Surgical diseases of small animals Flashcards

Question

Surgical therapy of the kidneys and surgical disease of ureters. Ectopic ureters

Answer 1

Kidneys Trauma causes rupture in vessels or rupture of parenchyma Nephrolithiasis Ca2+ and alkaline urine or UTI (haematogenous or ascending) Hydronephrosis Dilation of renal pelvis due to stones/inflammation/stenosis in kidneys or further down urinary tract ``` Cystic kidney disease Polycystic kidneys replace large portions of the parenchyma affecting function Genetic predisposition Hormonal - PTH + Vasopressin Dx: FNA + USG ``` Surgery Nephrotomy - biopsy, cystic excision, stone removal Nephrectomy - Complete - Partial Nephrostomy Cannulisation to create a permanent fistual - bypassing stones, damaged ureter Pyelolithomy Opening renal pelvis to remove stones ``` Ureter Ectopic ureters (opening of ureter anywhere but trigoneum of bladder) Most common cause of urinary incontinence in young dogs. Females at 8x higher risk Intra/extra-mural Cs: urine scalding Dx: contrast urography (iodine, air) T: Cystocentesis + ligate Nephrostomy ``` ``` Ureter obturation/obstruction Hypomotility of muscle Urolithiasis, neoplasia, urethrospasm Post-renal azotemia + uremia Dx: contrast x-ray, neurology, myelography T: Muscle atony - metaclopromide + cisapride (prokinetic) Urethrostomy ```

Answer 2

Bladder Urolithiasis Urinary stones (struvite, calcium, urate) Higher concentration of salts + alkaline urine Cystitis Bacteiral, stones, neoplasia Dx: Bladder becomes thickned ``` Feline lower UTI / FIC Congenital uroliths idiopathic/stress induced Primarily males Stages 1 - Inital disease 2 - No Cs but furtherment of 1 3 - PU/PD 4 - Uremic syndrome ``` Neoplasia TCC Cs: stranguria, haematuria, imaging, palpation Surgery Cystotomy - removal of stones, biopsy, ectopic ureters (urethrostomy) Two layer closure - schneiden + lambert ``` Cystectomy Removal of portion -Cut ventral or dorsal -suture submucosa NOT MUCOSA -Omentoplasty to help healing ``` Urethrotomy - stone Urethrostomy - Premanent urinary diversion due to chronic processes

