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203 Cards in this Set
- Front
- Back
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What type of rib spreaders are available in Thorasic surgery
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Finochietto
Haight |
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What type of induction should you use in patients with respiratory disease
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Don't use mask or chamber
intubate right away |
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What type of xrays are used to view the thorax
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Survey
Contrast & Angiography |
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What will you see in a contrast radiograph of megaesophagus
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contrast all along- dilation through length not including abdominal portion
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What will you see in a contrast radiograph of a PRAA case
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will see a puddle effect of contrast with gravity creating a trough
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what is ultrasound good for in the thorax
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great at evaluating flow
use for pulmonic stenosis, PDAs etc |
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What is endoscopy used for in the thorax
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evaluating the respiratory system
taking diagnostic samples removing FB per os |
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What is pneumothorax
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air accumulates in pleural cavity leading to loss of normal negative pleural pressure
this causes the lung to undergo elastic recoil and collapse |
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What are the 3 types of pneumothroax
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Closed
Open Spontaneous |
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What does closed pneumothorax involve
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restpiratory tract (tachea/ bronchi)
esophagus |
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What does open pneumothorax involve
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wound in the thorasic wall
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what does spontaneous pneumothorax involve
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pulmonary
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what is and how do you treat a mild pneumothorax
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a mild pneumothorax is non progressive meaning there is no severe hyperventilation, hypoxemia or respiratory acidosis
Tx with cage rest & observation |
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what is & how do you treat a moderate pneumothorax
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a moderate pneumothorax is deliniated by respiratory distress
Treat the thoracocentesis initially if pneumothorax recurs, insert a thoracostomy tube |
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what is & how do you treat a severe pneumothorax
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a severe pneumothorax is progressive & marked respiratory distress
Tx w/ a tube thoracostomy w/ continuous suction drainage or heimlich valve If leakage is significant or persists > 5-7 days do an exploratory thoracotomy |
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what cause an open (penetration/ rupture of chest wall) pneumothorax
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bite wounds
stab wounds Gunshot wounds Impalement Inadequate thoracotomy closure |
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Tension pneumothorax is seen as
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a shift in the mediastinum
compression of the opposite lung decompress ASAP see pulmonary bullae & blebs- can blow at any time -pneumonectomy/ lobectomy |
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what is contraindicated in a pneumomediastinum
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don't bandage - will move SQ emphysema
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what is a paradoxical respiration
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patient inhales and the thorax depresses instead of extending - "flail" chest
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Treat paradoxical respiration with ...
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ventilate well, intubate if possible
Nerve blocks around area- dec. pain & inc. in RR |
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What will you see if there is a diaphragmatic rupture
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lose contour of diaphragm
may have liver lobes in the thorax can be incidental finding in contrast radiograph- slurry contrast media in thorax is AbN |
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what is hydrothorax
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fluid in the thorax - place thoracostomy & drains - place ventrally
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What is chylothorax
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chyle in the thorax
lead to chemical pleuritis - & create difficulty breathing will see higher TG in sample then serum dec. fat in diet |
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What are the medical & surgical Tx options for Chylothorax
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Medical- dec. fat in diet
Sx- TD ligation Subtotal pericardectomy cat- Left lateral dog - Right lateral |
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PDA is what ?
what are the types? |
Patent Ductus Arteriousus
fetal opening doesn't close L--> R shunt Balanced - bad R--> Left shunt (1-2%) Can't Tx Females are 4x more likely to get |
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what is the key sign in PDA
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continuous machinery murmur
at the left heart base its pathoneumonic- meaning diagnostic |
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What is the Tx for PDA
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First treat 2ndry problems:
Tx pulmonary edema atrial fibrillation congestive heart failure w/ diuretics & digitalis as needed before Sx Occlude the duct open in PDA |
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How do you occlude the duct in PDA
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Surgical ligation
Coil occlusion - causes blood to entrapt, femoral A. placement, double umbrella = more surface |
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How do you approach Sx ligation for treatment of a PDA case
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TD ligation is < $$ than coil
95% success Thoracotomy Left intercostal space DOG= 4th; Cat= 5th 2 ligatures- silk braided so won't slip. Tie thorasic side first then pulmonic. Reflex bradycardia (Branham reflex) may occur- atropine should be available, tightening 1rst lig slow might prevent sever bradycardia |
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What is the most common of the 7 vascular ring anomalies
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PRAA (95%)
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what is PRAA
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Malposition of Aorta. Ligamentum arteriosum stricture on esophagus so solid food can't pass.
