Surgery2 Final

Front 1

eruption of dog and cat teeth

Back 1

dog deicduous
I3, C3, P 4-12 weeks

dog permanent 4556
I4, C5, P5, M6

cat deciduous 235

cat permanent 3455

Front 2

Dental formulas

Back 2

Dog
I3/3 C1/1 P3/3 M2/3

Cat

I3/3 C1/1 P3/2 M1/1

Front 3

special requiremets for thoracic surgery

Back 3

mechanical ventilation

lots of analgesia

finochietto retractors

Front 4

median sternotomy technique

Back 4

que:
 Dorsal recumbency
 Open with an oscillating saw
o Or a chisel and osteotome or bone cutters
 Opened exactly in the midline – this is very important
 Preserve 2 or 3 sternebra/ribs cranially or caudally for
stabilisation
 Need to provide mechanical ventilation
 Open the chest with a Finochietto retractor

closure

Closure with cerclage wire
o You need a rigid closure so need to cerclage
around every rib through the whole length
 Stability important to prevent dehiscence

Front 5

INTERCOSTAL thoracotomy technique

Back 5

Lateral recumbency
 Choose appropriate side and intercostal space
 5th rib is the most common, but depends on which
structures you are aiming to access
 Sharply incise the skin, subcut and cutaneous trunci
muscle
 Incise and retract the longissimus dorsi with scissors
 Transect the scalenus, pectoral, serratus ventralis and
intercostal muscles
 Use a Finochietto retractor to spread the ribs
o They actually spread quite far
 Closure:
 Place four to eight heavy monofilament sutures around
the ribs adjacent to the incision
 Resorbable or non-resorbable
 Then suture the muscles and skin

Front 6

WAYS TO DRAIN THE PLEURAL CAV

Back 6

Ways to drain the pleural cavity
o Needle thoracocentesis
 Easy and quick, relatively painless
 Can be done on unsedated animal
 Rapid evacuation of air or fluid
o Thoracic drainage
 Requires general anaesthesia
 Needs to be aseptic
 Better drainage (larger diameter); might be better for pyothorax
(thick pus) common in cats
 Prolonged drainage

Front 7

post op care thoracotomies

Back 7

Thoracotomies; post-operative care
o Thoracic drain (1-2 days)
 Fluid or air accumulation
 Instillation of local anaesthetic
o Systemic analgesia!
o Intensive monitoring

Front 8

what do you need for a thoracocentesis

Back 8

butterfly catheter- short needle

stopcock

20-50ml syringe

no GA or sedation generally

aseptic prep

Front 9

how to thoracocentesis

Back 9

7th-9th intercostal space
 Prepare aseptically
 Insert needle close to the caudal rib (of each ICS) Behind every rib there is an intercostal artery and vein running immediately behind the rib so try to stay close to the cranial border of each rib
 Bilateral if necessary
 Do not stick the needle in straight as you may puncture the lung
 Use a 45° angle and keep the bevel parallel to the lung surface

Another person may generate negative pressure with the syringe
and fluid or air should come out very easily if present
 Record how much you remove

can repeat periodically but if goes on for a few days consider a drain

Front 10

indications for thoracic drains

Back 10

Indications – anything that requires continuous drainage (fluid or air)
 Persistent traumatic pneumothorax
 Spontaneous pneumothorax
 Pyothorax
 Chylothorax
 After thoracic surgeries

Front 11

steps for inserting thoracic drain

Back 11

GA and prep

skin incision at 11IC

subcut tunnel to 8/9IC

insert 1cm using haemostat or stylet

secure with C clamp

3 way stopcock

withdrawn fluid or air

close stopcock

secure with chinese finger trap sutures

post of rads to check posistion

bandage aseptically

Front 12

common thoracic injuries due to blunt trauma

Back 12

Lung contusion
 Most common intrathoracic injury but usually does not require
treatment
 Stomach in the image is dilated with air as dyspnoeic animals
swallowing air

Pneumothorax
 Most common thoracic injury requiring treatment
 Laceration of trachea, bronchi, lungs
 Lung is contracted back from the chest wall and you can see air
in between the lung and the thoracic wall
 A lot of difficulty getting oxygen

