Trachea And Thoracic Surgery Flashcards by Corinne Perra

A cervical ventral midline approach allows access to what structures?

Cranial cervical trachea 
Sternohyoideus and sternohyoideus mm 
Recurrent laryngeal n 
Vagosympathetic trunk 
R and L common carotid arteries 
Thyroid glands 
Esophagus

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A median sternotomy allows access to what structures?

Caudal cervical and cranial thoracic trachea

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An intercostal thoracotomy through the right 3rd ICS allows access to what structure?

Cranial thoracic trachea

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An intercostal thoracotomy through the right 4th ICS allows access to what structure?

Tracheal bifurcation

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What are the surgical diseases of the tracheal?

Tracheal collapse 
Esophagotracheal/esophagobronchial fistual 
Foreign body 
Neoplasm 
Trachea rupture (trauma) 
Hematoma

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How is tracheal collapse managed medically?

Cough suppressants (lifelong) - hydrocodone, or butorphanol
Corticosteroid (pred) to reduce inflammation
Antibiotic if secondary to infection

Sedation for events that cause excessive excitement/stress - acepromazine

Bronchodilator (theophylline) useful in some cases

Lifestyle changes and weight loss

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When do we surgically treat tracheal collapse?

Only when medical management has failed

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What are possible surgical treatments for tracheal collapse?

External prosthetic tracheal rings - for cervical trachea only

Intraluminal stent

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How are external prosthetic tracheal rings placed?

Only in cervical tracheal

Ventral midline cervical approach

Secured to cartilaginous rings

Must start and end ring placement in area of normal trachea

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What are complications for external prosthetic tracheal rings?

Laryngeal paralysis. -> damage during surgery or continued trauma from implants

Tracheal necrosis -> secondary to damage to trachea’s segmental blood supply (life threatening)

Pneumothorax -> diffusion of air through mediastinum during surgery

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How is an intraluminal stent placed?

Self-expanding nitinol stent

Placed fluoroscopically or endoscopically

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Advantages of placing an intraluminal stent?

Minimally invasive
Shortened anesthesia time
Can be used in cervical and thoracic trachea

Immediate improvement in clinical signs

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Complications of using intraluminal stenting?

Stent fracture
Stent migration
Tracheitis
Collapse beyond stented region —> mainstream bronchi

Tracheal obstruction secondary to granulation tissue formation —> can respond to treatment with corticosteroid and colchicine

Tracheal rupture

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What is internal tracheal trauma usually caused by?

Rupture or necrosis secondary to ET tube (cats > dogs)

Foreign bodies

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When is external trachea trauma seen?

Blunt or penetrating injuries
Bite wounds
Lacerations

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Clinical signs of tracheal trauma?

SQ emphysema 
Anorexia 
Lethargy 
Stridor 
Coughing 
Dyspnea

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How are minor treachal tears treated?

Medically

cage rest
O2 supplement
sedatives
thoracocentesis/thoracotomy for pneumothorax
temporary tracheostomy (maybe)

If dyspnea persists or worsens —> surgical repair

primary closure of tear
simple continuous pattern
fine absorbable suture

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Surgical intervention is indicated for tracheal tears when… ?

Dyspnea persists or worsens with medical management

Pneumothorax persists >2-3 days

Severe damage is visits

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What technique is used for tracheal resection/anastomoses?

Split cartilage technique

results in least amount of stenosis postop
difficult in small dogs and cats

Can resect 25-50% of trachea in adult dogs, only 20-25% in puppies

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Complications for tracheal resection and anastomoses?

SQ emphysema 
Pneumomediastium and pneumothorax 
Infection 
Stricture
-> poor apposition of mucosa
-> tension 
-> inflammation

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When is a permanent tracheostomy indicated?

Salvage procedure

untreatable upper airway obstruction
upper airway treatment failure

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What is the long-term care for a permanent tracheostomy ?

Excessive secretions for weeks pot op

Maintenance of opening - clip hair
No swimming
Protection from foreign bodies- plant material
Harness

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What is the prognosis for permanent tracheostomies?

Good for indoor dogs if underlying dz in benign

Poor to guarded in cats
-mucous plugs are common
Median survival time is 20-42days
Soft tracheal cartilage may predispose to collapse

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What is the most common surgical approach to the thoracic cavity?

Lateral thoracotomy

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What surgical approach allows access to the thoracic cavity during celiotomy or other procedures that may require access to the abdominal cavity?

Transdiaphragmatic

What are the indications for a median sternotomy?

Bilateral thoracic exploration Cranial mediastinal masses Cranial thoracic trachea *Leave manubrium/xyphoid intact

How is a median sternotomy closed?

Figure 8 of polypropylene sutures or orthopedic wire

What are minimally invasive approaches for thoracic surgery?

Thoracoscopy -> can have intercostal or trandiaphragmatic subxiphoid portals Video assisted -> uses thoracoscopy telescopes and either standard surgical instruments/ endoscopic

T/F: positive pressure ventilation is required for thoracic surgery

True

Removal of an entire lung is called?

Pnumonectomy

When is a pneumonectomy indicated?

Disease is diffuse through multiple lung lobes (neoplasia, abscess, trauma, infiltrative inflammatory disease)

What is the surgical approach for a pneumonectomy?

Lateral intercostal approach

You are doing a total lung lobectomy on on the left cranial lobe. Which intercostal space do you enter through?

Left 5th

You are doing a total lung lobectomy on on the left caudal lobe. Which intercostal space do you enter through?

Left 7ths

You are doing a total lung lobectomy on on the right cranial lobe. Which intercostal space do you enter through?

Right 5th

You are doing a total lung lobectomy on on the right middle lobe. Which intercostal space do you enter through?

