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272 Cards in this Set
- Front
- Back
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What is the difference in the cervix between the dog and cat?
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No palpable cervix in the cat
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What is another name for the mesometrium?
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Broad ligament
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From where does the uterine artery arise?
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Internal pudendal artery
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Which arteries also supply the cranial uterine horns?
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Ovarian arteries
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From where do the ovarian arteries arise?
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Branch from the aorta
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Where does the right ovarian artery drain?
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Into the vena cava
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Where does the left ovarian artery drain?
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Into the left renal vein
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The ovaries may also be supplied with blood from where?
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Branches of uterine arteries
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All vessels that are encountered during an OVH are located with what structures?
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-mesovarium
-mesometrium |
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In dogs, the vessels may become obscured by what?
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Fat
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Where is the OVH incision made?
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Ventral midline, from umbilicus up to 4-6 cms from pubis
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What type of incision should be avoided?
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Keyhole
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Once the ovary is located, where is the clamp placed to manipulate the ovary?
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On the proper ligament
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How is the ovary released and elevated?
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Suspensory ligament is torn
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What technique is used to ligate the ovarian pedicle?
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3 clamp technique
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After placing circumferential ligatures, where is the ovarian pedicle transected?
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Between the middle and distal clamps
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In relation to the uterine vessels, where is the mesometrium divided?
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Laterally
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In dogs, where is the uterus transected in reference to the cervix?
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Cranially
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Where is the uterus transected in the cat?
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Caudal 1/3 of the body (no obvious cervix)
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When ligating the uterus, which structures are ligated first?
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Vessels
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What condition can be caused by leaving a remnant of ovary?
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Stump pyometra
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What device can be used in place of ligatures?
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Hemoclips
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The right and left ovarian pedicles are checked for bleeding by using what to retract the abdominal contents?
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Mesoduodenum
Mesocolon |
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Before closing, what structures must be checked?
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Ureters, to make sure they did not get ligated
Check for sponges |
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What is the approach for OVH by laporscope?
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Cat- right flank
Dog- may need both flanks |
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What are the standard OVH post op care procedures?
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-exercise restriction
-e-collar -isolate patients in estrus -good pain control |
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Primary uterine intertia, as a cause of dystocia, is a result of what?
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Lack of oxytocin or calcium, lack of adequate fetal mass (labor never begins)
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What are the causes of secondary uterine inertia?
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Muscular fatigue of uterus secondary to prolonged labor, electrolyte or glucose deficiency
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Which breeds are prone to obstruction of the birth canal due to pelvic-fetal disparity?
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Brachycephalic breeds
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What other conditions can cause obstruction of the birth canal?
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-pelvic mass
-healed pelvic fracture -uterine malposition |
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What are some of the other causes of dystocia?
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-fetal oversize (incomplete twinning, hydrocephalus, single fetus)
-uterine rupture -fetal malposition |
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Prolonged dystocia (greater than 4 hours) can have what effect?
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Stillbirth
Neonatal death |
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What are the clinical indications for C-section?
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-dystocia refractory to medical mgt
-previous dystocia or hysterotomy -pts w/ pelvc fx malunions -prolonged gestation (72 + hrs past due date) -acute collapse -intrauterine fetal death and decay -maternal toxemia -severely damaged or necrotic uterus |
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In prepping for a C-section, how is a local anesthetic administered?
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As a line block or via epidural
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What are the responsibilities of the 2 teams involvd in a C-section?
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1- performs the surgery
2- tends to the newborns |
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What pre-op patient evaluation steps are taken for a C-section?
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-physical exam
-rectal and sterile vaginal exam -abdominal rads -blood glucose and calcium |
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Pre-op patient management includes IV fluids and antibiotics plus what else?
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-correct electrolyte deficiencies
-IV dextrose |
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Is oxytocin given as part of the C-section procedure?