Rib fractures
o Rupture intercostal musculature
o Haemothorax
o Diaphragmatic hernia

Front 13

clincial signs of thoracic trauma

Back 13

Clinical presentation
o Shock symptoms
o Tachypnoea
o Dyspnoea
o Cyanosis
o Cardiac arrhythmias
o Auscultatory changes
o Deformation of rib cage
o Subcutaneous emphysema (can come from pneumothorax)

Front 14

approach to emergency thoracic trauma case

Back 14

Emergency treatment
o Cardiovascular stabilisation
o Oxygen supplementation
 Oxygen mask (short term)
 Oxygen cage (small animals)
 Nasal oxygen (larger dogs)
o Prevent stress
o Thoracocentesis
 Stabilise before taking radiographs!
o I.e. thoracocentesis with pneumothorax will cause the animal to be much
more stable
 Pain medication is also very important
 Treatment of thoracic wall trauma

Front 15

approach to severe chest wall trauma

Back 15

make sure its clean, make sure its airtight (gladwrap)

reduce stress

provide O2

Front 16

causes of pneumothorax and treatment of traumatic

Back 16

Traumatic

 CLosed Perforation of lungs, trachea, bronchi, oesophagus

Open- commwith outside (rare)

SPONTANEOUS,

primary : tall deep chested dogs

secondary: Secondary
o Pneumonia
o Abscess
o Granuloma
o Neoplasia

 Most common reason is tear of a lung lobe
 Treatment
 Required if it is significant enough to cause clinical signs
 Thoracocentesis (may have to be repeated)
o Most cases should heal with thoracocentesis,
supportive care and oxygen
 Thoracic drain if air leak continues
 Surgical exploration if air leak continuous over 5 days (rare)
 Tracheal, bronchial or oesophageal tears are more likely to require surgery than lung parenchymal tears

Front 17

approach to spontanous pneumothorax

Back 17

 Primary spontaneous pneumothorax
o Deep chested dogs
o Bullae – air filled bubbles in the lung
o Blebs – on the surface of the lung
 Possibly confluent alveoli which can rupture
o Conservative treatment
 Continuous suction for 5 days

Recurrence rate 50%
o Surgical treatment (recommended)
 Partial lobectomy to remove affected bits of lung
 Recurrence rate <12%

Front 18

ddx pleural effusion

Back 18

Pure transudate (hypoproteinaemia, CHF)
 Serosanguinous (lung lobe torsion, diaphragmatic hernia)
 Haemorrhagic (trauma, neoplasia)
 Chylous (chylothorax)
 Inflammatory (pyothorax)
 Non-septic vs. septic
 Neoplastic

Front 19

chylothorax aetiology and tx

Back 19

Increase of hydrostatic pressure in the cranial vena cava
 Right heart disease
 Pericardial effusion
 Cranial mediastinal neoplasia
 Trauma
 Lymphangiectasia
 Often idiopathic
o Treatment
 Conservative (not commonly successful)
 Thoracic drainage
 Diet
 Surgical
 Treat primary cause
 Ligation thoracic duct (dorsal to aorta)
o Mass ligation of the tissue dorsal to the
 Pericardectomy ( R heart pressure)
 Omentalisation
 Pleuroperitoneal shunting

Front 20

thoracic wall tumours and tx options

Back 20

 Neoplasia of the thoracic wall
o Tumour types
 Fibrosarcoma
 Osteosarcoma
 Chondrosarcoma
 Mast cell tumour
o Wide surgical excision required +/- adjunctive therapy
 Could not remove more than 4 ribs
o Thoracic wall resection
 Closure of the defect

Front 21

MEDIASTINAL TUMOUR TYPLES, dx, tx and px

Back 21

o Diagnosis
 Rads: mass in cranial mediastinum
 Fine needle aspirate
 Differentiation is very important for treatment
o Tumour types
 Thymoma (dogs > cats)
 Surgical excision
 Thymic lymphoma (cats > dogs)
 Chemotherapy
o Thymoma
 Older animals
 Cranial mediastinal mass
 Can cause paraneoplastic syndromes
 Myasthenia gravis
 Hypercalcaemia
 Good prognosis with surgical excision

