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107 Cards in this Set

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What is the most often way abdominal trauma is diagnosed?
Abdominocentesis

-measure PCV/TP, BUN, lactate
-cytology
-culture and sensitivity
False hernias (traumatic) are more likely to what?
form adhesions
cause strangulation
What are the most common locations for traumatic abdominal hernias?
paralumbar (weakest part of the wall)
caudoventral (prepubic tendon avulsion)
What is the most common concurrent injury with intra-abdominal trauma?
orthopedic (esp. pelvic)
Normally, abdominal traumatic hernia surgery is scheduled 3-5 days after trauma to allow inflammation to subside and better able to hold suture. When is emergency surgery considered?
strangulation of viscera
continued deterioration
penetrating wounds
How are the following things repaired?
-prepubic tendon rupture
- paracostal hernias
prepubic tendon rupture - suture to pubis

paracostal hernias - circmcostal sutures
What are the most common injuries that cause hemoabdomen?`1
trauma to: spleen, liver, kidney
-UP TO 38%

-mortality is 27%
What is seen on US with hemoabdomen?
-peritoneal fluid
-organ damage
- FAST technique (Focused Abdominal Synography for Trauma)
What is the accuracy of abdominocentesis vs. diagnostic peritoneal lavage when diagnosing hemoabdomen?

What are you looking for with the fluid?
abdominocentesis - 50-60% (need 6 ml/kg fluid)

DPL - 80-100% (need 1 ml/kg)

-doesn't clot, PCV, creatine
When would you go to surgery for hemoabdomen?
-increasing volume
-increasing PCV of effusion
-unable to stabilize patient
What are 2 medical therapies for hemoabdomen?
abdominal counterpressure wrap (contraindications are: thoracic trauma, resp. compromise, diaphragmatic hernia)

blood transfusion
What percent of penetrating abdominal wounds have damage to abdominal viscera?
70%
Which abdominal traumatic wounds are surgical emergencies?
-penetrating abdominal wound
-evidence of septic peritonitis
Which abdominal wounds would you stabilize then go to surgery?
-uroabdomen
-abdominal wall hernia
Which abdominal wounds do you manage conservatively?
hemoabdomen
What are 4 effects of peritonitis?
1 - effusion
2 - inactivated fibrinolytic system
3 - illeus
4 - reflex rigidity
What are the top 4 sources of peritonitis?
1 - GI
2 - Urogenital
3 - Hepatobiliary System
4 - Penetrating FB

*usually polymicrobial infections
E. coli and B. fragilis
What are virulence enhancing factors for peritonitis?
bile salts
gastric mucin
hemoglobin
barium
When evaluating an animal for peritonitis, what 2 biochemical tests do you run on the fluid?
glucose - 20 mg/dL less than blood glucose

lactate - 2.0 mmol/L greater than blood glucose
What are treatments for peritonitis?
-fluid resuscitation because lots of fluid and protein loss (similar to burns)
-IV antibiotics (broad spectrum initially)
-treat DIC, hypoproteinemia, anemia
-GI protectants
What types of closure options are there for peritonitis?
open -loose cranial 2/3 of incision with sterile bandage over top
closed - closed suction drain (Sump-Pump, Jackson Pratt, VAC)
What things must be monitored with peritonitis?
BP
BW
Urine output
hematology
ECG
What is the prognosis for peritonitis?

What are negative indicators?
20-67% mortality depends on ability of surgery to control contamination

