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99 Cards in this Set
- Front
- Back
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What are the normal anatomic borders of the soft palate?
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lateral tonsilar crypts on each side
midline is the epiglottis |
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What are some congenital components of brachycephalic airway syndrome?
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stenotic nares
elongated soft palate hypoplastic trachea |
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What are some secondary components of Brachycephalic airway syndrome?
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everted saccules (can exacerbate signs)
edema/inflammation |
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If combined with other components hypoplastic trachea can cause these major clinical signs.
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collapse
cyanosis |
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How do you determine if the trachea is hypoplastic?
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determine the diameter:thoracic inlet ratio
measure ventral T1 to dorsal manubrium --non-brachycephalic >0.2 --brachycephalic <0.16 --bulldogs <0.13 |
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when do dogs most commonly die during anesthesia?
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right at intubation or early on in the recovery period
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Seeing everted saccules is equal to stage _______ laryngeal collapse.
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stage 1 laryngeal collapse
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what is the clinical presentation of brachycephalic airway syndrome?
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variable signs:
inspiratory stridor stertorous (snoring) exercise intolerance heat/humidity intolerance cyanosis |
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What does a rhinoplasty do?
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increases the nostril radius
----decreases resistance |
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What vessels supply the caudal 3 mammary glands?
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caudal superficial epigastrics
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What vessels supply the cranial 2 mammary glands?
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the internal thoracic
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The only time you do not recommend surgery with mammary neoplasia is...?
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with inflammatory carcinoma
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When do you recommend chemotherapy with mammary neoplasia (in cats only???)
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recommended in all cases due to high metastatic rates
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What are the functions of the spleen?
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hematopoesis
filtration lymphocyte storage |
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what is the #1 splenic tumor in cats?
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mast cell tumors
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what is the #1 splenic neoplasia in dogs?
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hemangiosarcoma
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Rule of 50 for splenic tumors.
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50% are hematomas
50% are malignant neoplasias ----of the malignant neoplasias, 50% are hemangiosarcomas |
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Diagnosis of splenic neoplasia
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-regenerative anemia (polychromasia and reticulocytosis)
- nucleated RBCs -mitral murmur -abdominocentesis - bloody - liver metastasis (SGPT and SAP) |
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What are the three different ways to do a total splenectomy?
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hilar ligation technique
splenic and short gastric ligation mass ligation-torsion |
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Which vessels should you conserve in a total splenectomy?
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left gastroepiploic artery
short gastric branches to the left limb of the pancreas |
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What can be seen in the post operative course of a splenectomy?
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leukocytosis - transient for 2-4 days
thrombocytosis - transient for 2 weeks regenerative anemia blood parasites - hemobartonella sudden death (hemorrhage, PTE, Ventricular tachycardia) |
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Why do cats scratch?
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scent marking
visual marking muscle stretching claw conditioning |
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What size tube do you use for a thoracotomy tube?
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you want to approach the diameter of the main stem bronchus
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What are some complications of drain placement?
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infection
foreign bodies tissue trauma malfunction subcutaneous emphysema discomfort may inadvertently increase the amount of drainage |
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What is the one thing that must be incorporated into the skin otherwise the tissue will necrose?
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the subdermal plexus
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What 3 plexuses make up the direct cutaneous vessels?
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superficial plexus
middle plexus subdermal plexus |
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Which three areas have mobile skin?
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trunk
cervical region upper extremities |
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Which areas have limited mobility of the skin?
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head
anogenital region distal extremities (below elbow/below stifle) |
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What occurs when your incisions are perpendicular to your tension lines?
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more incisional tension
wider scar |
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What occurs when your incisions are parallel to your tension lines?
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minimal incisional tension
small scar |
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what are full thickness skin flaps?
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they include the epidermis and all layers of the dermis and the subdermal plexus
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What is a random pattern flap?
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there is no direct artery and vein to supply the flap
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what is local skin mobilization?
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when you relax the incision
use a combination of incisions made juxtapositional to the defect and also undermining -use: nerves, vessels, bone are exposed |
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How do you measure a rotational flap?
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length of arc needs to be 4x the length of defect
---you want the base of any flap wide b/c that is where the blood supply is |
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What is a transpositional flap?