Front 22

what can thymoma cause

Back 22

MG and hyperCa- paraneiplastic

Front 23

primary lung neoplasias- most common and dx

Back 23

 Bronchial/alveolar carcinoma (most common)
Clinical signs- Cough, weight loss, anorexia, hypertrophic osteopathy
(rare)
CS only occur when the tumour is quite big
HO = painful bony proliferation, so may be presented for lameness

Radiographs (always do 3 views when looking for tumours) Left lateral Right lateral VD

FNA if possible- 80% diagnositic

Front 24

prognostic factors for primary lung tumours

Back 24

negative- over 5 cm

pleural effusion

ln involvement

Prognosis (Merck vet manual):
 Median survival time for dogs having surgical treatment
of a primary lung tumour is 120 days
 Mean survival time without node involvement is 12
months and if the LNs are involved or multiple tumours
are found the survival time is only 2 months
 Recurrence or metastasis is a common cause of death

Front 25

when do you see lung lobe torsion

Back 25

Appears spontaneously without any known reason or there is a
disease causing the lung to be heavier and therefore more likely
to twist
 Blood supply and air occluded with twisting
 Large dogs (narrow chests e.g. Afghan)
 Primary or secondary
 Right middle or left cranial lobes
 Similar breeds to those predisposed to pneumothorax
 Small dogs (pugs)
 Primary
 Commonly left cranial lobe

Front 26

tx of lung lobe torsion

Back 26

lobectomy wihtout untwisting

might look emphysematous- air trapped

Front 27

surgical lung disease

Back 27

lung torsion

lung neoplasia

3. Lung laceration
4. bronchooesophageal fistula
5. Granuloma, abscess

Front 28

wher would you approach for a lobectomy an\d how much lung can you take

Back 28

 Lobectomies
o Approach: intercostal thoracotomy at 5th ICS as this is where the
bronchial tree is located
o Can remove 50% of the lung tissue
 The left side consists of 40% of the total lung mass; and the right
is 60%

Front 29

how to do partial lobectomy

Back 29

approach from 5th IC space

Quite a simple procedure
 Removal of less than distal 2/3 of lung lobe
 Technique:
 3 rows of encircling sutures with very fine suture material and then remove the lung lobe OR thoracoabdominal stapler- 3 rows PREFERED

fill chest cav with saline and look for bubbles

Front 30

indications partial lobectomy vs total lobectom

Back 30

neoplasia, lung tears, bullae/abscess/blebs at periphery

 Lesions located at or reaching base of lung lobe
o Neoplasia
o Lung lobe torsion
o Abscess

Front 31

how to total lobectomy

Back 31

Ligation of individual structures
 Artery, vein, bronchus
o Separating of the structures can be quite difficult
o Close the bronchus with 2-3 layers
 Exception: lung lobe torsion – ligate or staple without
untwisting

a

Front 32

etiology of pericardial effusion

Back 32

o Aetiology
 Neoplastic (quite common)

-HS- look for splenic tumour

- HBT- benign
 Idiopathic
 Traumatic
 Heart failure

Front 33

when does cardiac tamponade occur and what is its presentation?

Back 33

o Cardiac tamponade (when pericardial effusion occurs rapidly and there
is no time for the heart to adjust)
 Reduced cardiac filling and cardiac output
 Venous dilation
 Weak peripheral pulse
 Muffled heart sounds
 Presentation:

collapse, weak peripheral pulse, jugular distension as blood can’t get back into the heart, abdominal effusion
etc.
 Emergency!

Front 34

dx tx pericardial effusion

Back 34

rads- v round heart

u/s to confirm

pericardiocentesis- u/s guided

Use over the needle catheter
 Right 5th or 6th ICS
 Better to visualise with US if possible
 Try to aspirate the fluid
  Send fluid for analysis i.e. neoplastic cells, infection,
increased PCV etc.

