Flashcards in Surgical conditions of the Airways Deck (79):
rhinarium - congenital deformities
cleft - harelip primary cleft palate
rhinarium - lacerations
haemorrhage - can heal by 2nd intention
primary closure can also be done
rhinarium - neoplasia
squamous cell carcinoma
wide local excision
nasal cavity - chronic hyperplastic rhinitis
infl in nasal cavity - stimulates hyperplasia of mucous membranes + incr mucous secretion
nasal cavity - chronic hyperplastic rhinitis - treatment
specific therapy for underlying predisposing factors
rhinotomy + turbinectomy
nasal cavity - trauma
usually little need for orthapaedic fixation
decr maxillary fractures
possibility of acquired palatine clefts
occasional sequestrum formation
nasal cavity - dental disease
lesions in oral cavity
nasal cavity - intranasal neoplasia
most are malignant - carcinoma, adenocarcinoma, chondro, fibro, osteo - sarcoma
benign polypoid rhinitis
nasal cavity - mycotic rhinitis - treatment
if medicine fails - place irragation tubes via sinusotomy
nasal cavity - foreign bodies
sudden onset sneezing, serous discharge
may progress to mucoid/purulent in chronic
rhinotomy may be needed for confirmation
congenital defects of the secondary palate
unable to suckle properly + nasal return of milk
if mild - chronic nasal discharge
aquired defects of the secondary palate
trauma due to tooth extraction or other
chronic nasal discharge + sneezing due to impaction of food into nasal cavity
Brachycephalic Airway Obstruction Syndrome - Primary pathology
Long soft palate
Brachycephalic Airway Obstruction Syndrome - secondary pathology
Eversion of the mucosa of the lateral laryngeal venricles
many brachycephalic dogs have tracheal hypoplasia, redundant pharyngeal mucosa + scolling of epiglottis
Brachycephalic Airway Obstruction Syndrome - clinical features
mild - exercise intolerance/dyspnoea when stressed
worse in heat + stress
noise on inspiration + expiration
laryngeal + pharyngeal oedema
Brachycephalic Airway Obstruction Syndrome - diagnosis
hematology + serum chemistry
lateral radiography of larynx
pharynx + larynx exam
Brachycephalic Airway Obstruction Syndrome - clinical actions
Cool intravenous fluids
Whole body cooling
Brachycephalic Airway Obstruction Syndrome - treatment
staphylectomy (removal of uvula)
resect everted mucosa of lateral laryngeal ventricles
post-op tracheostomy management
in bulldogs - narrowed trachea.
no surgical treatment
live a normal life, providing their upper airway is in good condition
can be v.severe
post op care for tracheotomy
Insert sleeve removed and cleaned every 2hrs
Nebulization every 4hrs
Limit physical activity
Suction tube only if necessary.
causes of laryngeal collapse
laryngeal paralysis - Aetiopathogeneis
Acquired - trauma, neoplasia, secondary to polyneuropathy/polymyopathy
laryngeal paralysis - clinical features
chronic progressive exercise intolerance
incri respi noise (esp in inspiration stridor)
cyanosis and collapse - heat stress and excitement, animals are often pyrexic.
laryngeal paralysis - diagnosis - obstructive crisis
cool intravenous fluids
external body cooling
Occasionally, rapid anesthetic induction and orotracheal intubation
tube tracheostomy will permit complete patient evaluation prior to definitive treatment.
laryngeal paralysis - diagnosis - stable patient
careful physical exam
Hematology & biochemistry: concurrent/intercurrent disease)
careful evaluation of laryngeal function under a light plane of anaesthesia.
laryngeal paralysis - treatment
left arytenoid lateralisation - Suturing of the arytenoid to the thyroid (lateralisation) or cricoid
post-op care - animal at risk of aspiration pneumonia
laryngeal neoplasia - clinical signs
types of laryngeal neoplasia
congenital rhabdomyosarcoma (oncocytoma), squamous cell carcinoma adenocarcinoma, chondrosarcoma, fibrosarcoma and lymphoma
laryngeal paralysis - treatment outcome
Overall 85 - 90% improved long-term
Short term complication rate of 30%
All postoperative deaths involved concurrent disease
laryngeal paralysis - treatment complications
poor arytenoid abduction
in the dog and the cat
sign similat to laryngeal paralysis and laryngeal tumours
biopsy diagnosis of all laryngeal neoplasms prior to definitive treatment.