-preop hypotension,/hypoalbuminemia, very young or old,
Larygeal paralysis is caused by paralysis of the recurrent larygeal nerves which leads to what?
neurogenic atrophy of the dorsal cricoarytenoid muscle and paraysis of the arytenoid cartilages
What drugs are good to help diagnose larygeal paralysis under a light plane of anesthesia?
1 - thiopental alone
2 - doxapram exagerates paralysis if present
Other than observation of the larynx, what are other diagnostics that you could perform in an animal you suspect of having larygeal paralysis?
1 - neuro exam
2 - esophagram
3 - thoracic rads
4 - thyroid panel
5 - cervical radiographs
6 - electrodiagnostics
What is the goal of surgery for larygeal surgery?
enlarge the glottis
-arytenoid lateralization is the most common --> tied back to thyroid or cricoid cartilage
What is the long term complication of tie back procedure?
good for short term - 90%
poor for long term - progressive neuro deficits
What are methods for surgically correcting larygeal paralysis?
1 - tie back
2- partial larygectomy
3- castellated larygofissure
4-reinnervation
5 - permanent tracheostomy
What is the complication rate to partial larygectomy?
50%
-webbing is common
-aspiration pneumonia
What is a castellated larygofissure?
-castellated incision in ventral thyroid that widens the glottis
-vocal folds removed and mucosa closed
What are indications for a permanent tracheostomy?
1 - dogs with higher risk of aspiration pneumonia
2 - severe larygeal collpase
3 - failed larygeal surgery
What is the difference between Hansen Type I and Type II IVDD?
I - chondroid metaplasia, disc extrusion, more common

II - fibroid metaplasia, disc protrusion, annulus fibrosis hypertrophy
What is the most common location for cervical disc herniations?
Most uncommon?
common - C2-3
uncommon C7-T1
What percentage of dogs have a unilateral forelimb lameness with cervical IVDD?
Are neuro deficits more common or less common with thoracolumbar deficits?
50%

more common
What percentage of animals with cervical IVDD are tetraparetic?
40%

26% are ambulatory
What are infectious R/O for cervical IVDD?
1 -Diskospondylitits
2 - Toxoplasmosis
3 - RMSF
4 - Neosporosis
5 - Cryptosporidiosis
When diagnosing cervical IVDD, what are key features to look for on the radiograph and myelography?

Which test provides better detail of the spinal cord?1
rad
1 - narrowed disc space
2 - indistinct iv foramen (horse's head)
3 - calcified disc material in the canal

myelography

-extradural spinal cord
compression

-MRI provides better detail of the spinal cord
How many stages are there to cervical IVDD?

Which have good prognosis with cage rest?

Which have excellent with surgery?
7 stages

-I and II, maybe III

-2-5
What is the difference between stage 2 and 3 cervical IVDD?
2- severe neck pain, one episode
3 - severe neck pain, repeated episodes
What is the difference between stage 4 and 5 cervical IVDD?
4 - ambulatory tetraparesis
5 - ambulatory tetraparesis (weak))
What is the difference between stage 6 and 7 cervical IVDD?
6 - non-ambulatory tetraparesis (55% recovery with complete recovery)
7 - non-ambulatory tetraparesis with sensory deficits (surgery is guarded)
What are 3 types of analgesics to use on dogs with cervical IVDD that need 3-4 weeks of crate rest?
1 - antiinflammatories
2 - muscle relaxants (methocarbamol, diazepam)
3 - corticosteroids
What are 3 options for surgery with cervical IVDD?
1 - ventral slot
2 - disc fenestration
3 - dorsal decompression
What may a ventral slot result in?
vertebral fusion and domino lesions
What are 3 main complications to ventral slot?
1- hemorrage -> vertebral sinus or artery laceration and compressive hematoma formation
2 - vertebral instability (subluxation)
3 - spinal cord injury (impairment of ventilation)
What is accomplished with a disc fenestration?
nucleus pulposis is scooped out
What is removed with a dorsal laminectomy?
dorsal spinous process - window is burred into the lamina
What is included in the immediate post-op care with cervical IVDD surgery?
-monitor of respiration and neuro status
-turning and monitor of skin for pressure sores
-analgesia
What percentage of congenital AO subluxations occur due to an absent or hypoplastic dens?
malformed dens?
absent or hypoplastic dens (45%)
malformed dens (30%)
What is the typical signalment of animals with an AO subluxation?
toy
< 1year (55%)
What are concurrent problems with AO subluxation?
-hydrocephalus
-hepatic encephalopathy (PSS)
Why is myelography not a good idea with AO subluxation?
post-seizures can be fatal
What type of treatment is better for dens fractures?
neck brace --> head and neck in extension, bandage is cranial to the ears
What is the treatment for congenital AO subluxation?