Front 35

subtotal pericardectomy and its indications- new approach

Back 35

o Removal of pericardial sac ventral to the phrenic nerves
o Indications:
 Recurrent idiopathic pericardial effusion
 Idiopathic chylothorax
o Approach: R intercostal thoracotomy 4th or 5th ICS
o Don’t remove the whole pericardium but you remove most of it
 If you just remove a small window it may be possible for the
heart to herniate through and become restricted
 So either remove a very small window, or most of the
pericardium (most common)
o Thoracoscopy  Minimally invasive way of performing subtotal pericardectomy
and is becoming more popular
 Much less painful after surgery

Front 36

landmarks for performing a tracheotomy in the horse

Back 36

cranial 1/3 of neck- stay on midline and divide Sternothyrohyoideus muscle

horizontal inciision between tracheal rings

dont exceed 1/3 of tracheal circumference

Dyson tracheotomy tube

Front 37

complications of horse tracheotomy peri and post op

Back 37

carotid laceration

tracheal collapse

short term after

aspiraton

abscessation

cellulitis

tube clogs

Front 38

indications for a horse tracheotomy

Back 38

respiratory distres- laryngeal obstruction eg arytenoid chondritis, pharyngeal obstruction, nasal oedema

Anticipated URT compromise- surgery- arytenoidectomy

Front 39

care of tracheotomy tube in horse

Back 39

remove and clean twice a day- cover to check its working

apply vaseline

Front 40

indications caecal/large intestine trocharisation

example conditions

Back 40

colic + severe large colon/ caecal gas distension

- gas is priminent in the right paralumbar fossa- rectal to confirm

- when sx not an option

- can be comlications

caecal tympany

large colon displacement

large colon impaction

Front 41

potential complications of large intestine/ caecal trocharisation

Back 41

low grade localised peritonitis

local cellulitis

localised abscess

inflamm usually self limiting

Front 42

horse mediastinum

Back 42

fenestrated caudally

bilateral pneumothorax is possible

Front 43

initail management of pneumothorax or penetrating abdominal wound

Back 43

1. detailed and careful physical exam

2. clean and manually feel depth of the wound

3. perform diagnostics to assess the structures involved- u/s, rads

4. devise treatmetn protocol and decide whether field treatment or referal is required

Front 44

placing caecal/LI trochar

Back 44

clip R paralumbar
sterile scrub

local

small stab incision at R PL fossa

connect catheter to extension set and place in cup of water (bubbles if youre successfully decompressing the gas)
withdraw catheter if no longer retrievable

Front 45

benefits of trocharisation

Back 45

decompresion stumulates motility

relieves pain caused by distension

improves venous rtuen

improves ease o breathing

Front 46

Approach to penetrating thoracic wounds

Back 46

initial exploration

rule in/ out pneumothorax

- no lung sounds dorsally

- dyspnoea

- cyanosis

- tachypnoea

- restlessness

U/s rads ABG

Front 47

tx pneumothorax horse

Back 47

seal off wounds- air tight bandage

- wrap with gladwrap tightly then elastoplast

nasal oxygen insufflation if paO2 <80

- 15L/min

Assess shock, give fluids if necc

borad spec ABs

pain- NSAIDs

Front 48

abdominal wounds in horses- possible sequelae and diagnostics

Back 48

haemorrhage, contamination, GI viscus rupture, eventration

asses for GI involvement for any wound caudal to 5th rib

clean wound and use sterile gloves to palpate and evaluate wound

dx

1. Abdominocentesis

2. Rectal palp

3/. Ultrasound

4 +- rads

5 +/- laparoscopy

last resort ex lap

Front 49

causes of horse rectal tear

Back 49

usually iatrogenic

foaling

enemas

chronic small colon impaction

idiopathic

Front 50

grades of rectal tear

Back 50

1. mucosa +/- submucosa

2. torn muscularis

3. a. all layers but submucosa,- complications common- peritonitis, endotox, ladhesions

b. tear enters into mesentery

4. all layers- direct peritoneal contamination

Front 51

signs/suspicions of a rectal tear

Back 51

sudden relaxation of rectum

blood on sleeve

sweating

colic

restlessness

off feed

blood in maure

tachycardia, tachypnea, increase in temp

straining

Front 52

consequences of rectal tears and work up

Back 52

shock, peritonitis occur within 2 hours of grade 3 -4 tear

RESTRAINT and sedation

use lubricated bear arm to palpate

cardboard speculum + endoscope

control straining with caudal epidural

Front 53

blood supplt to the palates

Back 53

Minor palatine a.: mainly
supplies the soft palate
Major palatine a.: responsible
for vascular supply to mucosa
of dog + hard palate
Can ligate it ! won’t get any
necrosis as a result as there is
very good collateral blood
supply.
Will bleed quite a bit so better
to avoid if possible

