Surgery P&p - Final Exam Material

Front 1

in which tissue is the linea alba closed?

Back 1

the EXTERNAL RECTUS FASCIA

Front 2

which size sutures and which pattern should be used to close the linea alba?

Back 2

- 0, 2-0, 3-0
- simple interrupted
- if simple continuous is used, use one suture size larger than interrupted

Front 3

what is the purpose of abdominal subcutaneous closure? Which pattern is used?

Back 3

to ablate dead space and prevent seroma formation. A simple continuous pattern is used.

Front 4

what are five common sites of hemorrhage in an ovariohysterectomy?

Back 4

1. ovarian pedicles
2. uterine pedicle
3. broad ligament
4. abdominal wall muscle
5. subcutis

Front 5

what are four complications of the incision in an ovariohysterectomy?

Back 5

1. swelling
2. seroma
3. self-trauma
4. dehiscence and hernia of viscera through incision

Front 6

what are four mistakes that can lead to ligation of a ureter during ovariohysterectomy?

Back 6

1. poor technique
2. small incisions
3. FULL BLADDER
4. hemorrhage and poor visualization where clamp is applied

Front 7

what are six long-term complications of ovariohysterectomy?

Back 7

1. obesity
2. behavioral changes
3. urinary incontinence
4. orthopedic problems
5. osteosarcoma
6. coat issues (more shedding; smooth to fluffy)

Front 8

what causes recurrent estrus in an ovariohysterectomy?

Back 8

ovarian remnant

Front 9

why do we express the bladder before an ovariohysterectomy surgery?

Back 9

better visualization and less risk of damaging the ureter

Front 10

what causes fistulous tracts in an ovariohysterectomy?

Back 10

inappropriate suture

Front 11

when do you NOT need stick ties to ligate the uterine pedicles?

Back 11

when it is small enough to crush and ligate with a single clamp.

Front 12

what is the surgical definition of "infected tissue"?

Back 12

> 10^5 bacteria per gram of tissue

Front 13

what phase of the estrous cycle is associated with pyometra?

Back 13

diestrus

Front 14

when do bitches, not on hormone therapy, typically get pyometra?

Back 14

8-12 weeks after estrus

Front 15

what type of drugs can lead to pyometra in the bitch?

Back 15

progesterone analogs

Front 16

what are four bacteria associated with pyometra in the bitch/queen?

Back 16

1. E. coli
2. Staph
3. Strep
4. Klebsiella

Front 17

what are four clinical signs of pyometra in the bitch/queen?

Back 17

1. anorexia
2. PU/PD (endotoxemia)
3. fever
4. systemic illness

Front 18

what are four ways in which pyometra is diagnosed in the bitch/queen?

Back 18

1. physical exam
2. ultrasound
3. radiograph
4. clinical pathology

Front 19

clinical pathology of pyometra in the bitch/queen:
- CBC
- UA
- blood chemistry

Back 19

- leukocytosis, anemia
- UTI
- ± azotemia (renal or prerenal)

Front 20

what classification of sterility is a pyometra ovariohysterectomy surgery?

Back 20

contaminated

Front 21

if a bitch has pyometra, but the owner wants to breed before OVH, how would you accomplish this?

Back 21

- must be an open pyometra
- administer PGF2α
- must breed her
- next estrus after puppies, perform an OVH

Front 22

what is a "sterile pyometra"

Back 22

a misnomer. Actually hydrometra, which has a different pathogenesis.

Front 23

what is a "stump pyometra"

Back 23

infection of the remnant of the uterus because ovarian tissue was left in a spay

Front 24

in an ovariohysterectomy to correct pyometra, how does the incision differ from that of a normal spay surgery?

Back 24

larger; extends cranial to the umbilicus

Front 25

how do the ovarian pedicles differ in an ovariohysterectomy to correct pyometra surgery?

Back 25

they are usually more friable

Front 26

in an ovariohysterectomy to correct pyometra, what should you do after exteriorizing the uterus?

Back 26

pack the abdomen with lap sponges in case the uterus ruptures

Front 27

what breeds of dogs would you plan a C-section for?

Back 27

brachycephalic breeds such as English bulldogs and French bulldogs

Front 28

dystocia in the bitch:
- what % are medically managed and what % surgically managed?
- 3 etiologies for dystocia

Back 28

- 60% surgery, 40% medical
- uterine inertia, oversized/malpositioned fetuses, small pelvis

Front 29

what are three common metabolic abnormalities in a bitch with dystocia, which should be corrected before C-section?

Back 29

1. dehydration
2. hypoglycemia
3. hypocalcemia

Front 30

what is a minimum database for a C-section in the bitch?

Back 30

PCV, TP, chemistry desirable

Front 31

what are two indications for elective C-section in the bitch?

Back 31

1. brachycephalic breed
2. pelvic fracture malunions

Front 32

how is a bitch anesthetized for a C-section so that her pups are not hurt by the drugs

Back 32

- induce with propofol and maintain with propofol CRI
- glycopyrrolate (doesn't cross placenta)
- inhalant after the pups have been removed and umbilical cords severed

Front 33

what is the basic procedure for a canine C-section?

Back 33

1. need to work fast with anesthesia, surgery, and delivery
2. cautiously cut into the uterus - doesn't matter where
3. gently milk each fetus to incision and remove
4. open amniotic sac, clamp umbilicus, and cut
5. give neonates to tech for resuscitation and narcotic reversal
6. gently remove placentas
7. close uterus (3-0/4-0 absorbable; continuous appositional or double-layer inverting pattern)
8. lavage abdomen with warm saline
9. close (linea, ID, no skin sutures)

Front 34

how do you care for the neonatal pups after C-section and narcotic reversal?

Back 34

- clean the airway and nares
- ligate umbilical cord
- examine for abnormalities (especially palate and anus)

Front 35

what is the difference between a hernia, incarcerated hernia, and a strangulated hernia?

Back 35

- hernia: can be reduced and blood supply intact
- incarcerated: cannot be reduced, but blood supply intact
- strangulated: can't reduce and blood supply cut off

Front 36

what is the difference between a true hernia and a false hernia?

Back 36

- a true hernia is enclosed in the peritoneal sac
- a false hernia is a protrusion of organs outside the abdominal opening without a peritoneal sac

Front 37

what are the three parts of a hernia?

Back 37

1. hernial ring or neck
2. hernia sac
3. contents of the hernia

Front 38

how does size of the hernial neck correlate with its severity?

Back 38

smaller = more dangerous because of increased risk of strangulation

Front 39

what are two common locations for hernias caused by trauma?

Back 39

abdomen and diaphragm

Front 40

how does an animal present with a strangulated hernia compared to a non-strangulated hernia?

Back 40

- strangulated may be painful; non-strangulated are usually not painful
- strangulated are not reducible; non-strangulated are usually reducible (if they are not incarcerated)
- strangulated patents may have an intestinal obstruction, vomit, and be shocky

Front 41

what is the best way to confirm a strangulated hernia?