tube tracheostomy - Indications
Temporary airway diversion to permit surgery of oral cavity
Long-term ventilatory support
Emergency provision of airway
toy and small terrier breeds
poor tracheal cartilage development, poor tracheal conformation
exacerbated by LRT infections, heart disease and/or laryngeal dysfunction
disease usually causes a clinical problem in mid to late life
worsened by obesity.
tracheal collapse - Pathophysiology
Dynamic airway obstruction
Reduced alveolar ventilation
tracheal collapse - clinical features
ins + expiratory noise
Chronic “goose – honk” cough
dorsoventral flatening of trachea
tracheal collapse - diagnosis
PE – palpation of trachea
tracheal collapse - surgical therapy
in primary disease or where conservative management has failed
attempted salvage procedure
placement of prosthetic rings around the trachea
may need to be combined with arytenoid lateralization if laryngeal function is poor prior to or as a result of surgery.
tracheal collapse - intralumenal stents
older dogs with co-morbid disease
neck bite wounds, traumatic intubation.
In cats, blunt trauma to the chest may cause tracheal rupture/avulsion
tracheal trauma - clinical features
subcutaneous emphysema can be over whole body.
Pneumomediastinum + pneumothorax may result causing respiratory distress.
Respiratory distress - can vary with head position.
tracheal trauma - diagnosis
can be challenging.
cervical + thoracic radiographs - peritracheal, intermuscular, and subcutaneous emphysema.
+ve contrast studies using water soluble, organic iodide solutions if the diagnosis not obvious on radiography.
tracheal trauma - treatment
Conservative therapy - cage rest + observation if stable + don't have progressive lesions.
Surgical therapy if clinical signs are progressive and if respiratory distress is severe.
Lung lobectomy - indications
Primary lung tumour ( + LN)
Metastatic pulmonary mass
Lung lobe torsion
primary lung tumour
Majority are malignant
primary lung tumour - Clinical features
Cough (productive-haemoptysis) - 52%
Dyspnoea - 23%
Lethargy - 18%
Weight loss - 12%
none - 25%
primary lung tumour - diagnosis
Thoracic radiographs and/or CT
check for other masses if one found
primary lung tumour - treament
Exploratory thoracotomy and lung lobectomy
with differentiated adenocarcinomas without local LN involvement have longest postoperative survival times.
recheck every 3-6 months
when atmospheric air enters the pleural space
"closed" pneumothorax - lung is source of the leakage
animal has no history of trauma
spontaneous pneumothorax - causes
Ruptured pulmonary bullae or blebs.
Migrating inhaled plant material.
Chronic obstructive lung diseases
Asthma, tuberculosis, pulmonary neoplasia airway parasites (filaroides).
spontaneous pneumothorax - clinical features
Absence of lung sounds on auscultation and “thoracic resonance on percussion”
Radiography/CT – care in dyspnoeic animal
spontaneous pneumothorax - treatment
thoracocentesis or a chest tube
exploratory thoracotomy via median sternotomy and removal of diseased lobe
Prolonged pleural evacuation using chest drain.
lung lobe torsion
in both dogs and cats
right middle and right cranial lung lobes are most frequently involved
associated with pleural effusions (chylothorax), trauma, thoracic surgery, neoplasia, and chronic respiratory disease.
lung lobe torsion - Clinical features
accumulation of pleural fluid + necrotic lung lobe.
dyspnoea and a cough.
muffled lung sounds (consolidated lung lobe/pleural effusion)
lung lobe torsion - treatment
lobectomy of the affected lobe.
lung lobe torsion - diagnosis
Thoracocentesis, thoracic ultrasound, radiography and CT aid definitive diagnosis. Repeat imaging once chest is drained.
diaphramatic rupture (DR) - pathogenesis + pathophysiology
Blunt abdominal trauma - elevation in intra-abdominal pressure - rupture at weakest point
loss of diaphragmatic contribution to pulmonary ventilation
migration of abdominal organs into the thoracic cavity - lung volume.
diaphramatic rupture (DR) - pathogenesis + pathophysiology - acute
pulmonary contusions, rib fractures, pneumothorax, hemothorax and pain can all exacerbate poor pulmonary function.