What is the prefered approach?
surgery
-ventral stabilization (preferred approach)
-dorsal stabilization
What is the ventral stabilization for AO subluxations?

What is the time for crate rest after this procedure?
-pins and PMMA
-transarticular fixation

-6-12 weeks with external splint
What are complications to ventral stabilization with AO subluxation?
-death - up to 20% from cardiac or resp. failure
-larygeal paralysis
-tracheal necrosis
What about the thoracolumbar area allows for acute, rapid Hansen I disc extrusion?
intercapital ligaments T10-T11 caudally

-this is the most common region for IVDD (85%)--> usually UMN signs
What is the order of loss of neuro deficits? (5)
1 - spinal hyperpathia
2 - loss of CP
3 - loss of motor function
4 - loss of superficial pain
5 - loss of deep pain
How many stages are there to thoracolumbar IVDD?

Which stages do you consider surgery?
4

3,4
Name the stages of throacolumbar IVDD.
1 - back pain +/- CP

2 - recurrent back pain, ambulatory paraparesis

3 - non-ambulatory paraparesis - +/- back pain

4 - paraplegia
Myelomalacia affects 10% of deep pain negative dogs. What is it?
1 - CT moves cranially
2 - UMN --> LMN
3 - loss of abdominal tone
4 - abdominal breathing
What are the 3 techniques for thoracolumbar IVDD?
1 - hemilaminectomy (ventral or lateral disc material)
2 - dorsal laminectomy
3 - disc fenestration
With a hemilaminectomy, what do you remove with rongours?
articular processes and burr window over lamina of adjacent vertebrae, remove disc material an dcover defect with a fat graft
What are complications for a dorsal laminectomy with thoracolumbar IVDD?
laminectomy membrane
-greater instability
Does disc fenestration treat spinal cord compression?
no
What type of nursing care is most important with thoracolumbar IVDD?
-bladder expression, urinary catheterization
-pharm assistance - alpha agonists --> Phenoxybenzamine, prazosin
--> muscle relaxants - diazepam
What is the recurrence of CS with TL IDDD?
20%
-25% in Dachshunds
-15% in other breeds
What is in the inner ear?
-semicircular canals
-chochlea
What is the blood supply to the pinna?
caudal auricular artery and vein
What is a TECA?
-removal of horizontal and vertical ear canals combined with a lateral bulla osteotomy
Are drains indicated with a TECA?
no
What are keys to post-op care with a TECA?
1- bandage
2 - lub eyes
3 - analgesia
4- antibiotics
5 - e-collar
What is the most common concern with a TECA?
facial nerve paralysis - can be entraped on the calcified material - usually resolves in several weeks
What nerves do you need to watch out for when performing a ventral bulla osteotomy?
- lingofacial vein
-hypoglossal nerve
What are CS of feline inflammatory polyps?
could be:
1 - upper resp. signs
2 - otitis externa/media/interna
What is the recurrence of inflammatory polyps with:
traction avulsion
bulla osteotomy
-traction avulsion - 30% - post-op corticosteroids will reduce this
bulla osteotomy - < 2%
What are the most common aural neoplasias in dogs and cats?
dogs
1 - ceruminous gland adenoma/adenocarcinoma
2 - papilloma
3 - histiocytoma