Back 41

ultrasound

Front 42

what are two etiologies of an umbilical hernia?

Back 42

1. congenital/genetic
2. improper transection of umbilical cord

Front 43

what do you tell the owner that has a dog with a congenital umbilical hernia.

Back 43

do not breed - recommend spay/neuter

Front 44

what are two ways in which improper transection of the umbilical cord may lead to an umbilical hernia?

Back 44

1. too close to the body wall
2. failure of the umbilical ring to close normally

Front 45

how does an umbilical hernia present on exam?

Back 45

- soft, fluctuant swelling at the umbilicus
- may or may not be reducible
- palpable defect in body wall

Front 46

umbilical hernia in dogs:
- when do they outgrow them?
- how dangerous are they?

Back 46

- they do not outgrow them
- they are not very dangerous unless they are large enough to allow herniation of the intestine, which would pose a risk of strangulation

Front 47

when is correction of an umbilical hernia in a dog not necessary?

Back 47

if the ring is < 4 mm and the contents of the hernia are omentum or falciform ligament (as opposed to intestines)

Front 48

what is a common time to repair a benign umbilical hernia?

Back 48

at spay or neuter

Front 49

a large umbilical hernia that extends to the xyphoid is congenital and is often associated with which other congenital defect?

Back 49

peritoneal-pericardial hernia

Front 50

what is the basic procedure to correct an umbilical hernia?

Back 50

1. dissect skin and subcutis off of the sac to expose the linea alba cranial and caudal to the ring
2. open the hernia sac
3. replace contents into the abdomen
4. excise sac and debride edges of the ring
5. close linea with simple interrupted sutures
6. excise excess skin
7. routine closure

Front 51

who most commonly gets inguinal hernias that are
- congenital?
- acquired?
- how common are each of these?

Back 51

- congenital: males > females (rare)
- acquires older intact females (common); rare in males

Front 52

how does an inguinal hernia present on exam?

Back 52

painless unilateral or bilateral mass in the inguinal area that is soft in consistency.

Front 53

what are inguinal hernias in females often confused with? How do you make sure it is a hernia?

Back 53

lipomas and mammary neoplasia. Hernias can be pushed back into the inguinal ring.

Front 54

what are the two basic approaches to repair of inguinal hernias? Which is best and why?

Back 54

1. conventional inguinal approach where the hernia is incised and reduced over the medial aspect of the swelling.
2. midline approach (better of the two), where both inguinal rings can be visualized; the linea is incised to reduce

Front 55

when repairing inguinal hernias, which vascular structures should you be careful not to damage?

Back 55

pudendal artery and vein, which pass through the external inguinal ring

Front 56

what are three differentials for severe scrotal swelling post-castration?

Back 56

1. scrotal hernia
2. seroma
3. hematoma

Front 57

why should you not drain a scrotal hematoma?

Back 57

because you might inoculate it with bacteria. A hematoma is like blood agar.

Front 58

what are four reasons that cats scratch?

Back 58

1. scent marking
2. visual marking
3. muscle stretching
4. claw conditioning

Front 59

what are 5 aspects of an effective scratching post?

Back 59

1. stable. Hanging things don't work
2. texture (carpet, rope)
3. tall enough so that the entire length of the cat is stretched out
4. prominent location
5. near sleeping spot

Front 60

what percentage of cats are declawed?

Back 60

24%

Front 61

what have studies shown about the behavioral differences between cats with claws and declawed cats

Back 61

- declawed cats more likely to jump on counters
- nothing else

Front 62

what are the short-term and long-term complication rates of feline declaw?

Back 62

- short term: 25%
- long term: < 1-10%

Front 63

what are 6 short term complications of feline declaw?

Back 63

1. pain/lameness
2. bleeding
3. infection
4. swelling
5. dehiscence
6. behavioral change (avoid litter, hiding, etc.)

Front 64

what classification of sterility is a feline declaw surgery?

Back 64

contaminated

Front 65

how long should you keep a cat in the hospital after a declaw?

Back 65

24 hours

Front 66

what is a very bad complication of a declaw surgery that may result in amputation of one or both paws?

Back 66

ischemic necrosis

Front 67

what are five long term complications of feline declaw surgery?

Back 67

1. P2 protrusion
2. burned P2 (laser)
3. claw regrowth (because germinal center not removed)
4. palmigrade stance
5. chronic pain (this is bad)

Front 68

what is a complication of tourniquet usage in a declaw?

Back 68

radial nerve damage

Front 69

if the radial nerve is damaged due to a tourniquet (in an onychectomy), and this damage is not permanent, how long does it take for the nerve to return to normal?

Back 69

6 weeks

Front 70

what is the maximum time you should occlude the blood vessels with a ring block of the manus (e.g., for an onychectomy)?

Back 70

30 minutes

Front 71

what are three basic onychectomy surgical techniques that are used today?

Back 71

1. shears
2. P3 blade
3. P3 laser

Front 72

what is a defunct surgery that was once used as an alternative to onychectomy in the cat?

Back 72

flexor tenonectomy

Front 73

what are advantages and disadvantages of flexor tenonectomy over onychectomy in the cat?

Back 73

- advantages: less immediate pain, faster recovery time
- disadvantages, partial use of nails, nail clipping, 30% can't clip nails, thick and rough nails, high owner dissatisfaction

Front 74

guillotine (shears) method for onychectomy in the cat: advantages and disadvantages over P3 blade

Back 74

- advantages: fast, easy to learn, less pain than blade and laser, flexor tendons left intact
- disadvantages: very high complication rate, failure to remove entire ungual crest

Front 75

guillotine (shears) method for onychectomy in the cat:
- complication rate
- most common complication

Back 75

- 75-80% complication rate
- most common: take P2 and have osteomyelitis

Front 76

what blade do you use for a P3 disarticulation (onychectomy) in the cat?

Back 76

#10 or #11

Front 77

P3 blade onychectomy in the cat
- advantage over guillotine method
- disadvantages

Back 77

- advantage: lower complication rate
- disadvantages: not as fast, harder to master, more post-op pain, flexor tendons cut

Front 78

what is removed and what should you try to spare in a P3 blade onychectomy in the cat?

Back 78

- remove the entire ungual crest and flexor process
- spare the digital pad

Front 79

what are five complications of onychectomy and what technique (guillotine or P3 blade) is associated with each complication?

Back 79

- regrowth (10%): guillotine
- infection (16%): guillotine
- palmigrade stance (1.7%): both
- chronic lameness (0.8-1.4%): both

Front 80

P3 laser declaw:
- advantages
- disadvantages
- complications

Back 80

- advantages: less pain for 24 hours, less bleeding, no need to bandage
- disadvantages: steep learning curve, expensive equipment
- complications: burned P2, delayed necrosis, late bleeding if they run around too much

Front 81

what are four medications used to control pain associated with onychectomy in the cat?

Back 81

1. meloxicam
2. fentanyl patch
3. buprenorphine
4. carpal ring block

Front 82

how do you perform a carpal ring block in the cat?