Answer 3

``` Head traua RTA, fighting, falls Concussion - traumatised on impact Contussion - bleeding from blunt forse Coup-contrecoup - bilater contussion Diffuse axonal - shaking --> nerve tearing ``` Cs: eistaxis, coma, mydriasis Dx: imagine, increased ICP T: ABC, benzos ``` Spinal injury IVDD, trauma, ischemia Seen vental, dorsal or at ligaments Cs: ataxia, spastic, paralysis (depends on location) Dx: myelography T: ABC, Mannitol, benzos ``` Critical care Indications; shock, poisons, burns, seizures, bleeding ABC care Airway - remove obstruction + place ET tube Breathing - breathing patterns, Perform CPR, Thoracocentesis if fluid present Circulation - HR, CRT, MM colour, pulse intensity ``` Head trauma Supply O2 IV catheter -60-90ml/kg/hr (dog) -45ml/kg/hr (cat) BP - Colloids, crystaloids Glucose - hypoglycaemia Seizures - Benzo's IC pressure - mannitol NO STEROIDS DO NOT MOVE SEDATE IF NEEDED ``` Peripheral nerve damage Congenital/hereditary Acquired -Toxic, drug, chemical, heavy metals - Neuropraxia: disruption in transmission but no muscle atrophy - Anoxotmesis: damage and loss of function Neurotmesis: complete severance of axon Dancing doberman - Flex and extend the hip - develops to pariesis Distal denerving disease -Idiopathic in dogs --> muscle axons stripped of myelin Distal polyneruropathy of rotweillers

Answer 4

Atlantoaxial instability Dens becomes displaced or ligaments fail Developmental or acquired through trauma Subluxation results in compression of the spinal cord --> UMN signs in FL and HL X-Ray shows spinal process of axis over the atlas T: Neck brace, fusion ``` Wobbler's syndrome Caudal cervical vertebrae (C4-7) Can result from; -Instability + subluxation -Articular process enlargement --> Ligament hypertrophy -IVDD (protrusion) -Malformed ``` Types -Dynamic: when moving -Static: due to spondylosis Cs: HL ataxia (john wayne) IVDD Chondrodystrophic breeds (brachycephalics) -Extrusion - through annulus fibrosis -Protrusion - pushes annulus fibrosus (no rupture) Schiff-sherrington syndrome T3-L3 FL - Hyperreflexivity HL - Paralysis Surgical procedures Ventral slot - drill to look Facetectomy - remove cranial and caudal aspects Foraminotomy - remove roof Fenestration - Remove nucleus pulposus via annulus fibrosus Laminectomy Myelography Injection of iodine into sub-arachnoid space 0.3-0.45ml Cervical (cisterna magna) -Middle ear line, Wings of atlas and occipital protuberance (triangulate) Lumbar (L4-L6) - lumbosacral space - extradural (IVD protrusion) - intra-dural-extramedullary (neoplasia) - intramedullary (oedema, ischemia myelopathy) Intramedullary opacification = meningitis/myelomalacia

Answer 5

C:7 T:13 L:7 S:3 Cau:6-23 Diseases of IVD - Protrusion: mass impinging on SC - Bulging: Nuc. Pulp pushes on AF - Extrusion: NP breaks through AF Hansen I - Dehydration --> mineralisation of NP and degeneration of AF --> Extrusion Hansen II - Fibrosis of NP --> normal AF --> bulging (protrusion) X-Ray: Narrowing and calcification Diseases of T-L vert Discospondylosis -Bacterial infection of vertebrae (Prostate or bladder) Dx: sclerosis Spondylosis deformans -Spinal Instability or luxation can result in osteophyte formation --> spurs can form Diffuse idiopathic skeletal hyperostosis -Boxers, calcification along SC assymptomatic until fusion Fractures - Vertebral body - Compression fracture Luxation -Displacement of bone from jont ``` Neoplasia -Meningioma -Lymphoma -Osteosarcoma -Fibrosarcoma Dx: Scintigraphy ```

Answer 6

Cauda equina syndrome -Instability, luxation, articular process enlargement and ligament hypertrophy, protrusion/extrusion Compress the cauda equina, (nerves of the SC behind the lumbar vert) T: laminectomy (removal of the doral lamina in the VC to make space for SC) LS transitional vertebrae Congenital malformation in which one vertebrae has the characteristics of another German shepards -Transitional LS segment: Vert w/ lumbar and sacral features (L7/S1) -Sacralisation: Lumbar vert with sacral wings (no proc. trans.) Causes; -Hip dysplasia, CES, scoliosis ``` Fractures Luxation Neoplasia -Osteosarcoma -Chondrosarcoma ```

Answer 7

Dx Clinical signs Cerical syndrome (1-5) UMN signs on FL + HL Cervico-thoracic syndrome (C6-T2) UMN - HL, LMN - FL "Root signature" Thoraco-lumbar (T3-L3) UMN - HL Schiff-sherington (FL extension + HL paralysis) Lumbosacral (L4-Ca5) LMN - HL Incontinance Imaging - X-Ray - Myelography (iodine, 3ml - 4.5ml) CT -Creates a cross sectional imagine by taking multiple x-rays at different angles and building an image MRI -Uses protons and energy release from them to construct an image using magnetic coils that surround the patient to visualise the brain/SC in slices. Gold standard. Spinal reflexes Also diagnostic Reflex testing -Muscle tone > myotactic reflex > flexor reflexes Mycotactic (patellar) Flexor (withdrawl pedal reflex - pinch between digits) Sensation (panniculus reflex) C-Biceps reflex T-Panniculus reflex L-Patellar reflex S-Perianal reflex

Answer 8

Panostitis juvenilis Inflammation of long bones with no lysis. Often large breeds with excess protein or calcium Dx: increased bone opactiy T: Pain relief Hypertrophic osteodystrophy Radius + ulna + tibia Usually bilateral in the metaphysis --> necrosis + haemorrhage X-Ray + histopathology (haemosiderin deposits) Ricketts Defective bone calcification in growing bones; -persistant hypertrophic cartilage -enlargement of epiphysis + costochondral junctions Cs: bone curvature T: Ca + P supplement Osteochondromatsis Benign bone nodules with cartilage caps Often on growth plates during ossification of GP Surgical removal of Exostosis Avascular necrosis of the femoral head - Traumatic: joint/hip trauma - Non-traumatic: embolism, hypovolemia ``` Neoplasia Characterised -Lytic -Proliferative -Mixed ``` Primary Benign: osteoma, osteochondroma, osteoblastoma Malignant: Chondrosarcoma, Fibrosarcoma, osteosarcoma Secondary Often humeral or femoral X-Ray of neoplasia - Periosteal reactions - -Solid - -Lamellated - -Sunburst - -Codman's triangle

Answer 9

Osteochondrosis Disruption of endochondrial ossification --> angular deformities, valgus, OCD OCD -4-6mnths. Cartilage thickens and blood flow becomes impeded to deeper cartilage --> necrosis and fragmentation Grading 1 - small defect in subchondral bone 4 - Vertical fracture + separation of the flap T: remove flap (arthroscopy) + cauterise Osteoarthritis Inflammation of bone due to -Septic: Bacteria --> toxins --> cartilage destruction --> osteomyelitis --> osteophytes + exostosis -Aseptic: Ca2+ -Autoimmune: Rheumatoid arthritis (like lupus) Results in osteoarthrosis (DJD) ``` Osteoarthrosis (DJD) Degeneration of cartilage remodelling of bone synovial membrane and peri-articular tissue damage Bone hypertrophy ``` Primary - aging, wear and tear Secondary - OA, joint instability Loss of cartilage causes bone on bone action (osteophytes) --> inflammation (destruction > production) Arthrotomy - Surgical exploration of the joint - Drainage of inflammatory joint fluid

Answer 10

Shoulder joint Glenoid cavity + humeral head Luxation (displacement of bone from joint) Lack of collateral ligaments (glenohumeral ligs) --> instability Subluxation - partial displacement Categorised: -Medial -Lateral -Cranial Congenital - minitures Acquired - RTA, Fighting T: Manual reposition, velapeu sling Surgical reconstruction of glenohumeral ligs (bicep tendons) Instability Abnormal movement of humeral head with destruction of periarticular tissues Graded: Low --> High Dx: ROM T: NSAID's physiotherapy, fusion, prosthesis, lig recon Bicep tendon disease Bicep brachii tendon affixes to spina scapulae. Instability of the joint can cause damage to the bicep tendon T: Tendonotomy/tenodesis OCD -cartilage --> necrosis --> fragment

Answer 11

Elbow dysplasia Group of diseases found in growing dogs (esp. giants) Developmental - nutritional (Ca + P) Genetic - Lrg + giant breeds Pathogenesis Multiple primary lesions --> osteoarthritic process Fragmented coronoid process -Mild --> full fragmentation OCD -Medial humeral condyle ``` Ununitied anconial process -Ulnar metaphysis -Physiological fusion at 4-5 months -Short ulna and radius can exaserbate or prevent fusion T: Lag screw fixation ``` Incongruence of elbow -Coronoid above radial head (asynchronus growth) Begins at 4 months Cs at 6 ``` Dx: Flex/Extension test Abducted stance (wide) X-Ray ML -110-120 - Neutral -45 - Flexed Cr-Cau -15 (OCD) ``` Grading - IEWG 0 - Normal 1 - Mild dysplasia + osteophytes (<2mm) 2 - Moderate osteoarthritis + osteophytes (2-5mm) 3 - severe OA + osteophyets (>5mm) + UAP T: Chondroprotectives (glycoasaminoglycan + chondroitin) Lag screw - UAP arthrostomy ``` Short ulna/radius syndrome Growth plates fuse prematurely Due to -Trauma -HyperVit A + D Other bone continues to grow Shortened bone pulls on the normal one --> bowing and luxation from the joint --> OA ``` Luxation/subluxation Irritation + inflammation --> cartilage destruction --> bone irritation --> inflammation (OArthritis) --> bone remodelling (OArthrosis) T: Arthrodesis + olecranon osteotomy

Answer 12

Coxofemoral joint (acetabulum + femoral head + ligs + glutes) Arthritis Joint inflammation -Septic: myocplasma, pasturella, staph -Aseptic: AI (rheumatoid) Arthrosis Degeneration of cartilage + formation of osteophytes 2nd to luxation, osteochondrosis, osteoarthritis and hip dysplasia Luxation of the femoral head Part of HD Avascular femoral head necrosis Salter-harris fractures OCD Legg-calve perthes disease -Thrombosis --> ischemia of subchondral bone --> necrosis + osteolysis X-Ray: flattened femoral head ``` T: Physical therapy Arthrodesis Chondoprotectants (GAG, Ch) (open) Arthrotomy if osteophytes (closed) Myorelaxants + repositioning Prosthesis ```

Answer 13