cats
1 - SCC (pinna)
2 - ceruminous gland adenoma/adenocarcinoma
What neoplasias are most common in the pinna - and which are more common in the cat?
1 - SCC - white cat
2 - basal cell tumors - cats
3 - melanoma - cats - either beinghn or aggressive
4 - Mast cell - benign in cats, aggressive in dogs
5 - histocytoma - dogs
What type of tumor is the SCC on the pinna of cats?
-locally aggressive with a low met rate
What are the 3 surgeries for SCC of the pinna?
1 - pinnectomy
2 - cryosurgery - limited to less than 5 mm superficial lesions
3 - photodynamic therapy
Tumors of the external ear canal in dogs and cats is usually malignant. What percent in dogs and cats?
cats - 88% (ceruminous gland adenocarcinoma is most common); also scc and sebacious gland adenocarcinoma, carcinoma of undetermined origin
dogs - 60%
What are congenital causes of diaphragmatic trauma?
-peritoneopericardial
-pleuroperitoneal
The 3 muscles of the diaphragm insert on the central tendon and these are innervated by what?
phrenic nerves - 5th, 6th, 7th
Where are the common locations for diaphragm tears?
-circumferential tears (40%) along the ribs - more common in cats
-radial tears (40%) along the muscle fibers - less common in cats
-20% combo
Respiratory dysfunction (dyspnea and tachypnea are the most common CS of diaphragmatic hernias) what does this result in?
-V/Q mismatch
-shunting of blood
-hypoventilation
-hypoxia
What percent of thoracic rads with diap. hernia have pleural effusion? Gas filled viscer?
pleural eff - 25%
gas filled viscera - 60%
What is part of the initial stabilization for diaphragmatic hernias?
1 - supp oxygen
2 - min. stress
3 - treat hypovolemia/shock
4 - analgesia
5 - elevate
6 - gastrocentesis
7 - thoracostomy tube
What are indications for emergency surgery with diaphragmatic hernias?
1 - gastric herniation with tympany
2 - hemorrhage with hypovolemia
3 - unremitting abdominal pain
4 - sig. resp. compromise
What are the complications after a diapragmatic hernia surgery?
1 - re-expansion pulmonary edema - most significant --> must gradually restore negative pressure over 12-24 hours
2 - Loss of Domain - increased intraabdominal pressure which can decrease the blood flow to the viscera --> ileus, dehiscenece, visceral ischemia, pain, hiatal hernia
A pleuroperitoneal hernia is failure of the pleuroperitoneal canal to close. What type of defect is this?
Dorsolateral defect +/- central tendon defect
-autosomal recessive inheritance in dogs and rapidly fatal
What is the most common pleuroperitoneal hernia?
peritoneopericardial hernia
-failure of the transverse septum development
-peritoneal cavity is continuous with pericardial cavity
what signs are more common with peritonealpericardial hernias?
GI signs - anorexia, poor growth, ect

Pericardial effusion - cardiac tamponade and RHF
Cervical vertebral fractures are most common where?
cranial
50% at C2 - dens
Are cervical or TL fractures more common?
Where are TL fractures most common?
TL

- 55% between T10-L2
-articular facets change directions from VD to sagittal
What percentage of vert fracures are lumbar?
30% with cranioventral displacement of caudal seg due to muscles
What type of injury is common in cats?
sacrococygeal - tail pull
Severity of spinal cord damage with vertebral fracture depends on what?
velocity, duration, and degree of compression
What makes up the dorsal column?
-laminae
-spinous processes
-articular facets
-ass. lig.
What is the Schiff-Sherrington Phenomenon?
-severe injury to thoracolumbar or lumbar cord with extensor rigidity of forelimbs but normal reflexes and postural reaction
What is spinal shock?
loss of reflexes caudal to the lesion - mimics LMN lesion
-seen in first 24-48 hours after injury
-still have panniculus
What is the most useful for diagnosing spinal cord trauma?
rads
-VD or DV only if cross table capability

-CT is the modality of choice

-myelography is not recommended because requires additional manipulation and adds very little information
What is the clinical presentation of tail pull injuries?
-limp tail with no deep pain
-urinary incontinence
-soft tissue injury

-prog is poor if urinary incontinance after 4 weeks
What is the minimal time for cage rest with vertebral fractures?
4-6 weeks
Is surgery recommended with cervical fractures?

sacral fractures?
no - high mortality (hemorrhage or further injury)

no - severe only with progressive neurodeficits
What are goals of surgery to fix vertebral fractures?
1 - realignment
2 - decompression
3 - stabilization
What types of methods are there for stabilizing verebrae?
1 - External Skeletal Fixation
2 - vertebral body plating - not suitable caudal to L4 (sacrifies the nerve root)
3 - pins and PMMA - anywhere and any sized animal
4 - dorsal spinous precess plating - plastic plates on 3 processes cranial and caudal to the fracture
5 - modified segmental fixation - cheep and any part of the spine in any sized dog