Front 54

CS cleft palate

Back 54

o Difficulty suckling because they can’t create negative pressure to
suck milk due to oral cavity being open to the nasal cavity (+
outside)
o Nasal discharge
o Concurrent cleft lip sometimes
o Aspiration pneumonia

Front 55

difficulties associated ith clift palate

Back 55

cant immediately treat surgically because tissues are so firable- need to wait till 3 or 4 months old

oesophageal feeding until then if defect is large

thoracic rads to check for aspiration

Front 56

acquired oronasal fistula

Back 56

oftn older small breed dogs

deep periodontal pocket formation, alveolar bone lysis

commonly maxillary canine tooth affected

need to remvoe the tooth root. advancement flap from the lip to pull over defect for tension free closure

Front 57

causes of oronasal fistulas + CSs

Back 57

dental disease

cleft palate

surgery

radiation

hyperthermic tx of oral lesions

sneezing

cx unilateral serous or mucopurulent nasal discharge

Front 58

tx small clefts

Back 58

1-2mm shoudl heal on own

just feed soft food

ab to prevent infection in nasal cavity, recheck 10-14d

if not heled. sx

Front 59

tx large clefts

Back 59

require sx, wont heal otherise

soft tissue repair may be enough

stabilisation of palate- pin +- wire may be needed

Front 60

flaps to fix cleft palate

Back 60

transpositional

- incise mucosa on 1 side and elevate from underlying bone- flap over to other side and suture to other side of defect

advancement

- releasing incisions either side- suture in the middle- 2 slim defects either side- only if defect is narrow

Front 61

ddx oral tumours in dogs

Back 61

malignant melanoma0 most agressive in terms of metastasis

- SCC- locally aggressive

- fibrosarcoma- locally agressive

- OSC

epulis- generally benign

- invasive but not malignant

Front 62

diagnosis and staging of oral tumours

Back 62

can it be resected

how locally invaseive

palpate for lnn involvement, aspitrate if large

chest rads

rads, ct

biopsy- incisional or skin punch

Front 63

surgical treatment of oral tumours

Back 63

wide margins- 2-3cm at least

mandibulectomies/ maxillectomies

Front 64

px oral tumours

Back 64

FSC and SC best- slow to metastasise

malignant melanoma- poorer px- 6-8MST

Front 65

pathogenesis sialocoele

Back 65

accumulation of saliva in the subcut tissue around the gland

occurs due to injury to the salivary gland or duct- rupture- saliva can leak- accumulates subcut, surrounded tissue franulation secondary to free sal in the tissues

cause often not identified- blunt trauma?

Front 66

presentation of sialocoele

Back 66

sublingual gland and duct most commonly affected

soft, non painful selling

Front 67

signalment of cervical sialocoele and dx

Back 67

Dogs> cats

males sl>females

any age

soft fluctuant swelling

clear, yellowish viscous fluid

low cell count

mucin stain confirms saliva (PAS)

Front 68

ddx of cervical sialocoele

Back 68

cervical abscess

fb

haematoma

cystic or neoplastic lnn

cyst

sialoadenitis

sialoadenosis

neoplasia

sialolith

might need sialography to determine the side affected

Front 69

treatment of sialocoele

Back 69

sublingual and mandibular sialadectomy- within the same capsule

dissect and ligate as far cranial as possible

Front 70

sublingual soalocoele tx

Back 70

aka ranula

rupture of sublin

saliva accum lateral to tongue

removal of all tissue or marsupialisation- incide and suture edges to the mucosa

Front 71

emergency tracheostomy procedure

Back 71

ventral midline incision from cricoid extending 2-3cm caudally

separate sternohyoid and make transverse thacheotomy through annular lig between 3/4 or 4/5 rings