Back 82

1. bupivacaine and lidocaine in the same syringe
2. prep area
3. flex carpus and inject 0.2 mL SC with a 25-gauge needle over the radial nerve branches
4. massage
5. 0.2 mL lateral/medial aspect of carpal pad
6. massage

Front 83

what type of suture is used to close an onychectomy in the cat?

Back 83

plain gut, Vicryl Rapide, or other rapidly disappearing suture

Front 84

how long should you keep a cat in the hospital after declaw?

Back 84

3 days

Front 85

comment on bandaging after declaw
- what is best
- time
- technique

Back 85

- no bandage is best
- short time period is best if they are used
- spiral tape, tape strips to keep them on; make the bandage easy to remove to ↓ sloughing of skin

Front 86

what are two rule-outs for chronic pain in a feline declaw?

Back 86

1. mechanical damage
2. infection

Front 87

what are two drugs used to treat chronic pain associated with feline declaw

Back 87

amitriptyline and gabapentin

Front 88

what is the #1 reason for malpractice lawsuit in small animal medicine?

Back 88

declaw gone bad

Front 89

to protect yourself legally, what must you insist on doing after declaw, or have a waiver signed in lieu?

Back 89

radiographs

Front 90

opening of the abdominal cavity is called what?

Back 90

celiotomy

Front 91

what is the difference between celiotomy and laparotomy

Back 91

celiotomy is entering the abdominal cavity; laparotomy is a celiotomy performed lateral to midline

Front 92

for non-emergencies, what is a good minimum database for an exploratory celiotomy?

Back 92

- appropriate blood work
- thoracic radiographs
- special imaging ± contrast

Front 93

what has replaced exploratory celiotomies in recent years?

Back 93

ultrasound

Front 94

what are three goals of exploratory celiotomy?

Back 94

1. complete and thorough exploration
2. BIOPSY
3. culture when appropriate

Front 95

what antibiotic is commonly used perioperatively for an exploratory celiotomy?

Back 95

cefazolin

Front 96

what are the two most important aspects of an effective exploratory celiotomy?

Back 96

good visualization and palpation

Front 97

for a complete exploratory celiotomy, how large should your incision be?

Back 97

xyphoid to pubis

Front 98

what is the most effective way to control hemorrhage in an exploratory celiotomy surgery?

Back 98

electrocautery

Front 99

what abdominal structure must be removed for an effective exploratory celiotomy in the dog?

Back 99

falciform ligament

Front 100

from what embryologic structure does the falciform ligament originate?

Back 100

umbilical vein

Front 101

when removing the falciform ligament in a dog, what must be done to prevent complications?

Back 101

clamp and ligation to prevent hemorrhage; the falciform ligament is highly vascularized in the dog

Front 102

what type of retractors are used in an exploratory celiotomy? (2)

Back 102

1. Balfour (Small and Medium animals)
2. Frazier (small animals)

Front 103

in an exploratory celiotomy, what should be done before opening the linea alba?

Back 103

palpate for adhesions so that you don't cut viscera

Front 104

what is a precaution to take when using retractors in a celiotomy?

Back 104

make sure intestinal loops don't get caught in the retractor blade

Front 105

what two things maximize visual exposure of an exploratory celiotomy?

Back 105

1. large incision
2. good lighting

Front 106

what is a good thing to do in order to completely explore the cranial viscera of the abdomen during an exploratory celiotomy?

Back 106

exteriorize and pack off the spleen

Front 107

how do you keep tissues "happy" when doing surgery?

Back 107

ensure they are moist, but don't use so much liquid that you wet the drapes and get strikethrough

Front 108

if you see a lesion during an exploratory celiotomy, how do you determine what it is?

Back 108

- biopsy
- don't guess or you might be wrong and get sued

Front 109

what are 6 systems examined in an exploratory celiotomy?

Back 109

1. GI
2. hepatobiliary
3. urinary
4. lymphatics
5. endocrine (adrenals and pancreas)
6. repro (uterus, ovaries, prostate)

Front 110

what is important to take away from an exploratory celiotomy?

Back 110

a biopsy

Front 111

what are two benign lesions on the spleen that may be confused for malignancy?

Back 111

1. siderotic plaques
2. modular hyperplasia

Front 112

in an exploratory celiotomy, what are two things you should inspect the diaphragm for?

Back 112

1. integrity
2. mets

Front 113

what are the six liver lobes in the dog?

Back 113

1. left lateral
2. left medial
3. quadrate
4. right medial
5. right lateral
6. caudate

Front 114

which two liver lobes are fused in the cat?

Back 114

quadrate and right medial

Front 115

where does the gall bladder duct reside?

Back 115

between the quadrate and left medial lobes

Front 116

how does the cat's gall bladder differ than the dog's

Back 116

the cat's gall bladder is bipartite, whereas the dog's is simple

Front 117

in an exploratory celiotomy, in addition to visualization and palpation of the gall bladder, what else should you do to assess it?

Back 117

express it

Front 118

which ligament does the bile duct traverse?

Back 118

hepatoduodenal ligament

Front 119

where does the bile duct terminate?

Back 119

minor duodenal papilla

Front 120

where does the pancreatic duct usually terminate in the
- dog?
- cat?

Back 120

- cat: major duodenal papilla
- dog: minor duodenal papilla

Front 121

which side of the liver is largest?

Back 121

left

Front 122

what comes out of the gall bladder to become hepatic ducts?

Back 122

cystic duct

Front 123

in an exploratory celiotomy, why can't you exteriorize the duodenum and pylorus?

Back 123

because the hepatoduodenal ligament, which contains the bile duct, cannot be broken down, and it holds these structures down in the abdomen

Front 124

what should you expect when you palpate the pylorus?

Back 124

- feels like a donut
- contracts upon palpation

Front 125

where do you find the
- right limb of the pancreas?
- the left limb of the pancreas?

Back 125

- right: in the mesoduodenum
- left caudodorsal to the stomach, in the omentum

Front 126

to exteriorize the bowel in an exploratory celiotomy, what structure can be cut, due to its avascularity?

Back 126

duodenocolic ligament

Front 127

pancreatic biopsy:
- which lobe is easiest to biopsy
- where should you obtain a biopsy?
- how do you biopsy?
- how likely is pancreatic biopsy to cause pancreatitis?

Back 127

- right lobe easiest
- if there is a lesion, biopsy from the lesion; otherwise, if general pancreatic dz, do the right lobe
- obtain biopsy by dividing a lobule with a mosquito hemostat and bluntly dissect
- post-op pancreatitis is rare

Front 128

what landmark do you use to inspect the small intestine and in which direction do you inspect the SI in an exploratory celiotomy?

Back 128

find the ileo-ceco-colic junction and run the bowel retrograde

Front 129

what is a landmark to identify the ileum?

Back 129

antimesenteric ileal artery and vein

Front 130

how much of the SI can you resect and still have a viable patient?

Back 130

70%

Front 131

why do you do an incisional, rather than an excisional biopsy, of the mesenteric lymph nodes?

