Surgical conditions of the Airways Flashcards Preview

Respiratory > Surgical conditions of the Airways > Flashcards

Flashcards in Surgical conditions of the Airways Deck (79):
1

rhinarium - congenital deformities

stenotic nares
cleft - harelip primary cleft palate

2

rhinarium - lacerations

haemorrhage - can heal by 2nd intention
primary closure can also be done

3

rhinarium - neoplasia

squamous cell carcinoma
wide local excision

4

nasal cavity - chronic hyperplastic rhinitis

infl in nasal cavity - stimulates hyperplasia of mucous membranes + incr mucous secretion

5

nasal cavity - chronic hyperplastic rhinitis - treatment

specific therapy for underlying predisposing factors
rhinotomy + turbinectomy

6

nasal cavity - trauma

epistaxis, deformity
usually little need for orthapaedic fixation
decr maxillary fractures
possibility of acquired palatine clefts
occasional sequestrum formation

7

nasal cavity - dental disease

mucopurulent discharge
unilateral
radiography
lesions in oral cavity

8

nasal cavity - intranasal neoplasia

most are malignant - carcinoma, adenocarcinoma, chondro, fibro, osteo - sarcoma
benign polypoid rhinitis
exploratory rhinotomy

9

nasal cavity - mycotic rhinitis - treatment

if medicine fails - place irragation tubes via sinusotomy

10

nasal cavity - foreign bodies

sudden onset sneezing, serous discharge
may progress to mucoid/purulent in chronic
rhinotomy may be needed for confirmation

11

congenital defects of the secondary palate

unable to suckle properly + nasal return of milk
aspiration pneumonia
if mild - chronic nasal discharge

12

aquired defects of the secondary palate

trauma due to tooth extraction or other
aspiration pneumonia
chronic nasal discharge + sneezing due to impaction of food into nasal cavity

13

Brachycephalic Airway Obstruction Syndrome - Primary pathology

Stenotic nares
Long soft palate

14

Brachycephalic Airway Obstruction Syndrome - secondary pathology

Eversion of the mucosa of the lateral laryngeal venricles
Laryngeal collapse
many brachycephalic dogs have tracheal hypoplasia, redundant pharyngeal mucosa + scolling of epiglottis

15

Brachycephalic Airway Obstruction Syndrome - clinical features

mild - exercise intolerance/dyspnoea when stressed
worse in heat + stress
noise on inspiration + expiration
laryngeal + pharyngeal oedema

16

Brachycephalic Airway Obstruction Syndrome - diagnosis

PE
hematology + serum chemistry
thoracic radiography
lateral radiography of larynx
pharynx + larynx exam

17

Brachycephalic Airway Obstruction Syndrome - clinical actions

Oxygen supplementation
Cool intravenous fluids
Whole body cooling
Sedation
Emergency
intubation/tracheostomy

18

Brachycephalic Airway Obstruction Syndrome - treatment

rhinoplasty
staphylectomy (removal of uvula)
resect everted mucosa of lateral laryngeal ventricles
post-op tracheostomy management

19

tracheal hypoplasia

in bulldogs - narrowed trachea.
no surgical treatment
live a normal life, providing their upper airway is in good condition
can be v.severe

20

post op care for tracheotomy

Constant monitoring.
Insert sleeve removed and cleaned every 2hrs
Nebulization every 4hrs
Limit physical activity
Suction tube only if necessary.

21

causes of laryngeal collapse

Orotracheal intubation
Emergency tracheostomy
Partial laryngectomy
Arytenoid lateralization
Permanent tracheostomy

22

laryngeal paralysis - Aetiopathogeneis

Congenital
Acquired - trauma, neoplasia, secondary to polyneuropathy/polymyopathy
Acquired (Idiopathic)

23

laryngeal paralysis - clinical features

chronic progressive exercise intolerance
dysphonia
incri respi noise (esp in inspiration stridor)
chronic cough.
cyanosis and collapse - heat stress and excitement, animals are often pyrexic.

24

laryngeal paralysis - diagnosis - obstructive crisis

hyperthermic.
Sedation
oxygen supplementation,
cool intravenous fluids
external body cooling
Occasionally, rapid anesthetic induction and orotracheal intubation
tube tracheostomy will permit complete patient evaluation prior to definitive treatment.

25

laryngeal paralysis - diagnosis - stable patient

careful physical exam
Hematology & biochemistry: concurrent/intercurrent disease)
Thoracic radiographs
careful evaluation of laryngeal function under a light plane of anaesthesia.

26

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

27

laryngeal neoplasia - clinical signs

Dysphonia
Sonorous respiration,
Exercise intolerance,
Respiratory distress.

28

types of laryngeal neoplasia

congenital rhabdomyosarcoma (oncocytoma), squamous cell carcinoma adenocarcinoma, chondrosarcoma, fibrosarcoma and lymphoma

29

laryngeal paralysis - treatment outcome

Overall 85 - 90% improved long-term
Short term complication rate of 30%
All postoperative deaths involved concurrent disease
processes

30

laryngeal paralysis - treatment complications

poor arytenoid abduction
hematoma formation
laryngeal penetration
aspiration pneumonia

31

granulomatous laryngitis

in the dog and the cat
sign similat to laryngeal paralysis and laryngeal tumours
biopsy diagnosis of all laryngeal neoplasms prior to definitive treatment.

