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65 Cards in this Set
- Front
- Back
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Define Nociception What are the two types of nociceptors? |
Response to a noxious stimulus A type- "first pain"- well localized and transient C type- "second/slow pain"- diffuse and persistent |
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What are the two types of pain? |
Visceral- viscera, poorly localized Somatic- Peripheral, easily localized aching, stabbing or throbbing |
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What are the three parts to Nociception? |
Transduction (noxious stimuli at the nociceptor)
Transmission (propagation of a nerve impulse) Modulation (modify the nociceptive transmission) |
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What are the three components of pain? |
1. Nociception 2. Perception of pain (must be concious) 3. Response (behavioral change as a result) |
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What is "Wind-up" pain? Hyperalgesia? Allodynia? |
Pain that gets worse over time due to the build-up of chemical mediators in the spinal cord Stimulus that should be a certain level of pain is much more painful than it should be Painful for something that shouldn't be painful at all |
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What are some negative effects of pain? |
Stress response results in poor wound healing Weight loss and negative energy balance Delayed recovery Increased incidence of post-op complications Decreased ventilation efficiency Self-mutilation Pain may become chronic and more difficult to treat |
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What is the visual analogue scale (VAS) |
A numerical scale that has been developed for figuring out how much pain the animal is in |
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What are some of the signs of pain in dogs? |
Guarded behavior, hunched posture Shivering Panting Staring eyes Physiologic sympathetic signs- palpation, HR, RR |
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What are some signs of pain in cats? |
Hiding, back of cage Refuse to change body position Lack of grooming Aggression Squinted eyes Physiologic sympathetic signs |
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What is preemptive analgesia? |
Preventing pain, limiting wind-up before surgery |
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What is Multimodal Analgesia? |
Administering two or more classes of analgesics to get better effects |
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When using a CRI, what type of extension set do you want to use? Why? |
Use a Microbore extension set so that the drug doesn't get stuck in the lining of the tubes |
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What genetic changes have to happen in order for cancer to occur? |
1. Activation to proto-oncogenes into oncogenes- mutation in one allele needed 2. Inactivation of tumor suppressor genes- mutation in both alleles needed *typically multiple mutations needed to have clinically evident neoplasia |
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Define Tumor |
Any mass or nodule regardless of underlying cause |
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Define Metastasis |
Spread of neoplasia to an organ or location not directly connected to the primary neoplastic mass Regional- spread to lymph nodes that drain the location of primary mass Distant- metastasis to other organs not directly associated to the mass |
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Define Benign |
Mass that grows in one area but does not invade adjacent tissues or metastasize |
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Define Malignant |
Mass that possesses the ability to metastasize and/or invade and destroy adjacent tissues |
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Define paraneoplastic |
Systemic disease caused by humoral factors secreted by cancer cells |
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What are some causes of cancer? |
1. heritable genetic mutations (rare) 2. Biological agents (ex. FeLV, lymphoma) 3. Physical agents (ex. asbestos, vaccine adjuncts) 4. UV light 5. Ionizing Radiation 6. Older cells- more chronic insults of genetic material, more likelihood of neoplasia developing |
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What are the characteristics of neoplastic cells? |
1. Self-sufficient growth 2. Insensitivity to anti-growth signals 3. Tissue invasion, metastasis 4. Limitless replicative potential, evade apoptosis 5. Sustained angiogenesis *not all cells in the same mass have to be at the same level of malignancy |
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What are the three intentions of surgery when dealing with neoplasia? |
Curative- a chance to cure, removal of all neoplastic cells Adjunctive- removal of the mass to a microscopic disease to then use radiation Palliative- Removal of part of a mass to improve patient comfort |
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Cytology is diagnostic for what cancers? |
Round cell tumors- lymphoma, hitiocytoma, plasmocytoma, mast cell, TVT, melanoma Lipoma (Sometimes for carcinoma/adenocarcinoma, osteosarcoma) (Less commonly for sarcomas) |
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What are the benefits of using biopsy when diagnosing a neoplasia? Disadvantages? |