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Only if the cervix is dilated
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When selecting an anesthesia protocol, what drugs should you choose for sedation/anesthesia?
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Drugs that can be reversed in neonates
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Where is the C-section incision made?
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Ventral midline celiotomy, from umbilicus to just cranial of the pubis
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Where is the hysterotomy incision made?
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In the body of the uterus
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What drug is given is a placental attachment site bleeds excessively?
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Oxytocin
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Before closing the hysterotomy, it is important to remember to remove what?
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Any remaining placentas
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Before closing, what procedure would you perform in the case of a gross contamination?
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Copiously lavage with warm saline
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Describe the procedure of an En block C-section.
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-clamp all pedicles
-excise ovaries and uterus quickly -hand off to non-sterile assistants -ligate pedicles routinely |
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When is an episiotomy used?
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-dystocia
-vaginal hyperplasia -urethral catheterization |
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What steps are followed in the care of the newborn from a C-section?
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-remove all fetal membranes
-clamp umbilical cord and ligate -rub vigorously to dry and stimulate respiration -nares, nasopharynx suctioned -doxapram given -mouth to mouth if needed -examine for birth defects |
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What are the potential complications of performing a C-section?
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-bleeding
-pyometra -mastitis -wound infection -peritonitis -hypovolemia/hypotension |
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Most urinary tract surgery procedures are elective unless...
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The urinary tract is obstructed or injured, then it is an emergency
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Which organ of the urinary tract is most affected by trauma? Least affected?
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Most affected- bladder
Least affected- ureters |
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What are the primary step is diagnosing trauma to the urinary tract?
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-Hx
-PE -labs -rads -U/S -exploratory sx |
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Prior to any urinary tract surgery, what must first be corrected?
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Any metabolic disorders (uremia, hyper K+) due to a rupture of a urinary organ
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How are traumatic injuries to the kidneys ( car accident, blunt trauma, FB) treated ?
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-control hemorrhage/bleeders
-excise devitalized tissue -repair injured tissue -conservative Tx -uroperitoneum |
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What is Cullen's sign?
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Bluish periumbilical discoloration due to subcu intraperitoneal hemorrhage
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What types of radiographs are used to diagnose urinary tract problems?
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-survey
-contrast -angiography (U/S) |
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What are the 2 approaches for a nephrectomy?
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-celiotomy
-laparotomy |
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During a total or partial nephrectomy, after the vessels are identified, what structure is then peeled off?
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Capsule (nick and peel off)
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The renal artery and renal vein are ligated seperately...which one is ligated first in the case of bacteria?
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Renal vein
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When performing a partial nephrectomy, what type of tourniquet is used to hold off the blood flow of the artery and vein?
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Rummel tourniquet
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After closing the renal pelvis, in which order to you release the rummel tourniquets?
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Vein first
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Where are the ureters ligated?
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Close to the bladder to prevent backflow and a secondary bladder
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What are the clinical signs of nephrolithiasis?
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-depression
-anorexia -hematuria -pain on flank -incr. BUN if bilateral (not filtering well) |
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What is NOTES?
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Natural Opening Transluminal Endoscopic Biopsy
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What radiographic procedure is used to confirm the Dx of nephrolithiasis?
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IVP
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What surgical procedure is used to remove uroliths?
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Nephrotomy
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If needed, renal vessels can be clamped off for a maximum time of what?
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15 minutes
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Once the stones are removed from the pelvis of the kidney, what should you do next?
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Pass a red rubber catheter down the pelvis and flush retrograde and antegrade
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In male dogs, what is the more common location to find nephroliths?
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In the urethra near the os penis
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What 2 methods can be used to close the kidney after a nephotomy?
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-sutureless: hold the 2 halves together for 5 mins until the blod coagulates
-loose matress sutures of the capsule only |
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What are some of the causes of hydronephrosis?
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-lithiasis
-stenosis -compression -parasite |
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What tests are used to confirm hydronephrosis?