32

tube tracheostomy - Indications

Temporary airway diversion to permit surgery of oral cavity
Long-term ventilatory support
Emergency provision of airway

33

tracheal collapse

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.

34

tracheal collapse - Pathophysiology

Dynamic airway obstruction
Reduced alveolar ventilation
Chronic cough

35

tracheal collapse - clinical features

Exercise intolerance
ins + expiratory noise
Chronic “goose – honk” cough
Cyanosis/Collapse
dorsoventral flatening of trachea

36

tracheal collapse - diagnosis

Signalment
PE – palpation of trachea
Radiography
Fluoroscopy
Endoscopy

37

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.

38

tracheal collapse - intralumenal stents

older dogs with co-morbid disease
palliative measure

39

tracheal trauma

neck bite wounds, traumatic intubation.
In cats, blunt trauma to the chest may cause tracheal rupture/avulsion

40

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.

41

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.
Bronchoscopy
Exploratory surgery

42

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.

43

Lung lobectomy - indications

Primary lung tumour ( + LN)
Metastatic pulmonary mass
Lung lobe torsion
Pulmonary abscess/infection
Bullous disease
Trauma

44

primary lung tumour

Majority are malignant
Adenocarcinoma

45

primary lung tumour - Clinical features

Cough (productive-haemoptysis) - 52%
Dyspnoea - 23%
Lethargy - 18%
Weight loss - 12%
none - 25%

46

primary lung tumour - diagnosis

Thoracic radiographs and/or CT
check for other masses if one found

47

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

48

spontaneous pneumothorax

when atmospheric air enters the pleural space
"closed" pneumothorax - lung is source of the leakage
animal has no history of trauma

49

spontaneous pneumothorax - causes

Ruptured pulmonary bullae or blebs.
Migrating inhaled plant material.
Bacterial pneumonia,
Chronic obstructive lung diseases
Asthma, tuberculosis, pulmonary neoplasia airway parasites (filaroides).

50

spontaneous pneumothorax - clinical features

Tachypnoea
Dyspnoea
Exercise intolerance
Absence of lung sounds on auscultation and “thoracic resonance on percussion”
Radiography/CT – care in dyspnoeic animal

51

spontaneous pneumothorax - treatment

thoracocentesis or a chest tube
exploratory thoracotomy via median sternotomy and removal of diseased lobe
Prolonged pleural evacuation using chest drain.

52

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.

53

lung lobe torsion - Clinical features

accumulation of pleural fluid + necrotic lung lobe.
depressed,
inappetent
febrile.
dyspnoea and a cough.
muffled lung sounds (consolidated lung lobe/pleural effusion)

54

lung lobe torsion - treatment

lobectomy of the affected lobe.

55

lung lobe torsion - diagnosis

Thoracocentesis, thoracic ultrasound, radiography and CT aid definitive diagnosis. Repeat imaging once chest is drained.

56

diaphramatic rupture (DR) - pathogenesis + pathophysiology

acquired
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.

57

diaphramatic rupture (DR) - pathogenesis + pathophysiology - acute

post trauma
pulmonary contusions, rib fractures, pneumothorax, hemothorax and pain can all exacerbate poor pulmonary function.

58

diaphramatic rupture (DR) - pathogenesis + pathophysiology - chronic

effusion from surface of entrapped or strangulated organ(s) - hydrothorax - compromises lung volume

59

diaphramatic rupture (DR) - diagnosis

PE
radiography (can be obscured by pleural effusion)
GI contrast radiography

60

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

61

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

62

diaphramatic rupture (DR) - treament - ongoing pleural effusion anticipated

thoracostomy tube placed prior to closure of the dipahragmatic defect

63

diaphramatic rupture (DR) - treament - chronic defect healing

enhanced by debridement of the edges of the diaphragmatic rupture, not necessary for acute ruptures

64

Peritoneopericardial diaphragmatic hernia (PPDH) - pathogenesis + pathophysiology

congenital
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

65

Peritoneopericardial diaphragmatic hernia (PPDH) - diagnosis

As for acquired DR.

66

Peritoneopericardial diaphragmatic hernia (PPDH) - treatment

young - asap to reduce the risk of adhesion formation
older - can be managed conservatively
surgery
abdominal organs returned to peritoneal cavity

67

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.

68

Esophageal hiatial hernia (EHH) - pathogenesis

congenital
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

69

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

70

Esophageal hiatial hernia (EHH) - diagnosis

Hx
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

71

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.

72

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

73

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

74

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.

75

thoracic wall tumours - most common

Osteosarcoma + chondrosarcoma from costochondral junction

76

thoracic wall tumours - less common

hemangiosarcoma, fibrosarcoma, mast cell tumors and infiltrative lipomas

77

thoracic wall tumours - clinical signs

palpable mass
lameness - pulmonary osteoarthropathy.

78

thoracic wall tumours - diagnosis

radiography
thoracic CT and MRI
incisional biopsy

79

thoracic wall tumours - treatment

full thickness thoracic wall resection followed by reconstruction