Back 131

excisional can disturb the blood supply of the SI; however, isolated lymph nodes can be excised

Front 132

what three arteries must you not ligate when taking lymph nodes from the abdomen?

Back 132

1. celiac
2. cranial mesenteric
3. caudal mesenteric

Front 133

which kidney lies most cranial?

Back 133

right

Front 134

when inspecting the left kidney, what vascular structure will you run into? Can it be ligated?

Back 134

- left phrenicoabdominal vein
- yes, it can be ligated

Front 135

under which peritoneal structures do you find the right kidney, ureter, and adrenal gland?

Back 135

duodenum and mesoduodenum

Front 136

under which peritoneal structures do you find the left kidney, ureter, and adrenal gland?

Back 136

colon and mesocolon

Front 137

what % of CO do the kidneys receive?

Back 137

25%

Front 138

what is the most obvious structure when approaching the kidney in an exploratory celiotomy?

Back 138

renal vein

Front 139

in an exploratory celiotomy, if you are to palpate the renal artery, where is it located in relation to the kidney?

Back 139

dorsal and cranial

Front 140

what connective structure might you need to excise to expose the right kidney in an exploratory celiotomy?

Back 140

hepatorenal ligament; note, this is an avascular structure

Front 141

which kidney is intimately associated with the liver, in the renal notch?

Back 141

right

Front 142

what vein partially obscures the right adrenal?

Back 142

caudal vena cava

Front 143

in the dog, where is the left adrenal located in relation to the left kidney?

Back 143

cranial and medial to the let kidney

Front 144

what is a very bad complication of an adrenalectomy?

Back 144

damage to the renal artery, which would require nephrectomy

Front 145

on which side is an ovarian remnant from a spay most common? Why?

Back 145

right side, because it is more caudal and more difficult to exteriorize with a standard midline incision

Front 146

inspecting the urinary bladder in an exploratory celiotomy:
- what are 2 things you palpate for?
- how is the bladder handled most atraumatically?
- what is the best place to incise the bladder?
- besides bladder parenchyma, what structures comprise the trigone

Back 146

- palpate for mass or calculi
- use stay suture in the apex ± additional stay sutures for atraumatic handling
- ventral incision in most cases
- papillae + urethra = trigone (viewed best with a ventral incision)

Front 147

what peritoneal structures to the ureters traverse before terminating on the papillae of the urinary bladder?

Back 147

lateral ligaments of the bladder

Front 148

where does the prostate reside? How many lobes does it have?

Back 148

- in the pelvic cavity (not peritoneal)
- bilobed

Front 149

what are 4 diseases that cause an enlarged prostate?

Back 149

1. BPH
2. prostatitis
3. cysts
4. neoplasia

Front 150

why do we not perform prostatectomies?

Back 150

urinary incontinence

Front 151

what disease, causing an enlarged prostate, is reduced by neutering?

Back 151

BPH (not the others)

Front 152

how do you tell an undescended testicle from the prostate?

Back 152

look for a vas deferens

Front 153

what are three techniques to biopsy the liver?

Back 153

1. Guillotine technique
2. Wedge technique
3. Punch Biopsy

Front 154

what is the easiest way to perform a liver biopsy and what is the basic procedure?

Back 154

- Guillotine technique
- tie a single throw of suture (usually chromic gut) around biopsy site (e.g., at the tip of a lobe)
- pull tight, cutting through the parenchyma. Some vascular structures will be ligated.
- tie the suture
- cut the piece of liver distal to the suture.

Front 155

why is the Wedge technique for liver biopsy not routinely used in dogs and cats?

Back 155

because in contrast to humans, liver doesn't hold suture well because it is too soft

Front 156

what are 2 ways to achieve hemostasis after a liver punch biopsy?

Back 156

1. use a small "plug" of Gelfoam in the biopsy defect
2. cruciate or mattress suture in defect if no Gelfoam (note, liver doesn't hold suture very well in dogs and cats)

Front 157

small intestinal biopsy
- how much do you take?
- how do you close?
- what suture size, type, and needle point type?
- what should be done before returning the bowel loop to the abdomen?

Back 157

- full-thickness cut: from mucosa to mucosa
- simple interrupted is the best closure; also can use continuous
- use 3-0 or 4-0 PDS or Maxon on a tapered needle
- leak test with saline under moderate pressure before returning the loop to the abdomen

Front 158

what are two ways to perform a kidney biopsy?

Back 158

1. Tru-Cut needle
2. incisional

Front 159

what are advantages of a Tru-Cut kidney biopsy over incisional?

Back 159

- Tru-Cut only requires one suture
- incisional need to open the renal capsule and exteriorize the kidney
- incisional requires multiple sutures
- incisional requires pexy to abdominal wall to prevent torsion

Front 160

if you perform an incisional kidney biopsy, what type of suture pattern do you use to close it?

Back 160

cruciate or mattress

Front 161

what is the best way to perform a splenic biopsy?

Back 161

"Guillotine method", like the liver

Front 162

what are two ways to perform a splenic biopsy?

Back 162

1. Guillotine technique
2. Partial splenectomy, where part of the spleen is milked out if its capsule

Front 163

in an exploratory celiotomy, what are two things you should do before abdominal closure?

Back 163

1. lavage with warm saline
2. sponge count

Front 164

when is it ok to close a celiotomy with chromic catgut?

Back 164

never

Front 165

what suture size and type is a good choice to close the subcutis in a celiotomy?

Back 165

- cats: 3-0 or 4-0
- dogs: 3-0
- Monocryl

Front 166

what suture size is a good choice to close the skin in a celiotomy?

Back 166

- cats: 4-0
- dogs: 3-0
- or use skin staples

Front 167

what are the critical ABCs?

Back 167

- Airway
- Breathing
- Circulation (pulse, BP, ECG)

Front 168

in a wounded patient, after you have performed the critical ABCs, what do you do next?

Back 168

cover the wound ASAP

Front 169

in the critical ABCs, what are the three components of Circulation?

Back 169

1. pulse
2. BP
3. ECG

Front 170

which opioid analgesic is good for
- oral transmucosal in cats?
- CRI with maintenance solution?
- transdermal patches?

Back 170

- oral in cats: buprenorphine
- CRI morphine
- patch: fentanyl

Front 171

which commonly used opiate is not a good analgesic when used alone?

Back 171

butorphanol

Front 172

what are some disadvantages of fentanyl patches with regards to analgesia?

Back 172

- variability in effectiveness
- doesn't work immediately
- additional narcotics needed after the first couple of days

Front 173

what is a single sedative and one sedative cocktail to use in a wounded patient?

Back 173

- acepromazine - stable patients
- Domitor (medetomidine)/butorphanol/atropine

Front 174

how long does a Domitor (medetomidine)/butorphanol/atropine sedative cocktail provide sedation for in a wounded patient?

Back 174

20 - 30 minutes

Front 175

what are the preferred wound analgesics for less stable patients; what is one caveat?

Back 175

- topical local anesthetics
- must be careful not to use toxic doses

Front 176

what is a common local anesthetic cocktail to use topically in a wounded patient?