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-IVP
-urinalysis |
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What is the only test that can confirm a diagnosis of D. renale parasites?
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-urinalysis
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In which sex does ectopic ureter occur more often?
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Females (25:1)
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Which occurs more frequently in dogs...unilateral or bilateral ectopic ureter?
Cat? |
Dogs: unilateral (80%)
Cats: bilateral |
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Where is the incision made into the bladder in the case of ectopic ureter?
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Ventrally
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An ectopic ureter fails to open into the bladder and instead, may open where?
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-urethra
-vagina -uterus |
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What is meant by the description of an ectopic ureter that runs an intramural course?
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Runs submucosally
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What is an extramural ectopic ureter?
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Bypasses the bladder completely
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What radiographic technique is used to demonstrate an ectopic ureter?
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Excretory urogram and pneumocystogram
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What is the prognosis after surgery for ectopic ureter?
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60% continent post op
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What surgical correction technique is used for an intramural ectopic ureter?
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Neouretrostomy (new opening into the bladder)
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How is the ureter sutured in the Neouretrostomy technique?
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Mucosa needs to overlap the other tissues
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In the ureterneocystotomy the transplanted ureter is sutured to the bladder wall, what technique is used to open the ureteral end?
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Fishmouth
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What are the 2 primary causes of damage to the ureters?
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-trauma (initial 4 cm near kidney)
-iatrogenic from OVH! |
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Anastomosing a ureter can be made easier by placing what underneath?
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-a piece of colored cloth or rubber
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What suture technique is used when repairing a ruptured ureter?
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Opposite fishmouth
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What surgical procedure allows the ureter a chance to rest and heal?
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Nephrostomy
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How is the nephrostomy tube held in place?
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Chinese finger trap
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If you perform a pyelotomy (to remove a stone) what do you need to be aware of when suturing?
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No sutures in the lumen---nidus for growth
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When performing surgery on the bladder, what methods are used to elevate it from the cavity?
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-stay sutures
-babcock forceps (pack off with sponges) |
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Why should the bladder tissues be handled minimally?
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To minimize edema
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The central ligament of the bladder can be excised, why must the lateral ligaments be preserved?
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They contain the ureters
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Before closing a cystotomy, what should you do?
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Flush the bladder
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How is a cystotomy incision closed?
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-in 1 or 2 layers
-do not go through muscosa -absorbable suture material |
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How is the water test performed after closing a cystotomy?
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-inject water from syringe
-apply pressure by pressing the bladder against the pubis |
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The bladder has great regeneration capacity and can tolerate a cystectomy of up to how much?
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75-80%
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A salvage procedure of the bladder is used to re-establish urinary outflow. What are the potential complications with this procedure?
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Need clients willing to go through the recovery & retraining process
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What is a patent urachus?
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Urachus opens externally at the umbilicus
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What is seen on a PE of a pt. with patent urachus?
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Urine dribbling from umbilicus
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What is the tx. for patent urachus?
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Surgical excision
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What radiographic finding is often seen in cats without signs of UTI?
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Vesicourachal diverticulum
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What is the surgical treatment of a Vesicourachal diverticulum?
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Full thickness dissection
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What are the 5 types of incontinence?
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-urge (inflammation.infection)
-congenital -paradoxical (partial obstruction) -neurogenic -urethral sphincter mechanism incompetence |
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Medically, how would you tx urethral sphincter mechanism incompetence?
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with estrogen, testosterone, sympathomimetic drugs
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What sugrical procedures can be used to tx. urethral sphincter mechanism incompetence?
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-colposusension
-cystourethropexy -injecting teflon or collagen around sphincter |
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Bladder lithiasis occur at what age typically?
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3-7 years
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90% of lithiasis are located where?
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Lower urinary tract
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What are the types of bladder stones commonly found in the dog and cat?
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-struvite
-cystine -ammonium urate -oxalate |
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Why are Dalmations prone to ammonium urate stones?