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rectangular in shape
one of the borders of the flap will be shared with the defect 90 degrees of the long axis of the defect width of the base = width of the defect lose flap length when rotated |
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__________ flaps are the most cosmetic reconstruction we can do.
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Local flaps
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What is an advancement flap?
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make two skin incisions
make sure the incisions diverge away from each other in order to increase the width of the base undermine the flap (keep subdermal plexus) ---advantage is skin elasticity ---this is the one most people will do |
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what is a bipedicle advancement flap?
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-used for large defects in the thorax or abdomen
- use two smaller flaps ----this increases blood flow as compared to one larger single pedicle flap |
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What is a fold flank flap?
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based on the subdermal plexus
used primarily in CATS -use for abdominal and thoracic wounds |
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What are axial pattern flaps?
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based on direct cutaneous arteries and angiosomes
-they contain a direct arterial supply -named for direct artery and vein -"live piece of tissue that may die" |
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What is a benefit of the direct arterial supply found in distant skin mobization flaps (axial pattern flaps)?
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increase the length of the flap
cover larger defects greater distance |
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What is the caudal superficial epigastric flap and where does it come from?
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-for the caudal superficial epigastric artery and vein
-harvesting flap ----simplest ----boundaries ----mammary glands (3-5) |
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What do you use the caudal superficial epigastric flap for?
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flank defects
inner thigh defects stifle area perineal and preputial area |
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When performing a caudal superficial epigastric flap, you can only rotate it _________ degrees. More than that will cause _____________. This is what will kill a skin flap.
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180 degrees
venous congestion (severe) |
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What is a reverse saphenous conduit flap?
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It is on the medial aspect of the thigh
---special b/c can get reverse flow from the perforating metatarsal artery and the cranial branch of the medial saphenous artery |
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What is the reverse saphenous conduit flap used for?
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tarsal wounds
metatarsal wounds |
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What is necessary to perform prior to doing a reverse saphenous conduit flap surgery?
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--difficult dissection so know regional anatomy
---cranial and caudal branches-->make sure they are patent (can use a pulse doppler) |
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What are free skin grafts?
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dead pieces of tissue that may come to life
-they are transferred to a distant site (granulation tissue) -graft them over granulation tissue, fascia, and muscle ---DO NOT graft them over bone or tendon b/c there is no blood supply there for them |
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What two layers are contained in a full thickness skin graft?
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epidermis
dermis |
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When/where would you use seed or punch grafts?
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on the distal extremities
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What is a full thickness meshed graft?
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epidermis and dermis only
remove all subcutaneous tissue has a cobblestone appearance mesh using a # 11 or #15 blade |
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What are the three stages/types of free graft healing?
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plasmatic imbibition
inosculation neovascularization |
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What is plasmatic imbibition?
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gets fibrinogen-free serum like fluid from the graft bed (aka the cut vessels and lymphatics)
48 hours |
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What is inosculation?
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This is when capillary anastomosis occurs from the GRANULATION BED to the GRAFT (the vessels line up) -- new vessels are not formed
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What is Neovascularization?
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this is when new vessels grow into the graft dermis and new vessels grow into the cut graft vessels (basically new blood supply is growing)
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what are 4 causes of graft failure?
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movement (esp. shear forces)
hematomas seromas infection |
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How do you immobilize a graft to allow for greater chance of success?
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-bivalve cast
-external fixator (if bivalve cast doesn't work) -initial bandage change only after 72 hours -change bandage every 48 hours for 2 weeks |
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What causes wounds up on the body to heal better than distal extremities?
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b/c large muscle mass and lots of blood supply
distal extremities also have more tension |
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What is the most common penetrating foreign body in horses and what is the best way to find it?
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wood
ultrasonography |
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What are the 3 stages of wound repair?
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acute inflammatory phase (vascular and cellular response)
proliferative/repair phase (fibroblasts synthesize matrix) remodeling phase (collagen reogranization |
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what are the 4 most common reasons for delayed wound healing in horses?
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infection
movement (use casts to restrict this) cell transformation (squamous cell carcinoma and sarcoids can do this) foreign body/necrotic tissue |
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What is the involcrum?
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parent bone that has proliferated around the dead bone when you have a sequestrum
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What is the sequestrum?
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this is the dead bone
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What is the cloaca when there is a sequestrum present?