Can have w/ PDA |
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CS of PRAA
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can see regurgitation after weaning when start eating soft food. Squeeze thorax & see bulging esophagus @ thorasic inlet
(esophagus doesn't have serosa- has thickened adventicia) |
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PRAA is corrected how
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through laproscopic surgery - hemoclips or cut & coagulate proteins= better closure
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Post Op treatment for PRAA
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Tx pneumonia (if needed)
Elevated moist food feedings *might need to cont. for life |
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Prognosis of PRAA
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use long term follow up esophagrams to assess
megaesophagus rarely completely reversed- early Sx = better reversal. if esophagus diameter is 2x normal reversal is unlikely |
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what is seen in 40% of PRAA cases
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40% of PRAA cases have persistent LEFT cranial vena cava
Also can be hemiazygous vein |
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Correcting PRAA via exophageal approach
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cautious of vagus nerve branches
suture 1-2 closures- no serosal layer, suture tight leakes can cause hemo/pneumothorax |
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Approximating ribs
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needle in a reverse manner
don't suture intercostal muscles |
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Thoracocentesis can be done with
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Iv catheter
Turkel catheter 16-18 G needle Thoracostomy tube |
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When dealing with tube thoracostomy - what should the size be
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tube diameter =
main stem bronchus or 1/2 -1/3 the width of the intercostal space |
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what about holes in tubes for tube thoracostomy
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No more than 3 holes
(ea. additional only inc. flow by 5%) Size of holes 1/4 diameter of tube (>1/3 = weakness--> kinking) * want to flexible but not collapsible |
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Tube sizes orientation
dog/ cat 3-6 kg |
Tube: 14-16 Fr
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Tube size for
dog 7-15 kg |
Tube: 18-20 Fr
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Tube size for
dog 16-30 kg |
Tube: 22-28 Fr
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Tube size for
dog > 30kg |
Tube: 30-36 Fr
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Placing thoracotomy tube
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pull skin foreward
mark incision incise - place parallel to ribs - don't harm other structures, fix w/ purse string or finger trap. Release skin |
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Use what for patients < 15 kg
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3 way stop cock
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Use what for patients > 15 kg
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Heimlich valve
use prolonged period can become sticky. Valve narrow indicates flow/ color coded so can't place wrong |
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What is PRE
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Pulmonary Reexpansion Edema
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how can you prevent PRE
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insuflate the lungs slowly
leave behind semi-collapsed lobes |
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When to remove a thoracotomy tube
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20 kg dog:
- fluid collection is 50 cm^3 or less in 24 hrs - xray at 24 hrs doesn't show air or free fluid - drainage reduced to a volume that is consistent w/ the one produced by the tube itself: 2ml/kg/day |
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What is a subtotal pericardectomy used for
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Tx of chylothorax
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What is the approach for subtotal pericardectomy
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median sternotomy is preferred (caution phrenic nerve)
lateral thoracotomy left - Dog 4th, cat 5th circumfrential incision ventral to phrenic nerve |
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prognosis of granulomatous pericarditis
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Fair
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Prognosis of idiopathic pericarditis
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good
70-80% return to normal remaining cases have recurrence of effusion - may require pleuroperitoneal shunt |
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Explain a pleuroperitoneal shunt
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aspirates fluid w/i the thorax
shunts to abdomen recycled in abdomen owner needs to locate valve & pump 2-3x/ day |
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Sx approaches to the thorax
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lateral thoracotomy
median sternotomy thransthorasic |
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what are the types of lateral thoracotomy
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intercostal
rib resection- old technique periosteal stripping & rib resection |
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define transthorasic approach to the thorax
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bilateral lateral thoracotmy - connected across the sternum
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where:
esophageal FB @ heart base |
RIGHT
4th ICS |
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Cardiopulmonary bypass is done..