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Lack of an enzyme
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What is the possibility of bladder recurrence in the dachshund?
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Dachshund: 47%
Dalmation: 33% Schnuazer: 18% |
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What types of neoplasia affect the bladder?
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-leiomyoma (fibroma)
-transitional cell carcinoma -adenocarcinoma -leiomyosarcoma -rhabdomyosarcoma |
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What are the signs of bladder trauma?
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-dysuria, anuria
-hematuria -fluid in the abdomen -swelling & discoloration of the skin -abdominal distension and pain -uremia |
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What are the causes of bladder rupture?
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-trauma (blunt or sharp)
-obstructions -repeated catheterization -chronic cystitis |
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Uroabodmen is a medical emergency involving what conditions?
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-hyperkalemia
-uremia -dehydration |
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What type of catheter can be used for abdominal centesis, that has a safety tip?
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Purkel catheter
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What is the normal range for BUN of the abdomen?
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Zero
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What are the first steps in stabilizing a patient with bladder rupture?
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-fluid tx
-decrease kalemia -antibiotic tx (bacterial translocation) -urinary diversion -exploratory celiotomy |
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Which surgical procedure will allow the bladder to drain and let it rest and heal?
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Tube cystostomy
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What are the indications for performing urinary diversion surgery?
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-neoplasia
-trauma -neurogenic incontinence -temporary- following sx |
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What are the causes of feline urinary incontinence?
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-neurogenic
-iatrogenic (sx) -juvenile (vaginal aplasia w/ abnormal bladder neck and short urethra -FLUTD |
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When would you perform a urethrostomy?
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-non displaceable stones
-chronic stone formation -urethral stenosis -penile trauma |
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When performing a pre-scrotal urethrostomy on a male dog, how do you locate the urethra?
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-Find the inverted V of the os penis, urethra lies in it
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How are the sutures placed when performing a urethrostomy?
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Suture the mucosa to the skin
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What instrument makes suture removal easier?
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Spencer stitch removal scissors
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When performinga perineal urethrostomy on a tom cat, what additonal procedure is required?
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Partial penile amputation
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What are clinical signs of urethral trauma?
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-dysuria
-anuria hematuria -pain -hematomas |
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What are some causes of urethral trauma?
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-pelvic fx
-fracture of os penis (canine) -penile trauma -iatrogenic trauma (catheter induced) -contusion -laceration -rupture -obstruction |
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Clinical signs of urethral laceration or rupture can vary depending on the location of the injury which can be defined as what?
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Intrapelvis or extrapelvic
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What are some signs of intrapelvic urethral injury?
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-vomiting
-dehydration -abd fluid -abd guarding -hematuria -stranguria |
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What are some signs of extrapelvic urethral injury?
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-hemturia
-stranguria -subcutaneous fluid around thighs & perineum -cellulitis |
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The clinical signs seen with intra/extrapelvic urethral injury are releated to what?
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Where the urine is going
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What are the lab findings on a pt. with intrapelvic utrethral injury?
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-hemoconcentration
-elevated BUN (doubles in 5 hours) -elevated creatinine (doubles in 24 hours) -elevated K+ and Cl- -decreased Na+ |
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What are the lab findings on a pt. with extrapelvic utrethral injury?
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-no early findings
-late changes associated with tissue necrosis |
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What are the 4 types of urtherostomy that can be performed?
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-prescrotal
-scrotal -perineal -prepubic |
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How can the healing process be improved for a urethral laceration?
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-by placement of a soft rubber catheter (splint)
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How is a laceration of the urethra treated?
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-catheter diversion (Foley) 5-10 days
-rarely require suturing -topical tx of devitalized skin -systemic antibiotics |
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Hos is a complete rupture of the urethra treated?
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-urethral anatomosis
-urethral or antepubic catheter diversion, 5-10 days |
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In the sx tx of a traumatic injury to the urethra, a symphysiotomy may be needed, what is this procedure?