``` Laxity + arthritis of hip Multifactorial; -Genetic (German sheps) -Lifestyle (work load) -Nutritional (Ca + P) -Hormonal (oestrogen) ``` Cs: Bunny hopping, muscle atrophy, asymmetrical effusion Laxity - Subluxation (decreaed norberg angle) - Femoral head should be 50% covered by craniolateral acetabulum OA - "Morgan's line" Dx: ortolani signs - abduct + adduct femer = "click" X-Ray - VD - Rotate inwards - Stress VD - Frog legs (hip + stifle flex) - Norberg = 105degrees (physiological) T: Tripelvic osteotomy - bone plate that holds 3 parts of bone (ischi, ilii, pubis) Pectinal myectomy - Remove m.pectinus = reduced pressure Juvanile pubic symphsiodesis (>2 years) Screen and grade Minimum 2 views (VD + L) ``` FCI (>1 year age) A - normal 105 NA B - Asymptommatic but pathological C - Mild HD <100 NA D - Moderate HD <95 NA + Morgan's line + subluxation E - Severe HD <58 NA + ML + Luxation ``` OFA similar to FCI -Excellent, good, fair, transitional, mild, moderate. severe ``` BVA 9 radiographic criteria 1-NA 2-Subluxation 3-Position in acetabulum (cranial) 4-Position in acetabulum (dorsal) 5-Position of acetabulum edge (cranial) 6-Acetabular fossa 7-Femoral head exostosis ``` 58 per hip 116 total - high score = higher degree of HD