dont extend around more than hlf

suture around the cartiages either side

insert with curved haemostat opening incision

oppose muscle, sub cut and skin

suture or tie around neck

Front 72

tach tube care

Back 72

every 4 hours initially then BID

clean with 2% chlorhex

suction trachea- secretions dry up and cause blobs

cats obstruct easily

moisturise via nebulsiation or smal amounts of saline

Front 73

indications for permanent tracheostomy

Back 73

creation of stoma in the vetral tracheal wall- suture tracheal mucosa to skin

maintained for life or until surgically closed

trauma, layngeal paralysis, laryngeal collapse

BRACHYCEPHALIC DOGS

Front 74

instructions for owners after permanent tracheotomy palcement

Back 74

no swimmin

no harnesses

need to keep clean of secretions, especially in first 2 months

need to maintain healthy body condition as fat around ostetomy can obstruct it

Front 75

primary abnormalities brachycephalicsyndrome

Back 75

stenotic nares- medial collapse and partial occlusion

elongated soft palate- most comm component in dogs- pulled caudally dyring inspiration

hypoplastic trachea- congen tracheal stenosis

Front 76

secondary changes brachycephalic syndrome

Back 76

everted laryngeal saccules

laryngeal collapse

tracheal collapse

Gastrooesophageal reflux- hiatial hernia due to lots of neg pressure

Front 77

characteristics f stenotic nares, sequelae

Back 77

often o dont realise theyre abnormal

axial deviation of dorsolateral nasal cartilages

uper airway obstruction

stridor, exercise intolerance

negative pressure during inspiration

secondary changes at level of laynx and trachea over time

Front 78

techniques for nares surgery

Back 78

vertical wedge tech

horizontal wedge tech

absorbable sitires

Front 79

approach to elongated soft palate

Back 79

if in respiratory distess

O2, sedation, GCS

chest rads to check for 2ndary changes and aspiration or concurrent hypoplastic trachea

evaluate soft palate under GA

Front 80

Noraml elongated soft palate landmarks, approach to assess and tx

Back 80

normal- ends at the caudal border of the tonsils

and slightly overlaps the epiglottis

tru not to pull the tongue out much when assessing- will distort the area

also remove tube temporarily as will push soft palate up

GA necessary for dx so can do straight away

can resect with scissors, CO2 laser, electrosurg or bipolar sealing device

Front 81

principles of castration

Back 81

perform as young as possible

cooler part of the day will bleed less

enough staff

minimise stress

access to water before and after

reduce separation from mum

hygiene

inspect daily for 10d

Front 82

why castrate bull calves

Back 82

less fighting

WHS

prevent unwanted mating

steers easier to paddock

Front 83

how to ring castrate

Back 83

as young as 2d no older than 2w

older- doesnt completely block blood supply, blood goes in cant get out- enlarge

need to make sure both testicles are included

Front 84

why castrate early

Back 84

reduces painand discomfort

reduces bleeding and infection

faster recovery

easiwer to restrain

NSW- not supposed to castrate over 6m

Front 85

methods of restraint for calf castrate

Back 85

standing- harder

cradle- good if available

lateral- physical

Front 86

what do you need to castrate

Back 86

bucket of antispetic

blade

haemostat

gloves

sharps container

shallow tray of disinfectant

Front 87

how to emasculate castrate

Back 87

standing restraint best

feel for left spermatic cord in scrotum and move it to the outer edge

clamp for 10-20s

dont crush midline of scrotum with its bloodflow

reclamp 1cm belopw fist

repeat on r

Front 88

advantages and disadvanages of castration methods

Back 88

surgical- know the task is done

scalpel blades disposable and cheap

development of fat filled scrotal sac enhances appearance and market price

blood loss

risk of swelling and infection

blades WHSrisk

needs experience

Elastrator ring

calves can be done early- less stress

bloodless, no open wound

rings/applicators inexpensive

highest tetanus risk

cannot be older than 2w

no cod

Burdizzo

older calves can be done with reduced stress up to 6m

bloodless, no open woun

appears to cause less pain

needs good equipemtn and operator

emasculator is expensive

cannot visuallt comfirm is successgul

Front 89

methods of dehorning

Back 89

hot iron- under 2 months

2-3 months

dehorning knife

scoop dehorners

cup dehorners

aniamsl over 6 months

surgical wire

tippers

guilotine dehorners

horn saw

must get 1cm ring of hair around horn bud or might not get entire horn base and can regrow

