastroesophageal reflux was significantly higher in ILP dogs compared with the other 2 groups (P
Findings: "Injection of the Diaphragmatic Crus With Methylene Blue
for Coloration of the Canine Thoracic Duct"
- where is the best place to inject dye?
Methylene blue injected into the diaphragmatic crura and mesenteric lymph node was successful in coloring the TD; however, mean thoracic duct color grade and number of successful outcomes were significantly higher after mesenteric injection
Findings: Idiopathic Canine Laryngeal Paralysis as One Sign of
a Diffuse Polyneuropathy: An Observational Study of
90 Cases (2007–2013)
- what % of dogs had neurologic comorbidities and what was their complication rate.
Surgical correction positively associated with survival and owner assess QOL.
35/72 dogs had diffuse neurologic comorbidities.
Complication rate for dogs w/ neuro signs 74% vs. 32%.
Most common complication - asp pneumonia.
Characteristics and Survival of 121 Cats Undergoing Excision of Intracranial Meningiomas (1994–2011)
Cats undergoing excision of intracranial meningiomas had a low perioperative mortality and a long-term prognosis of more than 3 years
Urethral Prolapse in Dogs: A Retrospective Study
- what factors associated with post-operative hemorrhage
- what factors associated with recurrence
- was castration status significant
Most common breed- english bulldog.
Of 48 affected dogs, 46 had either resection and anastomosis (43 dogs) or urethropexy (3 dogs). The most common early postoperative complication was hemorrhage (39%); postoperative hemorrhage was less common when a simple continuous pattern was used for resection and anastomosis. Prolapse recurred in 57% of dogs available for long‐term follow‐up; recurrence was less common in dogs that were administered postoperative butorphanol or acepromazine.
Castration status was not associated with urethral prolapse or postoperative complications.
Evaluation of Video‐Assisted Thoracic Surgery for
Treatment of Spontaneous Pneumothorax and
Pulmonary Bullae in Dogs
Exploratory thoracoscopy was associated with a high rate (58%) of conversion to median sternotomy because of inability to identify leaking pulmonary lesions in dogs with spontaneous pneumothorax and pulmonary bullae.
Failure to convert to a median sternotomy may be associated with recurrent or persistent pneumothorax (i.e., more dogs recurred who did not receive median sternotomy and only received video-assisted surgery.
Long‐Term Outcome, Complications and Disease Progression in 23 Dogs After Placement of Tracheal Ring Prostheses for Treatment of Extrathoracic Tracheal Collapse
Of23dogs,22survivedtodischargeaftersurgery.Clinicalsignsimprovedin all dogs at 2 weeks after surgery and at long‐term re‐evaluation. Fourteen dogs (65%) required no medical management for respiratory signs after surgery. Four dogs (17%) were diagnosed with laryngeal paralysis at some point after surgery, but only 9% were diagnosed within 48hours of the surgery. Additional rings were placed between previously placed rings in 2 dogs, and 1 dog was treated with an endoluminal stent for intrathoracic tracheal collapse. Three dogs had clinical signs consistent with progression of tracheal collapse.
Antibacterial Efficacy of Several Surgical Hand Preparation Products Used by Veterinary Students
Which was most effective:
Ethanol +1 % chlorhex gluconate hand rubs or non-abrasive hand scrub method with 4% chlorhex gluconate were more effective in reducing bacterial CFU during surgical hand preparation vs. 2 different propanol solutions.
Complication Rates After Bilateral versus Unilateral Total Ear Canal Ablation with Lateral Bulla Osteotomy for
End-Stage Inflammatory Ear Disease in Dogs: 79 Ears
Dogs undergoing bilateral surgery did not have a significantly higher total complication rate, or higher neurologic, ocular, or incisional complication rates, than the unilateral procedure. No major anesthetic complications affecting outcome were recorded for either group.
Outcome of Donor Cats After Unilateral Nephrectomy as
Part of a Clinical Kidney Transplant Program
The prevalence of kidney failure in the donor population appears to be higher than that in the general population, but definitive conclusions cannot be made based on this study
Frequency of Dehiscence in Hand-Sutured and Stapled Intestinal Anastomoses in Dogs
No significant difference in frequency of dehiscence was noted between hand-sutured and stapled anastomoses in dogs but surgery duration is significantly reduced by the use of staples.
Assessment of Postoperative Pain in Cats After Ovariectomy by Laparoscopy, Median Celiotomy, or Flank Laparotomy
Laparoscopic ovariectomy, although slower, appeared less painful compared with conventional ventral midline and flank ovariectomy. Postoperative pain did not differ significantly between midline and flank groups
In Vitro Evaluation of the Aberdeen Knot for Continuous Suture Patterns with Large Gauge Suture
Aberdeen knots had higher knot holding capacity and relative knot security. None of aberdeen knots unraveled, but a portion of square and surgeons throws did.
Aberdeen knots had smaller volume and weight vs. the others.