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at RIGHT
4th ICS |
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cranial lung lobectomy
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5th ICS on either side
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Caudal lung lobe
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7th ICS on either side
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Intermediate lung lobe
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RIGHT
6th ICS |
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Thorasic Duct in the dog
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RIGHT
8th ICS |
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Thorasic duct in the cat
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LEFT
8th ICS |
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Caudal Esophagus
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LEFT
9th ICS |
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PDA, PS, PRAA
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LEFT
4th ICS |
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Cranial thorasic duct
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LEFT
3rd ICS |
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Approach to 4th LAteral Thoracotomy
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elevate thorax- 4th ICS highest
Incise parallel rib transect cutaneous muscle Transect Latissimus dorsi m. or retract dorsally Leaflets of serratus ventralis m. bluntly seperated, ventral to dorsal cut Intercostal muscles (transect ventral to dorsal, stay away from VAN at caudal margin of 4th rib) Incise pleura |
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summary of muscle incisions for 4th lateral thoracotomy
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1. cutaneous trunci m.
2. latissimus dorsi m. 3. serratus ventralis "fan shape" |
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ventilation during 4th lateral thoracotomy
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bag
stop as enter the thorax resume once in- collapsed lung = AbN metabolic state |
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Closure of lateral thoracotomy
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place tube
preplace sutrues around ribs & tie routine closure of musculature don't close Intercostal space close cutaneous trunci w/ SQ tissue in small patients don't overlap ribs routine closure of skin |
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Thoracostomy tube placement
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stab incision in skin & SQ tissue 2-3 ICS dorsal & caudal to thoracotomy incision
tunnel cranially 1-2 ICS, enter pleural space, position tube in thorax Place purse- string or chinese finger trap suture in skin around tube don't need to clamp to place. Aspirate as close thorax |
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Post op treatment for lateral thoracotomy
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maintain chest tube until space is free of air/ fluid
Analgesia |
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what analgesia can be given for lateral postoperative care
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Intercostal nerve blocks
Narcotic analgesics Intrapleural Bupivicaine |
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Median Sternotomy Indications
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Access to entire lung field for exploratory Sx
subtotal pericardectomy tx: chylothorax Aortic valve replacement |
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What is used for beelders in median sternotomy
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bone wax
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Closure of median sternotomy
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place thorocostomy tube
sternebrae closed with orthapedic wire in figure 8 pattern remaining pattern closed routinely |
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Thoracostomy tube placement in median sternotomy
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stab incision over 7th -9th ICS
tunel cranially 1-2 spaces to enter pleural cavity |
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Advantages of median sternotomy
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access to entire thoracic cavity
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Disadvantages of median sternotomy
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more lengthy
more difficult Increased morbidity more severe post op pain more severe physical dysfunction - patient may be unable to ambulate w/o assistance |
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Pulmonary surgical procedures
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complete lobectomy
partial lobectomy |
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Indications for complete lobectomy
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Disease process involving entire lobe or area near hilus of lobe
ex: lung lobe torsion, neoplasia, trauma, contamination or infection |
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Indications for partial lobectomy
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focal lesions distal in the lobe
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Sx technique for complete lobectomy
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isolate & pack off lobe
vessels & bronchus are ligated at hilus isolate pulmonary artery (Rt. angled forceps) Place 3 ligatures (middle lig. is transfixing) repeat process w/ pulmonary vein excise vessels between transfixing & distal ligatures transect bronchus btwn 2 crushing clamps 1-2 rows of horizontal mattress sutures, interrupted or continuous cut margin sewn over w/ simple continuous TA stapler may be used for complete lobectomy (isolate hilus, staple entire pedicle, excise distally) * good to selectively intubate lung |
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When should you ligate the pulmonary Vein before the Artery
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in small dogs & cats
ligate artery causes vein collapse = inc. difficulty in ligation Neoplasia Abscess |
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Sx technique Partial lobectomy
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crushing clamps prox. to lesion
1-2 rows cont. horizontal mattress sutures proximal to clamps 3-0/ 4-0 absorbable, small taper |