Front 90

vasculature tot he liver

Back 90

hepatic artery- 20% of blood 50% oxygen

portal v- 80% 50% o2

everything frmo GI tract (except caudal rectum) from portal V plus pancreas and spleen

hepatic v

carry blood from sinuses to the caudal vena cava

6-8 hepatic vv in the dog

Front 91

role of ductus venosus and when does it normally close

Back 91

shunts oxygenated blood from umbilical v to the sinus venosus- future right atrium- bypassing the foetal liver

normally closes 2-6 days after birth

Front 92

types of liver shunts

Back 92

intrahepatic-

ductus venosus still open- shunted through live, bypassing the liver cells and parenchyma

shunted into the caudal VC

- not always due to the DV

extrahepatic- other abnormal vessels around liver bypassing the liver

any tribute or theportal v itself connecting to the caudal vena cava

Front 93

Congenital PSS characteristics

Back 93

intrahepatic- 25%- large breed dogs

extrahepatic- 75%- small breed dogs and cats

clinical signs the same

stunted growth, weight loss, A-, poor doers

Hepatic encephalopathy

depression

circling

seizures

blindness

ptyalism

urinary signs- ammonium urate calculi

copper coloured eyes in cats

Front 94

diagnosis of PSS

Back 94

1. biochem/ haem

low urea

hypoglyc

hypoalb

anaemia- defect in Fe transport

ammonium urate crystals

2. Ammonium tolerance test- very particular handing. Must get to the lab quickly

3. pre and post preandial bile acids

4. scintigraphy

5. imaging- u/s

- shudlnt be any vessels entering portal v. between the R renal v an the diaphragm

6. CT angiograpy- gold standard- contrast media intravascularly- good for preop planning because can visualise the shunt

7/ Rads- small liver

Front 95

stabilisation of PSS patient prior to sx

Back 95

dont want to operate when encephalopathy signs

1. decrease bacterial ammonia production in small colon

- enema

- diet- hills l/d to reduce diet

- smaller meals often

- oral lactulose to bind ammonia

2. IV fluids + glucose if hypoglycaemic

3. Oral ABs- metronidozole, amoxyclav- reduce annomia production in bowel

4. Anticonvulsants/ supportive therapy

Front 96

Steps in PSS surg (EHS)

Back 96

1. identify shunt

- large, tortuous, often turbulent

- shoudlt be anything between R renal and hepatic vv entering CVC

- usually in area of epiploic foramen

- usually thin walled

2. occlude the shunt- complete or partial

3. take liver biopsy

Front 97

2 main ways to occlude EHPSS

Back 97

suture ligation

- complete or partial

-risk of portal hypertension if complete, especially if liver is small

- record portal v P with a splenic or jejunal v catheter (normal 8-13cmH20)

- if P doesnt significantly increase ligate comletely

- if it does partially ligate and repeat surgery later

gradual attenuation

ameroid constrictor

cellophane banding

- both result in shunt gradualy attenuating over 4-6w

- lower risk of portal hypertension

liver has time to adapt

Front 98

intraoperative signs of increase in portal presure

Back 98

- pallour cyanosis of the intestine

- increase intestinal peristalsis- angry looking intestine

- increased mesenteric vascular pulsation

- increaed portal v pressures- catheter into jejunal or splenic v

- significalnt decrease in central venous and arterial pressures

Front 99

approach to intrahepatic shunts

Back 99

open sx- extravascular- hard to dissect through liver

open sx- intravascular- complicated sx

closed- coil placement intravascularly- getting more popular

Front 100

post operative complications of EHPSS

Back 100

1. portal hypertension

- hypovolaemic shock- all in portals system- doesnt return tot he heart

- abdo distension and pain

- D+ V+

- lethal if not treated (go back in and remove completet ligation

2. seizures and encephalopathy

- up to 1/5 of animals

commonly within 3d

kept in hosp for 3 days- seizure watch- especially cats

3. more chronic

- recurrence of CSs- erestablished flow

- aquire multiple shunts with chronic portal hypertension- lots of little vessels bypass liver

not much you can do

Front 101

Px EH PSS

Back 101

mortality rates

2-32% surgical ligation

7% ameroid constrictor placement

6-9% cellophane

good (elevated biles, enceph after protein)- excellent outcome in 78-94% despite continued elevated BAs in some

up to 75% cats have post operative complication

if bile acids normal can start them on normal diet but doestn hurt to stay on l/d life long