Answer 14

Stifle (femoropatellar + femorotibial Med + Lat) ``` Luxation of the patella Common cause of lameness Patella slipping from trochlear groove Medial, lateral, bidirectional Results in varus/valgus ``` Medial luxation Quads hold the patella in place by inserting onto the tibial tuber causes varus Lateral luxation often causing valgus Grading 1 - No lesions 2 - Push patella easily returned 3 - Out of groove, medial movement, pushing limb laterally. Can be replaced 4 - Patella is STUCK medially, cannot be repositioned X-Ray: patella is superimposed on condyles T: 2-3 Soft tissue surgery 4 - Osteotomy of femer and tibia Patella fracture Trauma + extreme quadricep contraction T: Kirschner wires Radiographic exam ML - Flexed 90 Cau-Cra Lateral-oblique (dorsal recumbency)

Answer 15

Stifle stabilised by Medial and lateral collateral ligs around the joint (prevents twisting of the joint) Cruciate ligs inside the joint (prevents cranial and caudal movement. Meniscus - c-shaped cartilages in the stifle Cranial cruciate ligament rupture -Partial or full -Causes pinching on the medial meniscus Dx -Orthopedic exam (gait, palpation) -Tibial compression test (Tibia will pop forward when pressed on) -Cranial draw exam (instability side to side) Caudal cruciate ligament rupture -Less common Dx: Caudal draw exam (place dorsally --> tibia parallel to ground --> if ruptured --> caudal aspect of tibia will depress) Rupture of collateral ligaments Prevent abduction/adduction Varus - inward turning (medial) Valgus - outward turning (lateral) ``` T: Hyaluron + NSAID's Muscular flap (fascia latae) Meniscotomy Stabilising sutures Prosthetic ligaments ```