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Splitting the symphasis in 2
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What is an antepubic urethrostomy?
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Creation of a urethrostomy on the ventral body wall, cranial to the pubis
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When is an antepubic urethrostomy indicated?
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Salvage procedure for stricture, neoplasia, or trauma of pelvic, perineal or abdominal urethra
(recurrent stricture of perineal urethrostomy) |
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What are the disadvantages of antepubic urethrostomy?
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-urine scalding
-ascending urinary tract infection -potential for urinary incontinence |
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What is the sx tx for urethral prolapse?
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Suture urethra to penis
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What is FLUTD?
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Feline Lower Urinary Tract Disease
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FLUTD affects what % of cats?
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0.6- 1% of the general population
(2-6 years of age) |
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In which breed is their an increased risk of Flutd?
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-Persian
-reduced risk in Siamese |
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FLUTD is a syndrome of what symptoms?
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-dysuria
-hematuria/crystalluria -licking of genitals -reduced emission -urethral obstruction -sandy material -crying -constipation (owner thinks) SHOCK |
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UTI's are seen how often in FLUTD cases?
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-3% first time
20% after catheterization due to obstruction |
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How is FLUTD first treated?
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-medically
-diet |
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What is THP (Tamm-Horsfall) muscoprotein?
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-mucoprotien that is twice as high in the urine of cats with FUS
-number and size of struvite crystals when added in vitro to feline urine |
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How does a urethral plug differ from a urolith?
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plug: matrix of gelatinous structure, amorphous, friable or doughy
urolith: structure organized internally, non deformable, solid |
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Urethral obstruction in the cat is an emergency, how is it diagnosed?
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-PE
-urinalysis -culture/sensitivity -CBC -chem panel |
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The perineal urethrostomy in the cat is also called what technique?
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Wilson & Harrison
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When is the perineal urethrostomy procedure used?
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-salvage procedure to tx recurrent FLUTD and calculi in the male cat
-irreversible mural or extramural lesions causing recurrent/persistent obstruction -frequent obstrcutions despit medical tx |
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What does the procedure include?
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-the pelvic urethra is opened and sutured to the skin
-the penis is partially amputated -the remaining skin incision is closed |
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What position is the cat placed for the perineal urethrostomy sx?
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Trendelenberg
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What is the first step in the perineal urethrostomy procedure?
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Place a purse string suture in the anus
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Once the urethostomy is made, how do you check its patency?
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Slide a curved hemostat in
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Post op care of the perineal urethrostomy pt includes what?
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-indwelling catheter only if urethral tear is present
-remove sutures in 7-10 days -e collar -remove regular litter box |
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What are the common post op complications with perineal urethrostomy sx?
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-recurrent FLUTD and bacterial cystitis
-urethral stricture -urolithiasis |
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What is the #1 cause of post complications?
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Surgical technique
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What are some less common complications from perineal urethrostomy sx?
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-subcu urine leakage
-urine scald dermatitis -urinary incontinence -urethrorectal fistula -perineal hernia -rectal prolapse |
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What can be the cause of necrotic perineum from sx?
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Possible vascular damage from surgery
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What so you do in the case of urethral stricture/stenosis?
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Redo sx
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In the dog, where is the prostate located?
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Within the pelvic canal
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Was is BPH not a common condition of cats?
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Prostate is disseminated
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What is BPH?
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Benign Prostatic Hypertrophy- enlargement of normal prostatic tissue
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What is the cause of squamous metaplasia?
|
Estrogen production (Setoli cell tumor)
|
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What are some of the other diseases of the prostate?
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-Prostatic & paraprostatic cysts
-Prostatic abscess -Prostatitis -Prostatic neoplasia |
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What are the clinical signs of prostatic disease?