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how do you examine for air leaks
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incision is dripped with saline while inflated
large dogs the suture line may be placed in a bowl while infalted leaks = bubbles closed with interrupted sutures |
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what is tracheal collapse
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acquired, end stage disease of tracheal cartilage
--> mechanical collapse of trachea on inspiration/expiration |
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CS/ Hx for tracheal collapse
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chronic cough "honking"
chronic bronchial disease coughing with excitement cyanosis syncope |
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Grades of tracheal collapse
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Grade 1-4
Grade 1 = 25% collapse Grade 4= 100% collapse dorsal membrane & cartilages dip inward and reduce area of trachea |
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Surgication Tx of tracheal collapse
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dorsal membrane plication
ventral ring chondrotomy (not used) external tracheal splints (ring or spiral) Internal tracheal splints |
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Medical Tx of tracheal collapse
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weight loss
cough suppressants bronchial dilators sedation |
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What do you need to be cautious of in tracheal surgery
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the recurrent laryngeal nerve
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Tracheal spiral splint is placed between the trachea and what
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neurovascular structures
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the tracheal spiral splint is secured with
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5-0 monofilament nonabsorbable sutures
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when might you see tracheal necrosis
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when longitudinal blood vessels are compressed
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what are the disadvantages of external tracheal splints
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extensive surgical approach
anesthetic risk prolonged post op care prolonged pain high cost (anesthesia/ care) adjacent rings prone to collapse |
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what are the advantages of external tracheal splints
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most animals improve post operatively
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Advantages of INternal tracheal splints
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no sx- catheter delivery
shorter anesthesia less pain less cost entire trachea treated at one time |
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Disadvantages of Internal Tracheal Splint
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endoscopy/ fluro required
stent cannot be retrieved back into delivery catheter if wrong placement or size |
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Tracheal resection in adult dogs
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resection of 3-5 rings easily done
can resect 25% to 50% of trachea in adult dogs |
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Tracheal resection in puppies
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20-25%
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what type of suturing is used in tracheal resection & anastamosis
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tension sutures
placed 2-3 rings from suture line on each side pleural patch may be placed over suture line |
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Tracheal resection & anastamosis
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resect trachea between rings (split cartilage)
handle trachea with tape/ traction sutures suture dorsal trachea (back first) place sutures around rings, add tension sutures if necessary |
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Tube tracheotomy/ tracheostomy
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emergency procedure
bypass URT 5 rings caudal to crico cartilage pull and let heal by 2nd intention |
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what are the muscles cut for a treacheotomy
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sternohyoideus
sternothyroideus don't cut over 50%, 2 stay sutures = guide for changing tube |
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Tracheal FB diagnosis
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Rads
Contrast rads bronchoscopy |
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FB retrieval
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bronchoscopy & grasping equipment
balloon catheter retrieval Tracheotomy - rarely indicated |
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Tracheal resection & anastamosis
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resect trachea between rings (split cartilage)
handle trachea with tape/ traction sutures suture dorsal trachea (back first) place sutures around rings, add tension sutures if necessary |
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Tube tracheotomy/ tracheostomy
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emergency procedure
bypass URT 5 rings caudal to crico cartilage pull and let heal by 2nd intention |
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what are the muscles cut for a treacheotomy
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sternohyoideus
sternothyroideus don't cut over 50%, 2 stay sutures = guide for changing tube |
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Tracheal FB diagnosis
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Rads
Contrast rads bronchoscopy |
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FB retrieval
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bronchoscopy & grasping equipment
balloon catheter retrieval Tracheotomy - rarely indicated |
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continuity of the diaphragm is disrupted leading to protrusion of the Abdominal viscera through the diaphragm into the thorasic cavity =