Does not disseminate the tumor Does not change the treatment options Useful for tumor grading, aiding in determination of treatment and prognosis Disadvantages- results take longer, more invasive, diagnosis not guaranteed |
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Define Excisional Biopsy |
Removal of the entire mass with a margin of surrounding tissue used for- small cutaneous tumors, visceral tumors NOT USED IN OTHER SITUATIONS- knowledge of what the tumor is is needed to know how big the margins need to be |
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Define Incisional biopsy What are the three types? |
Removal of a piece of the mass by sharp incision 1. Wedge biopsy- use a blade to take a piece of mass 2. Punch biopsy- skin biopsy punch used 3. Needle biopsy- tru-cut or EZ core device used for soft tissue masses |
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What location in the lesion do you want to biopsy for a bone mass? For a soft tissue mass? |
Bone- center of lesion Soft tissue- periphery of the lesion *make your biopsy in a location that can be entirely removed with definitive surgery due to the possibility of seeding tumor cells in the biopsy tract |
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Describe how to stage a tumor using the TNM classification |
T- local tumor?- palpation, measurement, imaging (X,O,is,1-4) N- lymph node- cytology/biopsy of regional lymph nodes, imaging M- Metastasis- thoracic radiographs, abdominal ultrasound, CT/MRI |
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What are the different classifications/levels for a primary tumor in the TNM classification system? |
TX- primary tumor cannot be evaluated T0- no evidence of primary tumor Tis- carcinoma in situ (abnormal cells present, no spread) T1-4: size and extent of primary tumor, with definition variable by tumor |
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What are the different classifications/levels for regional lymph nodes (N) in the TNM classification system? |
NX- regional lymph nodes cannot be evaluated N0- no regional lymph node involvement N1-3- degree of lymph node involvement (# and location of nodes) |
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What are the different classifications/levels for metastasis in the TNM classification system? |
MX- distant metastasis cannot be evaluated M0- no metastasis M1- distant metastasis has occurred |
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Define En bloc |
All tumor tissues should be removed as a single unit- tumor with biopsy tract. NOT removed inlayers |
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Define Intracapsular surgical margins |
"Debulking"- bulk of tumor removed from within the capsule |
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Define Marginal tumor margins? Wide? Radical? |
Marginal- less than 1cm of normal tissue around the tumor Wide- 1-3 cm normal tissue in all directions, determined by tumor type Radical- >3cm or entire anatomical compartment removed (ex. amputation) |
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What are Halstead's Principles? |
Gentle handling of tissue Meticulous hemostasis Preservation of blood supply Strict aseptic technique Minimum tension on tissues Accurate tissue apposition Obliteration of dead space |
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What are the type of restraints used in field surgery for cattle? |
Physical- head catch, halter, hobbles, tie tail to themselves Chemical- alpha 2s, opioids, ace/ketamine |
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What are the common suture patterns for cattle surgery? |
Simple continuous- for peritoneum, muscle layers and subcutaneous tissue Simple interrupted Cruciate Ford-interlocking for skin Utrect- inverting pattern for hollow viscera Subcuticular- midline skin closure for umbilical hernia repair |
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If post-op antibiotics are needed after a cattle surgery, what is a good choice for drugs? |
Beta-lactams (ampicillin, ex.) given 2-5mg/kg once daily-3x daily DON'T use cephalosporins |
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What are the four signs of cardiopulmonary arrest? |
Loss of consciousness Absence of spontaneous ventilation Absence of heart sounds on ausculation No palpable pulses |
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What are the three steps to implementing accurate CPR? (in the order of importance) |
Chest compressions Ventilation Defibillation (if indicated) |
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What are the goals of CPR? |
Pump blood from chest to vital organs Increase venous return to heart during chest recoil Maximize cerebral and myocardial perfusion |
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How is cerebral perfusion pressure calculated? |
CPP = MAP (Mean arterial pressure) - ICP (intracranial pressure) |
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How is myocardial perfusion calculated? |
MPP = ADP (aortic diastolic pressure) - RAP (right atrial pressure) |
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What is the effective amount of chest compressions done in CPR? What makes a compression effective? |
100-120 compressions/minute Allow complete chest recoil, depress the chest 1/3 of the way minimum |