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-straining to urinate
-voiding small amounts of urine frequently -blood tinged diarrhea -dripping blood from penis -constipation & straining to defecate -passing small ribbon shaped feces -holding tail sightly away from rear end -hyperthermia -weight loss -lethargy -hunch gait or stance |
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The hunch gait or stance can also be in response to what condition?
|
Hip dysplasia
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How is prostate disease diagnosed?
|
-PE w/ digital rectal palpation
-ua, urine culture -abd and chest rads abd U/S |
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What additional diagnostics can help to diagnose prostatic disease?
|
-ejaculate evaluation
-prostatic massage -fluid: culture/sensitivity -FNA (cytology) |
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A prostate bx is performed with what type of needle?
|
-percutaneous- Tru-cut
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Prostatic abscess is an ascending infection from where?
|
-LUT or testes (B. canis)
|
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What are the clinical signs of prostatitis?
|
-lethargy
-hyperthemia -anorexia -urethral discharge -abnormal way of walking |
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How is prostatitis diagnosed?
|
-rectal: painful, enlarged +- soft areas
-UA: hematuris.pyuria -culture and sens -US: hyper/hypoechoic areas -Rads: +- enlarged prostate -hematology: leukocytosis |
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What types of antibiotics are used to tx prostatitis?
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Drugs that cross the prostatic-blood barrier
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How are abscesses from prostatitis tx.
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-surgically, omentalize
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What is the difference between a prostatic cyst and a paraprostatic cyst?
|
-paraprostatic cyst usually dont communicate with the prostate parenchyma
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How are prostatic cyst and a paraprostatic cyst diagnosed?
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Signs: large abdominal mass
Rectal: cysts: large, fluctuant, non-painful paraprostatic cyst: usually not paplpated per rectum Micturation: normal or hematuria |
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What diagnostic test may help evulate prostatic cyst and a paraprostatic cysts?
|
-rads: contrast may help
-U/S -FNA |
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What are the surgical options for treating prostatic cyst and a paraprostatic cysts?
|
-resect or omentalize cyst
-omentalise -castrate |
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What technique is now used to treat canine prostrate carcinoma?
|
Partial prostatectomy via YAG laser to eliminate post op incontinence
|
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What types of neoplasia affect the prostate of dogs?
|
-adenocarcinoma
-transitional cell carcinoma |
|
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Where do prostatic neoplasias metastasize to?
|
-lymph nodes
-bone -bladder -rectum -muscles |
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What are the signs of prostate neoplasia?
|
-tenesmus
-stranguria -hematuris -incontinence -rear limb weakness |
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What diagnostic tests can help in diagnosing neoplasia?
|
-rectal: firm, irregular nodule, +-pain
-rads for mets U/S -fna |
|
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What are the 3 surgical approaches to the thorax?
|
-lateral thoracotomy
-median sternotomy -thransthoracic |
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A right lateral thoracotomy approach would be used to access the throacic dog at the 8 ics of which species?
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Dog (thorcic duct on left in cats)
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An esophageal f.b. could be approached at what level with a right lateral thoracotomy?
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4th ics
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Which thoracotomy is more common...left or right?
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Left
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On a left thoracotomy the cranial lung lung is located where?
Caudal lung lobe? |
Cranial: 5th ics
Caudal: 7th ics |
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For the left lateral thoracotomy, the thorax is elevated so that which point is the highest
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4th ics
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Where is the thoracotomy incision made?
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Parallel to the ribs
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Initially, which muscles are transected?
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-cutaneous muscles
-latissimus dorsi |
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Performing a thoracotomy means you have to do what about the patient's breathing?
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Capture it---bag or ventilator
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What type of retractors are used during a thoracotomy?
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Finochettti
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The scalenus muscle is well developed in which species?
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Cheetah
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When performing a left lateral thoracotomy at the 4th ics, which nerve do you need to watch for?
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Phrenic n.
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Prior to closing the thoracotomy, what must you place?