Back 176

10:1 bupivicaine:lidocaine

Front 177

what are 3 ways to take the sting out of a local anesthetic when administering to a wounded patient?

Back 177

1. add small amount of bicarb
2. soak sponges - put sponges on wound and spray on anesthetic
3. combine 1:1 with KY Gel

Front 178

when is general anesthesia indicated for wound care?

Back 178

when wounds require immediate, aggressive debridement

Front 179

in a severely wounded patient, why might you use ketamine/valium over an inhalent?

Back 179

gas anesthetics produce profound hypotension, whereas ket/val does not.

Front 180

what are four types of analgesics/sedatives that are used at home to care for a wounded patient?

Back 180

1. NSAIDs
2. Narcotics
3. Acepromazine - if narcotics are not enough
4. topical local anesthetics

Front 181

for home care pain control, what narcotics are most commonly administered to
- dogs?
- cats?

Back 181

- dogs: Tylenol 4 (acetaminophen + codeine)
- cats: buprenorphine PO

Front 182

what is the problem with using tramadol for pain management?

Back 182

it either works well or doesn't not work at all - patient variability

Front 183

how far in advance before a bandage change should you administer a narcotic?

Back 183

1 hour

Front 184

although epidural catheters provide excellent analgesia for wound management, what are 4 disadvantages?

Back 184

1. expensive
2. learning curve
3. infection risk
4. urinary retention

Front 185

what are four basic reasons why we use analgesia/sedation in wounded patients?

Back 185

- multiple bandage changes
- pain control
- control aggression
- ↓ patient and care provider frustration

Front 186

what are 11 things that can cause cessation of wound contraction?

Back 186

1. contact inhibition
2. excessive tension
3. excessive movement
4. poor granulation tissue quality (e.g. exuberant)
5. exposed bone (periosteum is slow to heal)
6. eschar formation
7. obesity
8. indolent wound
9. medications/occlusive bandages
10. wound geometry
11. infection

Front 187

why does exposed bone cause cessation of wound contraction?

Back 187

periosteum is very slow to heal

Front 188

what is an eschar?

Back 188

burn coated with denatured protein; interferes with healing and should be debrided

Front 189

how can medications and bandages interfere with wound closure?

Back 189

- medications such as steroids are immunosuppressive and will slow healing
- if bandages are too tight, they will occlude blood vessels and slow infiltration of cells that mediate healing

Front 190

what is an indolent wound?

Back 190

a wound with a deep pocket beneath the skin edge, which has stopped contracting due to contact inhibition, and is not stuck down to the underlying granulation tissue

Front 191

what are the three best ways to treat an indolent wound?

Back 191

1. skin flap
2. skin graft
3. omental graft

Front 192

when is it indicated to close a severe wound?

Back 192

only if it looks like a clean surgical wound. Otherwise, wait to close it

Front 193

if a wound is contaminated (e.g. dirt, debris, hair, necrotic, bite, infection), when should it be closed?

Back 193

delayed closure until a granulation tissue bed has formed

Front 194

if there is not enough skin to sufficiently close a wound, what is usually done to close?

Back 194

second-intention healing

Front 195

in a severely wounded patient, after the patient is stabilized, what are the five initial things to be done to treat it?

Back 195

1. anesthesia
2. clip hair
3. debridement
4. lavage
5. bandaging

Front 196

for a severe wound, how do you protect it from contamination while you are clipping it? What do you do after you have clipped and rinsed?

Back 196

- apply KY gel so that hair will stick to the gel and come off with the rinse
- after the rinse, surgically scrub the skin peripheral to the wound

Front 197

how can the surgeon drastically shorten the healing process of a severe wound?

Back 197

good debridement and lavage

Front 198

when debriding a wound, what should you be careful to avoid doing?

Back 198

damaging important veins, nerves, and arteries

Front 199

why should you not lavage a wound with high pressure?

Back 199

destroys fibroblasts (does not drive bacteria deeper into the wound as initially thought)

Front 200

what is the ideal pressure of a lavage system?

Back 200

8 - 10 PSI

Front 201

what type of water should be used to lavage?

Back 201

tap water is fine; can also use sterile water, saline, 1% iodine, 0.05% chlorhex, etc.

Front 202

how do you lavage with a syringe?

Back 202

- 18 gauge needle is attached to a 3-way stopcock and a 60 cc syringe
- IV line with 1L of fluids on other stopcock port
- infuse fluids and remove with syringe

Front 203

although tap water has shown to be highly effective when lavaging wounds, what are 2 disadvantages?

Back 203

1. will rupture superficial cells because it is hypotonic
2. no antimicrobial activity

Front 204

if you want to lavage a wound, but cause no lysis of healthy tissue, what should you use?

Back 204

saline or LRS

Front 205

if you have an infected wound and want to lavage with betadine, what dilution should you use in the lavage solution?

Back 205

1:100 (1%)

Front 206

if you have an infected wound and want to lavage with chlorhexidine, what dilution should you use in the lavage solution?

Back 206

1:40 (0.05%) of a 2% stock solution

Front 207

when you mix chlorhexidine with saline, what happens? How does this affect its efficacy?

Back 207

it precipitates. No change in efficacy.

Front 208

in a lavage solution, what are two advantages of chlorhexidine over iodine? What is one disadvantage?

Back 208

- advantages: chlorhexidine works in the presence of organic material and has immediate and sustained activity; iodine is inactivated by organic material and only has immediate activity
- disadvantage: chlorhex has some Gram Negative resistance, whereas iodine kills everything

Front 209

duration of antibiotic for
- clean wounds
- dirty wounds

Back 209

- clean: none needed or 5-7 day prophylactic
- dirty: continue until wound has developed a granulation bed

Front 210

what are three indications for a wound to be dressed with an adherent (moistened) bandage?

Back 210

1. gross contamination
2. necrotic tissue
3. debris in wound

Front 211

what are two indications for a wound to be dressed with a non-adherent bandage?

Back 211

1. clean, healthy wound
2. granulation tissue present

Front 212

what are the three types of adherent bandages and the character of the discharge they are meant to absorb?

Back 212

1. wet-to-dry (most common) - medium discharge with low viscosity
2. wet-to-wet: high viscosity discharge
3. dry-to-dry: abundant low-viscosity discharge

Front 213

what layer(s) are moistened with saline in a
- wet-to-dry bandage?
- wet-to-wet bandage?
- dry-to-dry bandage?

Back 213

- wet-to-wet: first contact layer only
- wet-to-wet: first contact and secondary padding layers
- dry-to-dry: nothing is wetted

Front 214

wet-to-dry bandage:
- 3 common solutions to wet the primary layer
- what is used for the primary contact layer?

Back 214

- any solution (saline, LRS, chlorhexidine)
- 4x4 sponge, unwrapped, is used as primary layer to ↑ surface contact

Front 215

describe the components (layers) of a bandage

Back 215

1. primary layer: directly on wound (wound may be coated with wound stimulant or healing product) - adherent or non-adherent
2. secondary layer: cotton roll or cast padding - wicking of fluid from primary layer
3. tertiary layer: protective such as roll gauze, Vet Wrap, elastic on, bandaging tape, etc.