Right 5th

You are doing a total lung lobectomy on on the right caudal lobe. Which intercostal space do you enter through?

Right 7th

What suture technique can be used for partial lobectomy??

Suture proximal to clamps - one to two rows of continuous suture patter - excise mass and oversew transection site Guillotine suture may be used for biopsies and very small peripheral masses

What suture technique is used for complete lobectomy?

Triple ligation of vessels -cut between middle and distal ligatures Place horizontal mattress sutures in bronchus Oversew transacted end of bronchus with simple continuous pattern

What is the stapling technique for portion/complete lobectomy?

``` Thoracoabdominal stapler (TA) Locate hilus of lobe and stable entire pedicle (vessels and bronchus) ``` Excise lobe distal to staples

You just did a lobectomy on a dog.. what are you going to check for prior to closing?

Bleeding/hemorrhage Air leakage - fill thoracic cavity with saline and look for bubbles -ventilate up to 25-30cmH2O -very small leaks will likely seal within 24-48hours Chest tube placed via separate intercostal incision

What are surgical disease of the pulmonary parenchyma?

``` Spontaneous pneumothorax Traumatic pneumothorax Brochoesophageal fistulas Lung lobe consolidation and abscessation Bronchiectasis Lung lobe laceration Lung lobe torsions Neoplasia ```

What is the recommended treatment for spontaneous pneumothorax?

Partial or complete lung lobectomy —> access via median sternotomy The conservative treatment is by placing thoracostomy tubes but this is associated with a high rate of recurrence

What are causes of lung laceration?

Iatrogenic - thoracocentesis - thoracostomy tube - inadvertent cut during thoracotomy Rib fractures Penetrating trauma

When is surgical treatment of a lung laceration indicted?

Uncontrollable or unresolving pneumothorax Ongoing intrathoracic hemorrhage

What techniques can be used to surgically treat lung lacerations?

Continuous inverting suture pattern (eg lambert) Deep hemostatic mattress suture with simple continuous closure of laceration Partial or compete lobectomy

What dogs are most commonly affected by lung lobe torsion?

Large dog, deep chested: middle or left cranial lung lobe Pug: left cranial lung lobe

What are possible causes of lung lobe torsion?

Pleural effusion | Partial collapse of lung lobe

Lung lobe torsion results in ???

Venous and lymphatic congestion Consolidation Pleural effusion

Clinical signs of lung lobe torsion?

Acute Dyspnea, tachycardia, cough Exercise intolerance Hemoptysis Pyrexia, pale mm, decreased lung sounds ventrally

You have decreased lung sounds ventrally so you do a thoracocentesis, you see serosanguinous or chylous effusion.. and radiographs show a consolidated lung lobe what is your dx?

Lung lobe torsion

What is your initial treatment for lung lobe torsion?

For patient stabilization Thoracocentesis Oxygen supplementation IV fluids

What is the surgical treatment for lung lobe torsion?

Lobectomy —> intercostal thoracotomy *** DO NOT untwist lung —> avoid reperfusion injury

What is the prognosis for lobectomy due to lung lobe torsion?

Good for pugs Fair to guarded for other breeds -second torsion can occur

How long are chest tubes required after a lobectomy from lung lobe torsion?

3-5days

You have an idiopathic chylothorax.. how can you visualize the vessels during surgery?

Intestinal lymphangiography - oil or cream per os - methylene blue into ileocecal node or water soluble contrast into catheterized lymphatic

What are the surgical options for idiopathic chylothorax ?

MUST DO: Thoracic duct ligation or En bloc ligation Can do these added on.. Pericardectomy Cisternii chylii ablation Pleuroperitoneal shunt

How is an idiopathic chylothorax surgery managed post op?

Chest tube or pleuroport placement for continued drainage

Complications of surgery for idiopathic chylothorax?

Continues/recurrent effusion Lung lobe torsion

Prognosis for surgical treatment of idiopathic chylothorax?

60-100% resolution Worse in cats

What is a diaphragmatic hernia?

Loss of continuity of diaphragm resulting in movement of the abdominal organs into the thoracic cavity

T/F: congenital diaphragmatic hernias are most common

False Traumatic are most common

T/F: Most tears in the diaphragm are seen in the ventral portion

True

Most common presenting signs with chronic diaphragmatic hernia?

Respiratory and gastrointestinal signs - dyspnea, exercise intolerance, and lethargy - vomiting, regurg, inappetence

``` Muffled lung sounds Borborygmi auscultated in the thorax Tachycardia Tachypnea Empty abdomen on palpation ``` Dx?

Diaphragmatic hernia

You want to do diagnostic imaging to confirm a diaphragmatic hernia, what method will you use?

Radiographs with Positive contract celiography - inject dilute sterile contrast into abdomen - look for contrast in thoracic cavity - false negative results due to fibrin sealing diaphragm defect with chronicity Ultrasound (93% accurate)

Treatment for diaphragmatic hernia?

Stabilize first - consider pleural effusion in chronic cases (US thoracocentesis) - O2 therap - prop patient to move organs caudally

When is a surgery for a diaphragmatic hernia an emergency??

If stomach is herniated

What is the method used for a diaphragmatic herniorraphy ??

Ventral midline abdominal approach Organ resection - adhesions in chronic hernia - liver lobe torsion Replace organs into abdomen Repair tear with continuous suture pattern -PDS or proline -large defects with meth or muscle flap Exploratory for organ trauma Remove air from thoracic cavity

Complications seen with diaphragmatic herniorraphy?

Re-expansion pulmonary edema | ->

Trachea And Thoracic Surgery Flashcards

(70 cards)