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Thoracostomy tube
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When closing the thoracotomy what suture pattern is used for the intercostal muscles?
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None..not closed
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In relation to the thoracotomy incision, where id the stab incision made for the thoracostomy tube?
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2-3 ics dorsal and caudal
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What is the purpose of the thoracostomy tube?
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re-establish negative pressure
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How long is the chest tube maintained?
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Until pleural space is free of air and fluid
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What methods can be used to provide post op analgesia?
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-intercostal nerve blocks
-narcotics -intrapleural (must be give with affected side down) |
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When is a median sternotomy indicted?
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-access to entire lung field
-subtotal pericardectomy -aortic valve replacement |
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During a median sternotomy, how do u control the marrow bleeding from the cut sternum?
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beeswax
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How are the sternabrae closed?
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Orthopedic wire in a figure 8
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What is the preferred method of inducing anesthesia in a patient in respiratory distress?
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Intubate without delay do not use mask or chamber
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What is the pathiphysiology of a pneumothorax?
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-air accumulates in the pleural cavity, leading to loss of normal negative pressure
-lungs undergo elastic recoil and collapse |
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What are the sources of the air in a closed pneumothorax?
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-respiratory tract
-esophagus (fb) |
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What is the source of air in an open pneumothorax?
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Wound in thoracic wall
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What is a subcutaneous pneumothorax?
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occurs in the lungs, bleb/bullae blow
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What is the tx for a mild closed pneumothorax?
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-if mild, cage rest and obeservation
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What is the term for normal lung sounds?
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Vesicular murmur
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How would you tx a moderate closed pneumothorax?
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-respiratory distress
-thoracocentesis, thoracosotomy tube if needed |
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How would you tx a severe closed pneumothorax?
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-progressive, marked resp distress
-tube thoracostomy with suction drainage of Heimlich valve -exploratory thoracotomy if leak is significant of persists > 5-7 days |
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What are some causes of an open pneumothorax?
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-bite wounds
-stab wounds -gunshot wounds -impalement -inadeqaute thoracic closures |
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What is the cause of a flail chest?
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-2 consective ribs broken in 2 places
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What type of breathing is seen with flail chest?
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Paradoxical
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What type of wire is used to repair the broken ribs?
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Kirschner wire
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Why isn't a diaphragmatic rupture a true hernia?
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doesn't have peritoneal or serosa covering
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Serous fluid collecting in the lungs is referred to as what condition?
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Hydrothorax
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A rupture of the thoracic duct can result in what condition of the thorax?
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Chylothorax
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What is the sx tx for chylothorax?
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TD ligation
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A thoracotomy to tx a PDA in a dog is performed at what level?
For a cat? |
Dog: 4th cs
Cat: 5th ics |
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What type of murmur does a PDA produce?
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Continuous machinery mumur at left heart base
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What 2 sx approaches are available to treat PDA?
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-ligation
-coil occlusion |
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What type of suture material is used for a ligation of a PDA?
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Silk, braided (won't loosen)
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Which side of a PDA is ligated first...pulmonary or aortic?
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Aortic
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What is the Branham reflex?
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Reflex bradycardia may occur after ligating
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How can the Branham reflex be prevented?
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Tightening of the 1st ligature slowly
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Which is the most common of the 7 vascular ring anamolies found in dogs?
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PRAA
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True or False. The resulting dilated esophagus from PRAA should be surgically resected?
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False. Do not resect or plicate, growth will deal with it.
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What important structure must you be aware of when correcting a PRAA?
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Vagus nerve
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Post op care for PRAA includes what?
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-tx pneumonia if necessary
-elevate feeding |
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40% of PRAA cases will also present with what anomaly?
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Persistent left cranial vena cava- displace- don't ligate
Alos may be a hemiazygos vein |
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What is an en block resection of the thoracic wall?
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Removal of all tissues including pleura, ribs, intercostal muscles, fascia and skin
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When would an en block resection be indicated?