Front 216

in a wet-to-dry bandage, in which direction(s) is the secondary layer wrapped? Tertiary layer?

Back 216

both distal to proximal only

Front 217

describe the proper placement of the distal end of a limb bandage

Back 217

bandage is distal to the toes and the two middle toes are left exposed to check for swelling

Front 218

what is a complication of a limb bandage that does not cover the toes?

Back 218

may result in significant edema of the digits

Front 219

what type of bandage is often applied to difficult to reach regions such as the perineum and axillary regions

Back 219

tie-over bandage

Front 220

how do you place a tie-over bandage?

Back 220

- place loops of nylon suture 2-3 cm from wound edges
- place the primary layer inside the wound
- cover with a secondary layer
- run umbilical tape through the loops to secure the bandage
- conformable tertiary layer such as Ioban

Front 221

how often should a wet-to-dry bandage be changed?

Back 221

SID to BID, depending on level of contamination

Front 222

how do you change a tie-over bandage?

Back 222

- cut over the bandage to remove
- replace bandage and Ioban

Front 223

what are three nonadherent bandages that you can either buy or make?

Back 223

1. Adaptic (very expensive)
2. Telfa pads (inexpensive)
3. gauze sponges soaked in petrolatum and autoclaved

Front 224

when do you use a nonadherent bandage?

Back 224

on mature granulation tissue and/or wounds that have no further need for debridement

Front 225

why is Neosporin (e.g. bacitracin/neomycin/polymyxin B ointment) commonly used on nonadherent bandages?

Back 225

because it is a broad spectrum antibiotic that is petrolatum based, so it won't adhere to the wound

Front 226

what are two disadvantages of using Neosporin (e.g. bacitracin/neomycin/polymyxin B ointment) on nonadherent bandages?

Back 226

1. poor tissue penetrability, so it is not effective against deeply infected wounds
2. chronic use can lead to hypersensitivity to the neomycin component

Front 227

what is a highly effective antibiotic that is commonly used on burn patients, and has efficacy against Pseudomonas and fungi, as well as other microbes?

Back 227

silver sulfadiazine

Front 228

what are three advantages of using silver sulfadiazine in a wound (e.g., a burn)? 2 disadvantages?

Back 228

1. stimulates epithelialization
2. penetrates eschar and necrotic debris
3. highly effective against Pseudomonas, fungi, and other microbes
- slows wound contraction
- bone marrow and lymphocyte suppression with chronic and over use

Front 229

what are 10 effects of a sugar dressing?

Back 229

1. hyperosmolar environment
2. draws lymph into the wound - nutrition
3. inhibits bacterial growth
4. mechanically debrides
5. induces rapid formation of granulation tissue
6. decreased inflammatory edema
7. attracts macrophages
8. local energy source
9. stimulates production of protective protein
10. deodorizing because bacteria use this sugar instead of protein

Front 230

sugar dressing:
- how often do you change?
- how do you change?
- how thick should the sugar layer be?

Back 230

- change once to twice daily; if strike-through, change bandage; if sugar crystal present, you can change less frequently
- rinse with water and pat dry
- apply 1 cm thick coating of sugar

Front 231

when should you stop using sugar to dress wounds?

Back 231

once granulation tissue develops and epithelium starts to migrate

Front 232

why is hydrogen peroxide not good to use on wounds?

Back 232

creates free radicals and damages healthy tissue

Front 233

what must be true of honey for it to be efficacious on a wound?

Back 233

unpasteurized

Front 234

what are three properties of honey that makes it an effective wound dressing?

Back 234

1. has a peroxidase enzyme which produces antioxidants and stimulates angiogenesis
2. acidic pH of 3.7 - promotes healing and antibacterial
3. high osmolality

Front 235

what are 3 things you should never do with a penrose drain (that people often do anyway)

Back 235

1. never exits the primary incision
2. never have both ends sticking out of the patient. Only one end should be sticking out, and it should be in a gravity-dependent position
3. never fenestrate the drain, because it works by surface area; fenestration decreases the surfaces

Front 236

what are the two general functions of multi-fenestrated drains?

Back 236

1. elimination, drainage, or prevention of fluid or air accumulation
2. infusion of antibiotics, analgesics, and chemotherapeutic agents

Front 237

in what three ways do multi-fenestrated drains help wound healing?

Back 237

1. reduction of infected or necrotic material
2. remove fluid to decrease dilution of opsonins needed for bacterial phagocytosis
3. improve blood supply to area by reducing tension and bringing vascular tissues to other areas

Front 238

what are four advantages of continuous suction drains over passive drains?

Back 238

1. can exit in a dorsal or lateral position; penrose drains are gravity-dependent
2. less risk of contamination than passive drains, because they are closed systems
3. less frequent bandage changes
4. less likely to occlude

Front 239

if a dog chews out its multi-fenestrated drain, what should you do to prevent complications?

Back 239

- remove the drain and make sure all parts are there
- if all parts are not there, radiograph to find and remove them

Front 240

what can happen if you leave part of a multi-fenestrated drain in a patient?

Back 240

chronic draining infection

Front 241

what are four indications for multiple drain placement in the abdomen?

Back 241

1. gastric ulcer/perforation repair
2. foreign bodies
3. local abscess
4. pancreatic abscess

Front 242

what is a big problem with abdominal multi-fenestrated drains?

Back 242

fibrin tags will collect on the drains and clog them

Front 243

why is it important to monitor volume removed by multi-fenestrated drains

Back 243

because animal will need electrolytes and fluid replacement; also drains remove protein

Front 244

what diagnostic tests should be done 2-3 times per day on an animal with a multi-fenestrated drain?

Back 244

PCV, TP, electrolytes

Front 245

where do you sample fluid from a multi-fenestrated drain?

Back 245

from fresh fluid moving through the drain, not the stuff that has been sitting in the grenade

Front 246

drains produce a foreign body reaction; how much fluids are lost per day into the drain because of this reaction?

Back 246

5 mL/kg

Front 247

when is removal of a multi-fenestrated drain indicated? (2)

Back 247

- improvement in peripheral WBC and blood work (↓ bands, ↓toxic changes, resolution of other signs of sepsis such as coagulation and glucose abnormalities)
- change in fluid character (clearer, no toxic or degenerate neutrophils, no intracellular bacteria)
- note NOT BASED ON FLUID VOLUME

Front 248

what are three advantages of continuous suction drains over open abdominal drainage?

Back 248

1. ↓ hospitalization time
2. ↓ cost
3. ↓ professional investment

Front 249

how do continuous suction drains compare to open drains for abdominal drainage, with regards to patient mortality?

Back 249

most likely similar

Front 250

what are two indications for use of a thoracostomy tube?

Back 250

1. drainage of air and fluid from the chest
2. lavage and infusion of analgesics

Front 251

what are four complications of a (properly placed) thoracostomy tube?