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How do chest compressions generate CO? |
Small patients- cardiac pump theory Large patients- thoracic pump theory |
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Where do you place your hands for CPR in a large dog? Small dog or cat? |
Large dog- largest area of chest Small dog/cat- encircled or directly over heart |
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How often do you change compressors in CPR? |
Every 2 minutes With a maximum of 10 second interruption, during which you watch end-tidal CO2 |
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What ventilation rate should be implemented during an episode of CPR? |
10 breaths per minute- more is not better, each one causes an increase in intra-thoracic pressure, leading to a decrease in venous return and a decrease in CO |
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How does epinephrine work in an arresting patient? Side effects? |
Synthetic adrenaline, acting on Beta and alpha receptors, increasing systemic vascular resistance and arterial blood pressure, given every 5 minutes Increased myocardial oxygen consumption, tachycardia and GI ischemia can result |
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How does atropine work in an arresting patient? |
Vagolytic drug, parasympatholytic Indicated in bradycardia- maybe used in PEA or asystole? (not in human med but still used in vet med) |
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How does vasopressin work in an arresting patient? |
Nonadrenergic endogenous pressor peptide, causing periperal, coronary and renal vasoconstriction Benefits over epinephrine- no myocardial ischemia, works in acidic environments, longer half-life (one dose needed) |
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What are two anti-arrhythmic agents given for fibrilation or tachycardia that is not responding to fibrillation? |
Lidocaine- 1 mL/10Kg IV, IO or ET Amiodarone- 5-10mg/kg IV |
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When is Sodium bicarbonate given in an arresting patient? |
When there was a pre-existing acidosis or an arrest that has lasted more than 10 minutes leading to severe hyperkalemia |
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Whan is Calcium gluconate given in an arresting patient |
Severe hyperkalemia Known hypocalcemia 50-100 mg/kg IV |
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If the arrest is due to anesthetic agents, what reversals do you use? |
Nalaxone to reverse opioids Flumazenil to reverse benzodiazepines Atipamezole/Yohimbine to reverse alpha-2s |
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When would fluids be given for an arresting patient? |
In hypovolemic patients, NOT for euvolemic/hypervolemic patients |
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When is defribillation indicated in an arresting patient? |
When ventricular fibrillation or pulseless ventricular tachycardia is seen on ECG 3-5J/Kg (external), 0.3-0.5J/Kg (internal) |
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Where are the paddles placed on a small dog to do defribillation? |
Small dog- on either side of chest while dog is on their back |
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When a patient is arresting, what type of blood gas is most helpful? |
A venous blood gas. The arterial blood gas may be near normal while the venous blood gas is more reflective of the tissue acid base status. |
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What are the indications for doing internal cardiac compressions? |
Already in the chest/abdomen History of trauma Pleural/pericardial space disease (pleural/pericardial effusion, pneumothorax, diaphragmatic hernia, chest wall trauma, hemoperitoneum with on-going bleeding, large dogs, prolonged CPR with no response |
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What are the benefits of doing open-chest CPR? |
Associated with increases in CO, BP, coronary and cerebral pulse pressure Increased ROSC and neurologic outcome Visualize heart Aortic cross clamp Internal defribillation |
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Where do you perform open-chest CPR? |
Left lateral thorax, fifth intercostal space (where elbow meets chest) |
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What are some things you want to do in post-resuscitation of an arrested patient? |
Keep patient intubated and sedate if needed Mannitol in euvolemic patients, hypertonic saline in hypovolemic patients Elevate head Oxygen supplementation Maintain normal BP Maintain normocapnia |
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What are the indications for mechanical ventilation? |
1. Severe hypoxemia, unresponsive to therapy (pneumonia, ARDS, pulmonary contusions, pulmonary edema, CHF) 2. Severe hypercapnia, unresponsive to therapy (cervical disc disease, peripheral neuropathies) 3. Excessive respiratory effort |
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What are the indications for dialysis? |
1. Oliguric or anuric renal failure 2. Ureteral obstruction 3. Severe hyperkalemia 4. Severe volume overload 5. Dialyzable toxins (ex. ethylene glycol) |
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The universal sign for a cat that has already been spayed/neutered is what? |
A tipped left ear |