Knot with combined highest relative knot security with smallest size/wt was 4 throws using 3 USP polyglactin 910 (vicryl) .
In Vitro Evaluation of the Size, Knot Holding Capacity, and Knot Security of the Forwarder Knot Compared to Square and Surgeon’s Knots Using Large Gauge Suture
Forwarder knots had higher relative knot security and knot holding capacity vs. surgeon's or square knots for all suture types and number of throws. No forwarder knots unraveled, but proportion of others with <6 throws did unravel.
Forwarder knots had smaller volume and weight than surgeons and square knots with equal number of throws.
Investigation of Incidence and Risk Factors for Surgical
Glove Perforation in Small Animal Surgery
At least 1 glove perforation occurred in 26.2% of procedures.
- increased sx duration
- ortho sx
- surgical wire
- polyisoprene glove material
- primary surgeon
30% sensitivity of wearer to detect perforations
Evaluation of In Vivo Behavior of Ameroid Ring Constrictors in Dogs with Congenital Extrahepatic Portosystemic Shunts Using Computed Tomography
No ameroid constrictor closed completely: shunt occlusion was always dependent on soft tissue within the ameroid ring. Residual flow through the shunt was present in 4 dogs (18%), although this caused persistent elevation of shunt fraction in only 1 dog
The change in ameroid constrictor internal diameter was not significantly correlated with serum protein concentration.
Conclusions: Complete shunt occlusion after AC placement is usually dependent on soft tissue reaction. shunt occlusion.
Ameroid constrictors >/=5 mm diameter may not promote complete shunt occlusion
Evaluation of the Effects of Topical Zinc Gluconate in Wound Healing
Groups received 1 of the following randomized treatments: zinc gluconate in carrier solution, carrier solution, saline (0.9% NaCl) solution, chlorhexidine, chlorhexidine + zinc gluconate, corticosteroid, and no treatment
No significant differences were noted among the groups except the corticosteroid group, in which delayed healing was noted at 4 and 21 days. Bacterial isolates were similar and no differences in pain scores or weight gain were noted among groups. The wounds treated with corticosteroid at day 4 had decreased inflammatory cells and serocellular crust formation, and minimal neovascularization and granulation tissue formation. At day 21, that group had prolonged neutrophilic inflammatory cells, immature fibrosis, less re‐epithelialization, and more prominent serocellular crust.
The Effect of Low-Level Laser Therapy on the Healing of Open Wounds in Dogs
What were findings when compared to control (all male) vs. female historical control?
No difference in laser vs. control for all parameters.
Historical female controls (study dogs were all male) had significantly greater contraction and epithelialization compared to laser and control. Laser and control had significantly less inflammation than historical group early in would healing but surpassed by day 21. Fibroblast infiltration and collagen less in study groups than historical female controls.
Conclusion - laster didn't help healing of acute wounds but gender may influence wound healing.
Postoperative Respiratory Function and Survival After Pneumonectomy in Dogs and Cats
15 of 16 dogs (94%) and 6/7 cats (86%) survived to hospital discharge. After pneumonectomy, dogs had a significantly higher postoperative PaO2 on 21% oxygen and lower postoperative A-a gradient compared to dogs undergoing single lung lobectomy.
Knot Security and Tensile Strength of Suture Materials
Braided lactomer (polysorb) had greatest force to breaking, whereas polyglytone (caprosyn) had lowest force to breaking. No difference among forces required to break polypropylene and 2 nylon sutures (ethilon and monosof).
Highest strength- 5 throws, lowest = 2 throws.
There was no significant difference between the simple interrupted knots and the knots at the beginning of a simple continuous pattern; however, both were significantly less likely to fail than the knots tied at the end of a simple continuous pattern.
Surgeon experience had a significant effect on failure mode and tensile failure load.
Effect of Vascular Seal Configuration Using the LigaSure on Arterial Challenge Pressure, Time for Seal Creation, and Histologic Features
Vessel sealing using a single seal created with a single activation cycle was adequate for sealing canine carotid arteries. Histologic examination did not demonstrate any disadvantages to multiple seals or multiple cycle activations.
Effect of One‐Lung Ventilation With or Without Low‐Pressure Carbon Dioxide Insufflation on Cardiorespiratory Variables in Cats Undergoing Thoracoscopy
No significant effects on hemodynamic variables or oxygen delivery were observed after right or left‐sided OLV alone. Hemodynamic variables were also well‐preserved after OLV–CDI; however, oxygen delivery was significantly lower after left OLV–CDI compared with right OLV–CDI
Conclusions: OLV can be used in cats for thoracoscopic interventions. Although right OLV–CDI was tolerated better than left OLV–CDI, the technique requires further investigation before it can be recommended for widespread clinical use.
Effect of Metoclopramide on the Incidence of Early
Postoperative Aspiration Pneumonia in Dogs with Acquired
Idiopathic Laryngeal Paralysis
Perioperative metoclopramide, at the doses used in this study, did not affect the incidence of aspiration pneumonia in the short term postoperative period in dogs with idiopathic laryngeal paralysis undergoing unilateral arytenoid lateralization.