Answer 16

Trauma metabolic - Osteoporosis/chondrosis/malacia Neoplasia Classification Types: Simple, complex, communicated, compound(open) Salter-Harris Localisation - Spiral, oblique, transverse, communicated, avulsion, greenstick, fissure ``` Fracture assessment score Evaluates Mechanical -Configuration (simple vs communicated) -Patient size (Large dogs are heavier) ``` Clinical - Post-op co-op - active dogs (poor candidates) - Comfort - owner compliance Biological -Age, soft tissue injury, region on bone (distal heals slower) 1-10 (higher scores) = faster healing, lighter load on prosthesis and lowered rejection risk Treatment Incomplete fractures in young dogs can be splinted/cast Anyting more will require fixation, a bone graft can be used to accelerate healing Cerclage wire (kirschner wire) - Full circlage: around the bone - Hemi-circlage: through the bone and into medullary cavity Intramedullary pinning - Steinmann pin/kirschener wire - Stops bending pressure but does not prevent rotation so often done with another form of fixation (6-8wks) Bone plate -Versatile and often left in place External fixators - Pinned both above and below the break, often with an intramedullary pin - Often with ilizarov fixators

Answer 17

Primary (cortical) healing Requires rigid fixation that inhibits callous formation -Gap primary healing -Contact primary healing Gap - Stage 1: bone fills the gap (not connective tissue) - Stage 2: Haversian remodelling replaces necrotic bone Contact - Direct apposition allows cavity to form across the break by osteoclasts. - These canals/cavities then become filled with new bone by osteoblasts Secondary bone healing Absence of fixation 3 stages -Inflammation: immediately from break. oedema and pain stabilises movement of the break - Reparative: first few days. Callus forms + chondrification begins --> invasion of osteoblasts and blood vessels --> CT replaced with woven (fibrous) bone - Remodelling: Woven bone is replaced with lamellar bone Assessment of fracture healing 2 weeks - Haematoma at site 3-4 weeks - Bridging callus with mineralised edge 8-12 weeks - remodelling + cortical repair Complications Delayed union - poor fixation, little blood supply, nutritional Malunion - inadepqute fixation Excessive callus - movement, periosteal stripping Osteomyelitis - infection during malunion Arthrodesis Removal of cartilage, fusion of joint --> increases stability and strength + decreases pain Use of bone grafts, pins/plates or synthetic bone can assist healing

Answer 18

Often occur in multiple places due to shape Types: Stable - main joints in tact (symphesis pelvini, lumbosacral, hip, sacroilieac) Unstable - break of any main joint of the pelvis Cs: HL Paralysis (ensure there is no siatic n. damage) T: Conservative - rest and NSAID -Stable Surgical - Plates, screws, wires - Non-stable: - -Ileal - long oblique of the midline (plates required) - -Acetabulum - usually with femoral head displacement

Answer 19

Type and grading Benign - well divided cells Malignant - mesenchymal (sarcoma), epithelial (carcinoma) Aspects of tumours - Structure (differentiation) - Growth type (invasion (outside capsule with branches) or expansion (inside capsule)) - Growth speed (slow or fast) - Growth extent (spontaneous or continual) - Degree of Mx Surgical types Incision biopsy - histopath excision biopsy - CI'ed as can cause PNPS + metastasis Intracapsular resection - cannot be fully exsised due to location near a vital organ Marginal resection - Removal of tumour with no margins (+ chemo and radio) wide resection - Tumour and a wide section of healthy tissue around the tumour ``` Amputation FL -Scapula + humeral resection -Scapulectomy Humeral amputation ``` HL - Coxo-femoral disarticulation - Mid-femoral amputation Limb-sparing technique -<50% of bone, no joint or Mx Digital amputation - For neoplasia, fractures, toe deformities - Disarticulation to ensure no adverse reaction to necrotising cartilage