diaphramatic rupture (DR) - pathogenesis + pathophysiology - chronic
effusion from surface of entrapped or strangulated organ(s) - hydrothorax - compromises lung volume
diaphramatic rupture (DR) - diagnosis
radiography (can be obscured by pleural effusion)
GI contrast radiography
diaphramatic rupture (DR) - treament - emergency
24-48hrs of medical stabilization prior to surgical repair
If dilated stomach within the thoracic cavity, immediate action - trans-thoracic gastrocentesis
diaphramatic rupture (DR) - treament - stable
If gastric decompression can be maintained via nasogastric tube, non-surgical therapy can continue; if this is not possible emergency surgery is indicated
chronic DR with pleural fluid accumulation - withdrawal of the fluid prior to surgical intervention
diaphramatic rupture (DR) - treament - ongoing pleural effusion anticipated
thoracostomy tube placed prior to closure of the dipahragmatic defect
diaphramatic rupture (DR) - treament - chronic defect healing
enhanced by debridement of the edges of the diaphragmatic rupture, not necessary for acute ruptures
Peritoneopericardial diaphragmatic hernia (PPDH) - pathogenesis + pathophysiology
failure of septum transversum to advance - space between the 2 advancing lateral pleuroperitoneal folds
failure of the lateral pleuroperitoneal folds to unite or a result of intrauterine trauma
may be associated with other developmental abnormalities
Peritoneopericardial diaphragmatic hernia (PPDH) - diagnosis
As for acquired DR.
Peritoneopericardial diaphragmatic hernia (PPDH) - treatment
young - asap to reduce the risk of adhesion formation
older - can be managed conservatively
abdominal organs returned to peritoneal cavity
Peritoneopericardial diaphragmatic hernia (PPDH) - pathophysiology
loss of intrapleural volume - reduction in lung volume
displaced gastrointestinal organs may become partially or completely obstructed
cardiac defects can result in primary signs of cardiac compromise and other vascular defects - CNS, urinary tract and GI tract signs.
Esophageal hiatial hernia (EHH) - pathogenesis
defect in the formation of the esophageal hiatus,
laxity in esophageal hiatus - abdominal esophagus and cardia of the stomach move into the thoracic cavity or portion of stomach to enters thoracic cavity next to the abdominal esophagus
Esophageal hiatial hernia (EHH) - pathophysiology
impairment of the “high pressure zone” of the caudal esophagus
chronic gastroesophageal reflux, regurgitation and/or vomiting
chronic esophagitis, esophageal hypomotility and aspiration pneumonia
Esophageal hiatial hernia (EHH) - diagnosis
PE - may reflect secondary disease processes
radiography - gas-filled viscus in dorsocaudal thorax
alveolar pattern in the cranioventral lung fields
A barium paste esophagram + fluoroscopy
Esophageal hiatial hernia (EHH) - treament
surgical therapy in three steps
1) stomach is returned to the abdomen + phrenoesophageal ligament dissected
2) defect closed beginning dorsal to the esophagus and proceeding ventrally
The hiatus should be closed so that the esophagus is in a normal position.
3) gastric fundupexy using a tube gastrostomy or belt-loop gastropexy.
Non-penetrating thoracic trauma - treatment
single/small numbers of rib fractures and associated thoracic wall muscular contusions - managed conservatively
superficial bite wounds/skin avulsion wounds - surgical exploration and wound debridement
Penetrating thoracic trauma - treatment
exploratory thoracotomy based around the traumatic thoracic opening
removal of injured or devitalized tissue
pleural drainage and closure of the thoracic wall
Multiple rib fractures and flail chest - treatment
Stabilization of loose ribs + flail segments - relieve pain + improve ventilation
mechanically assisted ventilation (24 – 48 hrs) + medical therapy before definitive rib repair
Flail segments and unstable ribs may be successfully immobilized by percutaneously placed circumcostal sutures secured to an external splint
Open exploration of unstable ribs following massive bite wounds
Ribs may be stabilized by suturing to adjacent ribs, or may be resected if damage is severe
Closure of the wound with native tissues is ideal
massive trauma may necessitate reconstruction with synthetic implants.
thoracic wall tumours - most common
Osteosarcoma + chondrosarcoma from costochondral junction
thoracic wall tumours - less common
hemangiosarcoma, fibrosarcoma, mast cell tumors and infiltrative lipomas
thoracic wall tumours - clinical signs
lameness - pulmonary osteoarthropathy.
thoracic wall tumours - diagnosis
thoracic CT and MRI