Back 251

1. dislodgement
2. discomfort
3. obstruction
4. asending infection

Front 252

in which ICS do you put a thoracostomy tube?

Back 252

9th

Front 253

what happens if you insert a thoracostomy too far caudally?

Back 253

can perforate the diaphgram and possible lacerate the liver

Front 254

how many passes (and knots) is required minimally to secure a thoracostomy tube with a finger trap?

Back 254

5 passes (10 knots)

Front 255

how is a thoracostomy tube secured?

Back 255

purse string and finger trap or butterfly tape suture

Front 256

how does thoracostomy tube size relate to chance of pull-out?

Back 256

the wider the tube, the lower chance of pull-out

Front 257

where do you bandage a thoracostomy tube?

Back 257

over the drain exit site

Front 258

when placing a thoracostomy tube and suturing it with a purse string, how is this properly done?

Back 258

- SEPARATE purse string from finger trap
- at least 5 passes (10 knots) for the finger trap

Front 259

what is the procedure for placing a Chinese finger trap on a throacostomy tube?

Back 259

1. take a bite of skin directly under the tube and place a knot directly in the middle, along the length of the suture
2. bring suture ends opposite directions (use both ends so you don't half-hitch), encircling the tube, and tie a throw on top (don't use surgeon's throw)
3. wrap 360° and tie another throw
4. repeat 4-5 times
5. tie a full knot to secure

Front 260

how large should your thoracostomy tube be?

Back 260

same size as mainstem bronchus

Front 261

what is a more secure way to secure the end of a thoracostomy tube than a Christmas tree adapter?

Back 261

3-way stopcock with PRN caps; also allows infusion or aspiration

Front 262

why should you not clamp a thoracostomy tube with a hemostat?

Back 262

jaws will puncture the tube

Front 263

what is added to a thoracostomy tube to make sure it is closed?

Back 263

c-clamp

Front 264

comment on the use of continuous suction in a thoracostomy tube

Back 264

not indicated because it is uncomfortable

Front 265

how do you properly remove a thoracostomy tube?

Back 265

1. ± sedation, ± bupivicaine/lidocaine through the tube
2. pull to where the fenestrated part begins
3. cover it with a 4x4 so that you don't contaminate the wound through the tube on the way out
- the tube should come out easily

Front 266

what should you do if a thoracostomy tube does not pull out easily?

Back 266

Sedate the animal and see why it is sticking. There may be residual suture in there

Front 267

how do you drain an aural hematoma?

Back 267

fenestrate a butterfly catheter, insert into hematoma, and drain into a vacutainer

Front 268

how you you close the wound created by a thoracostomy tube?

Back 268

2nd intention

Front 269

what is the main indication to deliver medication through a multifenestrated drain?

Back 269

to treat nasal fungal infections (i.e., Aspergillus)

Front 270

what are three things you may infuse into the patient through a multifenestrated drain?

Back 270

1. fungal medication (e.g. into the nasal cavity)
2. local anesthetic in severe surgical wounds
3. antibiotics into a fracture site

Front 271

what are 7 potential complications of multifenestrated drains?

Back 271

1. infection
2. foreign bodies
3. tissue trauma
4. malfunction
5. SQ emphysems (usually self-limiting)
6. discomfort (not usually too big of a problem)
7. too much drainage

Front 272

what are the three major functions of the spleen?

Back 272

1. hematopoesis
2. filtration
3. lymphocyte storage

Front 273

if the spleen is removed, what is the next-in-line reticuloendothelial system organ?

Back 273

liver

Front 274

what are four clinical signs of a splenic mass that needs to be removed?

Back 274

1. abdominal distension
2. generalized weakness
3. pale MM
4. hemoglobinuria

Front 275

what are 6 diagnostic techniques for splenic disease?

Back 275

1. abdominal radiographs
2. thoracic radiographs
3. CBC, chem
4. abdominal ultrasound
5. FNA
6. abdominocentesis

Front 276

if you see abdominal masses on radiographs, what should you also do?

Back 276

take thoracic rads

Front 277

what is an important blood chemistry workup to take before spleen surgery?

Back 277

coagulation profile

Front 278

if an animal is in DIC or has a coagulopathy, what should you do before surgery?

Back 278

give them a blood transfusion before surgery

Front 279

most cranial abdominal masses are where? How do you tell?

Back 279

- spleen
- ultrasound

Front 280

if there are masses on the spleen and in the liver, what happens after splenectomy?

Back 280

the liver masses enlarge

Front 281

how do you use ultrasound to distinguish a benign splenic mass from a malignant mass?

Back 281

you can't

Front 282

what is the purpose of taking a FNA of a splenic mass before surgery? How does this affect your client communication?

Back 282

- to see if it is neoplastic or not
- owners may or may not elect euthanasia

Front 283

why don't veterinarians routinely take a core biopsy of the spleen?

Back 283

hemoabdomen. Spleen in animals does not suture well.

Front 284

what is a risk of taking a FNA of a splenic mass?

Back 284

seeding the abdomen with neoplastic cells

Front 285

what is the purpose of taking an abdominocentesis before splenectomy? How do the results affect your decision?

Back 285

- to see if the PCV of the abdominal fluid is 12 or less
- if > 12, do transfusion before surgery

Front 286

what are four indications for splenic surgery?

Back 286

1. trauma
2. splenic torsion
3. neoplasia (most common)
4. immune-mediated disease (used to do for IMHA, but no longer indicated: transient response and post-op complications)

Front 287

what is the most common way to manage a splenic traumatic injury?

Back 287

medically

Front 288

what are 4 indications for surgery for splenic trauma?

Back 288

1. medical management fails
2. lacerations
3. hematoma
4. avulsed vessels

Front 289

what are the most common blood vessels that are avulsed with splenic trauma?

Back 289

Short gastric vessels

Front 290

what is a common way in which the short gastric vessels are avulsed, and thus splenectomy is indicated?

Back 290

GDV

Front 291

what are two basic DDx for a fragile, liquid, bloody mass in the spleen?

Back 291

1. hematoma
2. neoplasia

Front 292

with regards to splenic trauma, what are hemostatins?

Back 292

(e.g., Surgicel), topical hemostatic agents applied to a splenic lesion

Front 293

comment on using hemostatins such as Surgicel™ to surgically manage splenic lesions?

Back 293

can work, but most of the time, partial or total splenectomy is performed.

Front 294

what is a common way to estimate blood loss from a surgery (e.g. spleen)?

Back 294

weigh the sponges

Front 295

comment on the PCV/TP of a dog with splenic injury

Back 295

may be normal, but if there is hemorrhage, the dog may be exsanguinated

Front 296

what is the definition of a splenic hematoma?

Back 296

enlargement of the splenic parenchyma, with an INTACT CAPSULE

Front 297

if hematoma of the spleen is benign, why do we perform total (versus partial) splenectomies?

Back 297

because they can become very large and have the possibility of being malignant. We need "100% confidence" of a normal spleen, which is practically impossible

Front 298

what is the most common indication for partial splenectomy in animals?