Comparison of Radiography and Computed Tomography for Determining Tracheal Diameter and Length in Dogs
CT tracheal measurements were on average 1.03 mm larger (P
Imaging and Clinical Outcomes in 20 Dogs Treated with
Thin Film Banding for Extrahepatic Portosystemic Shunts
The band resulted in complete closure of the vessel around which it was placed in 13 dogs. In the remaining 7 dogs, the vessel lumen was narrowed but not completely closed.
Conclusion: Thin film banding resulted in complete occlusion of many, but not all vessels around which it was placed. Even in dogs with inappropriate band location or with incomplete closure, clinical improvement can be expected based on our results.
Perioperative Management and Outcome of Bilateral Adrenalectomy in 9 Dogs
The median survival time in dogs surviving to hospital discharge was 525 days (range 67–966 days).
Lower mortality rate than previously described.
Negative Pressure Wound Therapy: Experience in 45 Dogs
Length of NPWT and mean hospitalization?
Median NPWT use was 3 days with a mean hospitalization of 7.8 days.
Overall, 96% of the wounds healed
Cardiopulmonary Effects of Laparoscopic Ovariectomy of Variable Duration in Cats
Duration of insufflation was associated with worsening of negative cardiopulmonary effects (respiratory compliance, increased CO2); however, these effects were reversible and resolved by the end of the procedure.
Risk Factors for Dehiscence of Stapled Functional End-to-End Intestinal Anastomoses in Dogs: 53 Cases (2001–2012)
IBD, location of anastomosis (colon), and intraoperative hypotension are risk factors for intestinal anastomotic dehiscence after stapled functional end-to-end anastomosis in dogs.
11% dehisced. Mortality 83%
Previously suggested risk factors (low serum albumin concentration, preoperative septic peritonitis, and intestinal foreign body) were not confirmed in this study
Long-Term Outcome and Complications Following Prophylactic Laparoscopic-Assisted Gastropexy in Dogs
No dogs had GDV in follow-up.
LAG was an effective procedure for prevention of GDV and was associated with high client satisfaction in this cohort of dogs. A moderate rate of postoperative wound complications occurred that were minor and self-limiting in nature.
Prospective Controlled Study of Gastroesophageal Reflux in
Dogs with Naturally Occurring Laryngeal Paralysis
Based on the limited number of dogs studied, it appears that dogs with naturally occurring LP have increased acidic reflux events compared to clinically normal dogs. GER can reach the most proximal part of the esophagus.
Comparison of Outcome After Use of Extra-Luminal Rings
and Intra-Luminal Stents for Treatment of Tracheal Collapse
Ninety-two percent of dogs undergoing ELR and 100% of dogs undergoing ILS survived to hospital discharge. ELR dogs were significantly younger (P1⁄4.009) and significantly fewer had main-stem bronchial collapse (P
Prospective Surgical Site Infection Surveillance in Dogs
% of dogs with SSI
What were risk factors?
What was most common bug?
Hypotension, class of surgery, and use of implant increased risk of SSI.
74% were staphylococci.
Outcome After Pneumonectomy in 17 Dogs and 10 Cats: A Veterinary Society of Surgical Oncology Case Series
- complication rate
- mortality rate
The overall incidence of complications for dogs and cats were 76 and 80%, respectively, with major complications in 41 and 50%, respectively. Respiratory complications (persistent pleural effusion, oxygen dependence, persistent increased respiratory rate, or coughing) were the most frequent complications. No animals died or were euthanatized intraoperative or within the first 24 hours postoperative. One dog (6%) and 2 cats (20%) died, or were euthanatized in the first 2 weeks postoperative.
Erythrocyte and Biochemical Abnormalities as Diagnostic
Markers in Dogs With Hemangiosarcoma Related
There was no significant difference in erythrocyte morphology in abdominal effusion or peripheral blood between dogs with HSA or non-HSA related hemoabdomen. Platelet concentration and peripheral blood PCV were significantly lower in the HSA group
Diagnostic Accuracy of Ultrasound to Predict the Location
of Solitary Hepatic Masses in Dogs
The sensitivity of ultrasound localization was 55% for left and right division masses and 29% for central division masses. Correct localization was 3.2 times more likely when the mass arose from the right or left division compared to the central division
Correct localization was significantly less likely when diffuse or multifocal hepatic disease was present
Ultrasound was specific but not sensitive for localizing hepatic masses, and localization accuracy was influenced by mass location and the presence of concurrent liver pathology.
Preoperative Differential Diagnosis of Canine Adrenal Tumors Using Triple-Phase Helical Computed Tomography
Of the 36 dogs with adrenal masses, cortical adenocarcinoma was most commonly diagnosed (16 dogs), followed by pheochromocytoma (13 dogs), and cortical adenoma (7 dogs).
morphological features, CT values, and intratumoral contrast attenuation were different between tumor types so may be helpful when arranging differentials