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diaphragmatic hernia
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etiologies of Diaphragmatic hernias
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Congenital
Acquired (traumatic) |
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What are the 3 types of diaphragmatic ruptures
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circumfrential
radial combined |
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What are the 3 types of congenital diaphragmatic hernias
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pleuroperitoneal (left side)
Peritoneal pericardial (assoc. ventral hernias) hiatal |
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what percentage of hernias are traumatic
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93%
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DX with Hx & CS
what are the leading causes of hernias |
1. vehicles
2. congenital 3. fights 4. falls |
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CS of diaphragmatic hernia
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dyspnea
tachypnea cyanosis orthopnea muffled heart sounds borborygmus (intestine)- careful with thin patients coughing vomitting exercise intolerance tucked up abdomen post prandial respiratory difficulty anorexia |
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Are signs for diaphragmatic hernias pathognomonic
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NO
signs can be intermittent or absent |
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what is the interval between trauma and Dx of Diaphragmatic hernias
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Hours to 6 years
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Diagnostic Techniques for diaphragmatic hernias
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Xrays - GI transit, intraperitoneal
US Fluroscopy (hiatal hernias) |
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Radiographic signs in diaphragmatic hernias
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interrupted diaphragmatic outline
soft tissue density in thorax gas-filled viscera in thorax loss of cardial silhoette incidental finding |
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auscultate and hear muffled heart & respiratory sounds
means ... |
(fluid or viscera in pleural space)
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ausculate and hear borborygmus
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intestines in pleural space
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Ausculatate and hear tympany on left thorax
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stomach is in pleural space
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why is the stomach in the pleural space such an emergency
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can dilate and extremely compromise the expansion ability of the lungs
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lab assessments for diaphragmatic hernias
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CBC
Renal & hepatic fxn serum electrolytes blood gas values ECG (RBC, WBC, BUN, CREA, TP) |
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When SX on diaphragmatic hernia
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ONCE STABLE
mortality higher < 24 hrs or > 1 year |
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what type of delay is recommended when Tx diaphragmatic hernias
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delay 1-2 weeks
succ ess rate is 90% |
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traumatic diaphragmatic hernia anesthesia
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pre oxygenate
minimize stress rapidly induce avoid resp. depressing drugs manually/ mechanically control respiration avoid over inflation of lungs |
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Stomach massive problem
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dilating = rapid and complete lung collapse
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why abdominal approach to diaphragmatic hernia
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more familiarized
bilateral access extendable via sternotomy/ paracostal incison But req. ventilatory support of patient |
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Thoracic approach for traumatic diaphragmatic hernia correction
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only one sided - must have accurate Dx
need experience w/ thoracic Sx good visualization suture over convex surface |
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Sx technique for repairing a diaphragmatic hernia
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gently retract herniated viscera into abdomen
if viscera is adhered in thorax, extend incision cranially & break up adhesions by sharp & blunt dissection under direct visualization. begin suturing radial tear at most dorsal margin anchor circumfrential tears by suturing around ribs nonabsorbable suture simple continuous or interrupted |
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Closing on diaphragmatic hernia repair
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anesthetist slowly expands lungs while last suture is placed to force air out of pleural space (Bruhlday doesn't like)
Place thoracostomy tubes - chronic hernia or herniated liver, drainage may be required for several days insuflate lungs gradually - reperfusion injuries --> pulmonary edema |
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When primary diaphragmatic closure NOT possible ... use..
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autogenous of synthetic grafts
fascia lata muscular pedicle graft from Abdominal wall omental pedicle flap Teflon or silastic sheeting advance diaphragm - cranially- work only when have problem related to last 2-3 ribs. |
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post op care of traumatic diaphragmatic hernia
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careful/ constant monitoring of patient
risk reperfusion injury risk of PRE risk hemorrhage/ bleeders risk pneumothorax Treat PAIN |
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prognosis for patient with Sx for traumatic diaphragmatic hernia in first 24 hrs
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GAURDED
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prognosis for patient with Sx for traumatic diaphragmatic hernia after first 24 hrs.