Back 298

trauma

Front 299

with avulsed vessels of the spleen (e.g. the short gastrics), what should be done at the beginning of surgery?

Back 299

small incision into the abdomen and suction to quantify blood loss; calculate transfusion amount

Front 300

why don't we do autotransfusions in splenic surgery?

Back 300

- expensive
- may be neoplastic
- takes too much time

Front 301

splenic torsion signalment:
- age
- gender
- breed

Back 301

- 3-6 year old
- male
- large and giant breeds (Great Dane)

Front 302

comment on the prognosis of an acute splenic torsion versus a chronic splenic torsion

Back 302

acute worse Px than chronic

Front 303

what are the two "types" of splenic torsion?

Back 303

- primary
- secondary due to primary stomach torsion

Front 304

what type of splenic surgery is gastropexy always indicated?

Back 304

splenic torsion (↑ risk of GDV), NOT SPLENIC MASSES

Front 305

what are 5 clinical signs of acute splenic torsion?

Back 305

1. acute pain
2. splenomegaly
3. cardiovascular collapse
4. DIC
5. normal → dead in 24-48 hours

Front 306

when removing a necrotic, torsed spleen, what should you be careful NOT to do and why?

Back 306

- do not reposition
- this will cause acute septic crisis and reperfusion injury. Remove the spleen with minimal manipulation

Front 307

when doing an exploratory celiotomy for an enlarged spleen, what must you be careful of in the cranial abdomen when poking around?

Back 307

careful with the lesser omentum, since this structure contains the left limb of the pancreas

Front 308

when performing a splenectomy on a torsed spleen, what are two etiologies of ventricular tachycardia?

Back 308

VASOACTIVE AMINES FROM:
1. spleen
2. PANCREAS

Front 309

what is a potential cardiac arrhythmia associated with removal of a torsed spleen?

Back 309

ventricular tachycardia (from vasoactive amines from the spleen or the pancreas)

Front 310

what are five clinical signs of a chronic splenic torsion?

Back 310

1. anorexia and vomiting
2. anemia
3. neutrophilia
4. hemoglobinuria
5. renal disease

Front 311

prognosis of splenic torsion
- acute? (common complications)
- chronic? (common complications)

Back 311

- acute: guarded (coagulopathy or arrhythmias)
- guarded: fair/good (some are prone to abdominal distention or bloating)

Front 312

what is a common complication of splenic neoplasia in brachycephalic dogs, where neoplasia is often overshadowed by other differential diagnoses?

Back 312

syncope

Front 313

what are six clinical signs of splenic neoplasia in the dog?

Back 313

1. inappetence
2. weight loss
3. pale gums
4. distended abdomen
5. hematuria
6. syncope

Front 314

what are five tumors of the spleen in which splenectomy is indicated?

Back 314

1. lymphoma
2. myeloproliferative disorders
3. mast cell tumor
4. malignant histiocytosis
5. hemangiosarcoma

Front 315

why is it important not to rupture the spleen during splenectomy due to neoplasia? (2)

Back 315

1. acute blood loss
2. seeding

Front 316

what is the most common splenic mass in the cat?

Back 316

mast cell tumor

Front 317

what is a prognostic indicator that a splenic tumor may be malignant? What is the % chance?

Back 317

- hemoabdomen
- 90%

Front 318

how often is a splenic tumor a hematoma and how often is it a malignant neoplasia?

Back 318

50% hematoma, 50% malignant

Front 319

what is the most common malignant neoplasia in the spleen of the dog? What is the prognosis?

Back 319

- HSA
- the worst of the worst; grave prognosis and short survival time

Front 320

how are feline splenic mast cell tumors (the most common neoplasm of the spleen in the cat) treated?

Back 320

- ± splenectomy
- some do chemotherapy

Front 321

what is a common abnormality in the CBC of an animal with HSA?

Back 321

nRBCs

Front 322

what are 5 clinical diagnostic indicators of splenic neoplasia in the dog?

Back 322

1. regenerative anemia - polychromasia & reticulocytosis
2. nRBCs
3. mitral murmur
4. bloody abdominocentesis
5. liver metastases - ↑SGPT (ALT) and ↑SAP (ALP)

Front 323

what is a common (20-25%), severe sequela to splenic HSA in the dog?

Back 323

HSA on the RAA

Front 324

signalment for splenic HSA:
- age
- common breed (specific)

Back 324

- 8-10 years
- German Shepherd

Front 325

which part of the heart may have a primary or secondary HSA in the dog?

Back 325

RAA

Front 326

what is the MST for HSA of the spleen in the dog?

Back 326

6 months

Front 327

what is the best technique for closing a partial splenectomy? What commonly used technique does not work?

Back 327

- USE A STAPLER!!
- non-crushing forceps with over-sew does not work

Front 328

what are the three techniques for total splenectomy?

Back 328

1. hilar ligation
2. splenic and short gastric ligation
3. mass ligation

Front 329

hilar ligation technique for total splenectomy:
- how is it done?
- why is it done?

Back 329

- ligate individual vessels up the concave area of the spleen (close to the spleen)
- this is done to avoid the pancreas

Front 330

when is a mass ligation of the spleen indicated? What is a mass ligation?

Back 330

- indicated for torsion of the splenic pedicle
- mass ligation = not separating artery from vein

Front 331

what blood vessels must be preserved in a total splenectomy? (2)

Back 331

1. left gastroepiploic artery
2. short gastric branches to the left limb of the pancreas

Front 332

perioperative treatment for splenectomy:
- three things given to maintain circulatory integrity
- what two drugs treat arrhythmias?
- comment on IV antibiotic therapy

Back 332

- fluids, whole blood transfusion, control acid/base status
- arrhythmias: lidocaine; procainamide
- IV antibiotic therapy is controversial

Front 333

how does a stapling device work for splenectomy?

Back 333

2 staples and cuts in the middle

Front 334

comment on the pros and cons of using a stapling device for splenectomy

Back 334

- decreases surgery time
- staples are very secure
- increased expense, however, saves money by saving time (e.g., anesthesia)

Front 335

what are 4 possible clinical pathological changes to the blood after splenectomy?

Back 335

1. leukocytosis (transient 2-4 days)
2. thrombocytosis (transient 2 weeks)
3. regenerative anemia
4. blood parasites (e.g. hemobartonella)

Front 336

what are the three most common reasons for sudden death post-splenectomy?

Back 336

1. hemorrhage (poorly ligated vessel)
2. pulmonary thromboembolism
3. ventricular tachycardia

Front 337

what is the MST in the treatment of canine splenic HSA with:
- surgery only?
- Sx + immunotherapy?
- Sx + immunotherapy + chemotherapy?

Back 337

- Sx only: 86 days
- Sx + immunotherapy: 91 days
- Sx + immunotherapy + chemo: 117 days

Front 338

when treating HSA via splenectomy in the dog, how do you maximize the survival time?

Back 338

adjuvant immunotherapy and chemotherapy