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-neoplasia
-extended trauma of the thoracic wall -bacterial or mycotic infection -multiple fistulae |
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What are the most frequent occuring neoplasias of the thoracic wall?
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-osteosarcoma
-chondrosarcoma |
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These tumors commonly arise where?
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At the level of the costochondol junction
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Why is polypropylene mesh helpful in closing a large resection?
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-non reactive
-resistant to infections -excellent tensile strength -porous -does not fragment |
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What is a diaphragmatic advance?
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Thoracic defect is converte dinto an abdominal defect
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What are the advantages of a diaphragmatic advance?
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-simple technique
-no need for prosthesis -no rejection -good functional results -good cosmetic aspect |
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How are small defects of the thoracic wall closed?
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Muscular layer is closed in a centripetal way, beginning from the four corners
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How are big defects of the thoracic wall closed?
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use myocutaneous flaps and/or omental pedicles
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What type of catheter is used for a thoracocentesis?
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Turkel catheter
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How big must the tube be that is used in a tube thoracostomy?
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Diameter must be similar to the main stem bronchus (or 1/2- 1/3 the width of the ics)
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A thoracic drain tube should have how many holes in it?
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No more than 3
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How big should the holes be?
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1/4 the diameter of the tube
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How is an argyle catheter place for a thoracostomy?
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Thumped into place (1 hit)
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When placing a drainage tube, how is the tube held by the forceps?
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Forceps should extend just beyond the end of the tube
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The thoracostomy tube is hooked to what on patients under 15 kgs?
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3 way stopcock
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The thoracostomy tube is hooked to what on patients over 15 kgs?
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Heimlich valve
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What is PRE?
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Plumonary Re-exapansion Edema
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How can PRE be reduced?
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-insufflate lungs slowly
-roll pt to 4 positons -cupping |
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If using a suction system with a tube thoracostomy, the pressure can be no higher than what?
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40 mm Hg
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When using a water seal with a thoracostomy, where should the bottle or evac unit be placed?
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20-30 cm below the pt
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How is the pt positioned is using Bupivicaine in the thoracic cavity?
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Side that needs to anesthetized is down
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When do you remove the chest tube?
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20 kg dog
When collection of fluid is 50 cm3 or less in 24 hrs When rads at 24 hrs does not show air or free fluid -when drainage is 2 ml/kg/day |
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What 2 approaches are considered for a subtotal pericadectomy?
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-median sternotomy (preferred)
-lateral thoracotomy (4-5 ics) |
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What is the px of a pt after sx for granulomatous pericarditis?
Idiopathic pericarditis? |
granulomatous pericarditis: Fair
Idiopathic pericarditis: good |
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What is a pleuroperitoneal shunt?
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Some cases of pericarditis, after tx, have recurrent effusion which can be shunted from the chest to the abdomen via a pleuroperitonel shunt
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When would a total lung lobectomy be performed?
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When there is a dz process involving the entire lobe or area near hilus of lobe
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When is a partial lobectomy considered?
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Focal lesions distal in the lung
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For a complete lobectomy, where are the vessels and bronchus ligated?
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At the hilus
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How is the pulmonary artery and vein ligated?
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3 ligatures, middles is transfixing
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If dealing with a neoplasia, which vessel is ligated first?
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Pulmonary vein
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For the complete lobectomy, how is the bronchus transected?
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Between 2 crushing clamps- 1-2 rows of matress sutures are placed through bronchus, cut margin is over sewn with simple continuous sutures
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How is a partial lobectomy performed?
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-crushing clamps place across lobe proximal to the lesion
-1-2 rows cont. horizontal mattress sutured placed proximal to the clamps (3-0 to 4-0) |
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What instrument can be used for complete lobectomy?
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TA stapler
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At the completion of a partial lobectomy, how is the area checked for leaks?
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Sterile saline dripped across the suture line while the lung is inlflated
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