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Excellent
reported survival rate = 60-90% most deaths are pre-operative many deaths occur during induction pre & post op anagement have greatest impact on mortality rate |
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Does a paracostal hernia require a drainage tube
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NO
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Peritoneal - pericardial hernia etiology
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dogs & cats - always congenital
faulty development parental injury of septum transversum assoc. w/ cardiac abnormalities & sternal deformities Abdominal organs inside PERICARDIAL cavity |
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CS of peritoneo-pericardial hernia
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often asymptomatic
signs may be variabe & intermittent cardiac murmur Right heart insufficiency muffled heart sounds low voltage ECG |
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peritineo-pericardial hernia (PPH) is a congenital associated defects. What others might you see
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ventral/ umbilical hernia
cardiac defects lack of union of the last sternebre associated w/ ventral hernia in 4 out of 13 dogs |
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What ancillary Dx are available in PPH
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survey radiographs
contrast radiographs GI transit celiography US |
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What radiographic signs are seen with PPH
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enlarged cardiac silhouette
discontinued ventral diaphragm structures with gas in pericardial sac sternum defects tracheal elevation |
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Sx treatment of PPH
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abdominal approach to diaphragm
relocate abdominal viscera debride edges of defect and close from dorsal to ventral DON"T close pericardial sac |
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PPH communicates w/ pleural cavity. Tx involves ...
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increasing the defect size to allow reduction
thorasic drainage ICU 24-48 hours |
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the protrusion of the abdominal content included in a peritoneal sac through a natural or acquired opening
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Hernia
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what types of hernias are there
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True
False Congenital & acquired |
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What is included in a hernia
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hernial ring
hernial sac hernial content peritoneal lining |
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the protrusion of the abdominal content through a debilitated area of the abdominal wall due to a surgical or traumatic origin with an intact skin
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eventration
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rupture of all the structures constituent of the abdominal wall with the protrusion of the visceral content, through a wound or surgical incision
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evisceration
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what is a reducible hernia
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content can be manually reduced
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what is a irreducible hernia
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content can not be manually reduced
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what is the difference between coercible & incoercible
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both are reducible- can be replaced
coercible- replaced & retained in the abdomen incoercible- reduced- but NOT retained |
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Irreducible hernia are seperated into incarcerated & strangulated hernias. whats the difference
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incarcerated- impossible reduce, blood supply not alterated
strangulated- impossible reduction of hernia, vascular compromise = ischemic lesions |
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patients with hernias look for possible associated congenital defects such as ...
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PSS
cardiac defects hypospadoa imperforated anus chryptorchidism PPDH |
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Clinical signs of umbilical hernia
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deformation
reducible/ irreducible redness/ pain symptoms will depend on content (i.e. vomit, lethargy) |
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Dx for hernias
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radiology
US |
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When should you do Sx for umbilical hernias
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ASAP
can wait though if small hernia/ incomplete vaccine plan stage of the hernia |
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Herniorrhaphy principles
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1. return all viable content to the abdominal cavity
2. close the hernial ring to prevent recurrences 3. obliteration of redundant tissue in the hernial sac 4. use the patients own tissues whenever possible |
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An indirect inguinal hernia goes into the
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scrotum
more in male |
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a direct inguinal hernia
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is more often in women
creates own sac medial to the scrotal tragectory |
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Differential diagnosis of inguinal hernia
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abscess
mammary neoplasia neoplasia from another origin hematoma inguinal lymph nodes fat eventration |
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what content can be seen in inguinal hernias
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omentum
spleen intestine fat uterus bladder possible ectopic pregnancy |
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Tx inguinal hernias
|
enlarge inguinal ring in a cranial direction
pull intestine out do nice enterectomy & replace into abdomen vest over pant closure |
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Diagnosis of scrotal hernia
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dorsal recumbency
reducible/ irreducible US when in doubt indirect IH pain inflammation usually unilateral hydrocele |
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Surgical treatment of scrotal hernia