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actual draining tract that goes down to bone or the dead space surrounding the sequestrum with inflammatory debris
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What are the deeper structures you want to evaluate/think about when assessing a wound in a large animal?
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joint
tendon sheath bursae tendons collateral cartilages bone ligaments |
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What are some procedures you would use for wound assessment?
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synoviocentesis (cytology/culture and sensitivity)
radiographs (contrast study) ultrasound nuclear scintigraphy |
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What factors are involved in your treatment decision?
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PE findings (type and degree of injury, specific structures involved, duration of problem)
owner expectations owner finances medical expertise and facility temperament of horse |
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When sedating for initial wound management and restraint and analgesia always give __________.
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Butorphanol (can combine with an alpha-2)
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When performing wound debridement, NEVER REMOVE ANYTHING UNLESS ____________.
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you are positive it is dead!!!!!
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What can be used for wound debridement (3 types)?
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mechanical
-sterile saline -gauze -dressings -sharp chemical autolytic (exudate eats away debris and necrotic tissue) |
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What do you use when you are lavaging a wound?
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-use a NONCYTOTOXIC SOLUTION
-saline -tap water NOT HYDROGEN PEROXIDE -use an appropriate pressure and volume (10-15 psi) |
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why do we not use hydrogen peroxide for lavaging wounds?
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because it is toxic to FIBROBLASTS ---so don't use on open wounds
---only good for removing blood from hair |
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what two things do we not use to lavage a wound and why?
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hydrogen peroxide
any scrubs (use diluted solutions instead) ===because they are toxic to fibroblasts |
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When do we use second intention healing?
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primarily lower limb wounds
--granulation tissue formation -contraction and epithelialization - healing is prolonged -increased scar formation -more after care required -less cosmetic |
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what is proud flesh?
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exuberant granulation tissue
-on the lower limb horses >>>>ponies -caused by: dysregulated fibroplasia chronic inflammation -bandage application stimulates |
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if granulation tissue protrudes above the skin surface, it ___________ healing.
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begins to hinder
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What ointment can you use on edematous granulation tissue?
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triamcinolone ointment
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What are the benefits of performing punch grafts in horses?
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easy
inexpensive standing horse functional rewarding (have a high take rate) |
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septic synovial structures in horses are an ___________.
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EMERGENCY --- they require immediate attention
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What is the etiology of septic synovial structures in horses?
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puncture wound/laceration
hematogenous (more likely in foals) iatrogenic |
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What are the treatments for septic synovial structures in horses?
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supportive care
pain management anti-inflammatories antimicrobials surgical management (wound repair, lavage,debridement and drainage) |
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Why and how do we use regional antibiotic delivery?
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intravenous, intra-articular, intraosseous, continuous delivery (beads)
-get very high concentrations -avoid systemic toxicity -wider selection of antibiotics |
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what is the front edge of the tooth?
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mesial edge
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what is the back edge of the tooth?
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distal edge
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what is the tooth surface towards the tongue?
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lingual
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what is the tooth surface towards the cheek?
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buccal
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what is the tooth surface towards the lips?
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labial
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What is the tooth surface towards the palate?
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palatal
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what is the upper right hand quadrant in the mouth numbered?
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100
deciduous = 500 |
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what is the upper left hand quadrant in the mouth numbered?
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200
deciduous = 600 |
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what is the lower left quadrant in the mouth numbered?
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300
deciduous = 700 |
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what is the lower right quadrant in the mouth numbered?
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400
deciduous = 800 |
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what is the rule of 4 and 9 when numbering teeth?
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canines are always #4 (xx4)
1st molar is always #9 (xx9) |
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when performing your oral exam pay close attention to....
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malodor/halitosis
occlusion periodontal disease tooth lesions masses pain |
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a scissor bite is ____________ occlusion
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normal
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an infraorbital block will block which teeth?
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the rostral maxillary teeth
~3rd and 4th premolar forward (definitely 3rd) |
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a maxillary block will block which teeth?
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all maxillary teeth, palate, bone, and lips
--to block teeth back from the 4th premolar, do a maxillary block perpindicular to the last molar ---remember that the eye is close |
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Which teeth are blocked by the mental foramen block?
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rostral mandibular teeth
(1st to 2nd premolar forward) |
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What does the mandibular block get?
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bone, all mandibular teeth, lips, rostral tongue, gingiva, and skin
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