Answer 20

Arthroscopy Visualise joint with minimal risk compared to open arthrotomy Indications - Shoulder - Elbow - Stifle - Tarsus Procedure -GA --> fluid egress + camera ingress. File down pathology or remove pathology Osteoarthritis -Aseptic: <4g of TP in synovial fluid Synovia fluid types - Non-inf - yellow, low TP - Inf - Yellow, opaque, high TP - Haemorrhagic - red - Infectious - green/purulent Rehabilitation and physiotherapy Reduction of pain, increase in mobility and strength. Prevent necrosis or atrophy Methods Cryotherapy - lowered inflammation Heat therapy - chronic joint stiffness (CI'ed in acute) USG - increases blood and lymph flow Massage - increases blood and lymph flow ROM - prevents atrophy Electrical stimulation - muscle contraction Exercise - weight baring, wheelbarrow Hydrotherapy - allows strengthrning without pain due to upper thrust

Answer 21

Induction Pre-med -medetomidine + buprenorphine -medetomidine + midozolam + acepromazine Induce - Propofol: 5mg/kg (0.5ml/kg) - alfaxalone: 0.3ml - 0.6ml/kg Peri-op care Fluids Fluids (10mk/kg/hr) and O2 -IV, IM, SubQ, IO, IP, PerOs Crystalloids -Water based -Lactated ringers (0.9% glucose) KCl - for acidosis from hypokalaemia (diabetes) Hypertonic - oedema or shock (pulls fluid into vessels) Colloids - Large particals that stay in the blood (regulates oncotic pressure) - Hexastarch, albumin, whole blood or plasma Dosage - Maintainence: 50-60ml/kg/day - Shock crystalloids - -80-90ml/kg (dog) - -50-60 ml/kg (cat) - 1/2 or 1/3 given over 10-20mins usually - Shock colloids - -3-5ml/kg/hr ``` Monitoring HR - 60-140 (110) Temp - 36-38 degrees Resp - 6-20 bpm O2 Saturation - >95% CRT - <2 Seconds BP - 60/90 ``` ``` General anaesthesia Requires: Analgesia, Anemnesis, Immobility, Unconciousness, Muscle relaxation ``` ``` Barbituates - old but gold Non-barbituates (propofol) - lowered liver damage and clears faster Dissociatives - ketamine, zolazepam Inhalation - sevo and iso --Much safer and faster clearing ``` ``` ASA system 1 - Minimal risk 2 - slight risk: young, old, obese 3 - moderate risk: fever, anaemia, murmur 4 - high risk: systemic disease 5 - extreme risk: Moribund E - Emergency ``` ASA score of >3 are 10x more likely to crash under GA Pain management NSAID's - meloxicam, ketoprofen, carprofen, paracetamol (no cats) Opioids - buprenorphine, butorphanol, tramdol, morphine Behaviour is the idicator for pain, some vet associations have made questionaire sheets to assess pain using body positioning and behaviour (willingness to eat or drink)

Answer 22

Lameness Disharmony of swing and stand phase Causes; -Pain: usually soft tissue -Neurological: ataxa / MG -Mechanical: scarring or shortening of ligaments -Orthopedic: Fracture, joint incongruency or osteomyelitis -Metabolic: Ca/PTH/P/Vit D -Circulatory: Ischemia/infarcts -Infectious: Inflammation is painful (osteomyelitis) Grading 0 - Normal weight baring 1 - weight bare at rest (stand), lame on trot 2 - partial weight baring at rest + walk 3 - no weight baring at walk 4 - can weight bare at rest or walk 5 - Reluctant to rise. walks <5 steps ``` Dx lameness History -When (walk, rest, run) -Onset -Which limb -Timing -BCS, Age and breed ``` Eliminating neurological, arthritis, muscular issues Proprioception, spinal reflexes, pain responce (or lackthereof) ``` Observation Short stride (reduced ROM) Goose-stepping FL - Head bob HL - hip raising ``` Palpation Standing - superficial Laying - deep Check for crepitus, pain, atrophy, malformed joints Drawer test - Cranial: thumb on patella and finger on tibial crest - Looseness compared to femer = torn cranial cruciate - Caudal: tibia parallel to ground, if caudal aspect drops = torn caudal cruciate Tibial compression test -Pressure on tibia --> popping forward = cruciate torn ``` Imaging X-Ray - breaks USG - arthritis Arthroscopy Muscle enzymes neurological exam and deficits ```

Surgical diseases of small animals Flashcards

(46 cards)