with or without orchiectomy which has a higher recurrence |
Orchiectomy decreases chance of recurrence of scrotal hernia
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Sx approach to scrotal hernia
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inguinal approach
reduce content- place in abdomen close tunics. don't strangulate vessels. walking stitch to close big dead spaces |
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Femoral hernia
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protrusion through femoral canal
similar to inguinal hernia |
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Types of femoral hernia
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reducible - palpation femoral ring
irrieducible- similar to IH or inguinal eventration |
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how do you test for femoral hernia
|
palpation standing on hind leg
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post op concerns for hernias
|
atb- only if intestines opened
Nsaids- stretch tissue hurts restrict exercise feeding: soft/ low residue diet |
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which way should you repair a diaphragmatic hernia
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repair dorsal to ventral
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T/F:
pericardial peritoneal hernia doesn't require a throasic tube |
True
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pelvic diaphragm is what type of hernia
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a pseudo or false hernia
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when is perineal hernia seen most
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Females
7-9 year old 95% non castrated 2/3 unilateral right |
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What breeds are more predisposed for perineal hernias
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GSD
Collie Boxer Pekignese Dachshund Mongrel |
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etiology of perineal hernias
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Atrophy (neurogenic & senile)
myopathies endocrine disorders prostatomegaly constipation tenesmus |
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Dx of perineal hernias
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CS
PE radiography (with or with out contrast) US finger palpate - uni/bilaterally |
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types of perineal hernias
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flexure
saccule dilatation diverticle real - seromuscularis seperates false- all layers intact |
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Pelvic diaphragm is different in the cat because...
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No sacrotuberous ligament
internal/ exteral sphincters are striated |
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etiology of perineal hernia
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perineal ureTHROSTOMY
megacolon perineal masses |
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CS of perineal hernia
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constipation
tenesmus inflammation edema dysuria anal dilatation rectal mucosa prolapse dyschezzia |
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Extra things to do in perineal hernias
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bladder
catheterization- make sure bulge isn't entrapped bladder centesis empty anal sacs purse string sutures- may have flexure/ sacculations empty rectum manually, NO Enemas = seeping during Sx |
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Sx approach to perineal hernias
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perineal
lateral |
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Extras for Sx correction of perineal hernias
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anal glands are at 5 & 7 o'clock
double glove incise skin/SQ, curved incision, bluntly seperate flap from peritoneal fashia, fat comes out like grape bunch (whitish/ pink) complicated = maroon or dark red DON"T damage pudendal n. --> INCONTENANCE |
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if prostate is enlarged during perineal hernia repair
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castrate
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where are sutures placed when correcting perineal hernia
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through sacrotuberous ligament
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post op complications of perineal hernia
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rectal prolapse
incontinence dehiscence sciatic nerve lesion- < 5%, suture entrapment. Functional recovery takes 2-4 weeks caudal approach DO NOT approach via herniorrhapy perineal hernias have a 10-46% recurrence |
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Alternate methods for correcting perineal hernias
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implants
polypropelene mesh swine intestinal submucosa support primary repair suggested colopexy - left side cystopexy - rt. side deferentopexy - vas defrens if intrabdominal & perineal procedures done- do intra-abdominal first |
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intact male dogs commonly get what perineal neoplasia
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perianal gland adenoma > adenocarcinoma
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why do cats not get perianal gland adenoma
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no perianal or circumanal glands
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what perineal neoplasia is seen in female dogs & neutered male dogs
(& hyper Ca) |
apocrine cell adenocarcinoma of the anal sac
or Apocrine gland adenocarcinoma |
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Treating anal sac disease
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Medical
empty sacs Atb +/- CCS Sx Anal sac excision |
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Perineal fistulas
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around the anus
have to remove ALL draining tracts epithelium if left behind might cause recurrence of fistula use x mattress NOT simple interrupted |
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what is the Sx treatment for removal of perineal fistulas
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Open
Closed |
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open Sx correction of perineal fistulas
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cut skin
incise SQ incise external anal sphincter |
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Closed Sx correction of perineal fistulas
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don't enter anal sac
plaster of paris/ wax to deliniate contour of the gland folley catheter- saline or air to dilate suposatories and cream for pain |