Front 102

steps to successful caesarian

Back 102

1. patient selection
2. supportive medicine- Ca if needed, pre op ABs
3. site and patient prep
4. Ketamine/ butorphanol IM - 45 mins
LOCAL ANAESTHESIA
5. surgical techniquw
6. after care

Front 103

caesarian incision

Back 103

use the round of a big blade

anticipate calf size

through muscles

grab and exteriorise uterus

grab bottom of hock and foot and use scalpel blade to incise from tip of toe to point of hock ~30cm

cut amnion

make sure uterus incision is big enough not to tear when you pull calf out

can use sterile chains on calf legs

one person take calf away and clean it up

other person hold uterus- should start to contract

Front 104

suturing uterus and abdomen post caesarian

Back 104

tend to leave membranes in

bury knots so doesnt abrade and cause adhesions

2 layer suture similar to bladder- inverting pattern

monensin or vicryl 1, 2 or 3

uterus contacting so 2nd layer important

wash uterus and incision with sterile saline

remove blood clots with gauze

1st layer peritoneum and transverse m- starting at bottom, locking knot for first throw

2nd layer- internal oblique and external oblique

3rd later- skin- ford interlocking, some prefer mattress or cruciates- top to bottom

Front 105

post operative care caesarian

Back 105

1. ABs

systemic 5-7d penicillin or oxyteracycline

intrauterine pessary

+/- 100ml penicillin intraabdominally

2. oxytocin

3. NSAIDs towards end of surgery

4. oral fluids and calcium

about 20L fluids if dehydrated

Front 106

post caesarian care of calf

Back 106

cut cord, dip navel in chlorhex or iodine

colostrum ~4L good quality

Front 107

complications surgical castration

Back 107

bleeding, swelling

infection- scirrous cord- try to cut t. vaginalis close to neck of scrotum

tetanus

death

Front 108

suturing an ear laceration

Back 108

. Suture both concave and convex
surfaces
2. Avoid dead space between skin
and cartilage

Front 109

surgical repair of aural haematoma

Back 109

1. S-shaped skin incision on the
concave surface of the ear
2. Expose haematoma and contents
from end to end
3. Debride, remove fibrin clot and
irrigate the cavity
4. Full thickness mattress sutures
(concave surface), spaced out by
0.5-1cm in a longitudinal direction
5. Use monofilament suture material
6. DO NOT suture the incision
closed
7. Allow a slight gap for continued
drainage
8. Place light protective bandage
over the ear

Front 110

tx options aural haematoma

Back 110

Needle aspiration
• Corticosteroids - local
or systemic
• Surgery

Front 111

ear neoplasia and dx

Back 111

Squamous Cell Carcinoma
• More common in cats
than dogs
• Typically found on the
edge of the pinna
• Diagnosis is confirmed by
cytology or biopsy

Front 112

treatment of pinnae SCC

Back 112

cryosurgery if small

Pinnectomy
1. Partial or complete pinnectomy
made 1-2cm from the tumour
2. Remove affected portion of the
ear
3. Suture remaining skin over
exposed cartilage
4. Avoid tension on wound closure
5. Use monofilament simple
interrupted sutures

Front 113

indications for surgery for otitis externa

Back 113

if conservative treatment fails

- recurrent dz

- occlusion of external ear canal

- predisposing factors

goals are to increase drainage, ventilation, facilitate med application, remove local disease or diseased tissue

Front 114

epidemiology of umbilical hernia and ddx

Back 114

inherited

more common in holsteins

conditioned by environmental factors

ddx abscess- treat first if both

Front 115

indications for umbilical hernia sdx in calf

Back 115

1. if you can fit your fist in it

if small- leave and recheck

dont leave too long or will get harder to operate on

2 .if calf is 3-6months and still has it

3. irreducible

4. entrapment or sepsis suspected- tx abscess first

operate after 4w

Front 116

surgical technique for calf umbilical hernia

Back 116

- starve for 24 hours

- xylazine or triple stun then infiltrate with LA

- dorsal recumbecny

pack prepuce

- eliptical incision- blunt dissection to expose hernia sac- drain and resolve infection before sx if poss

- incise at junction of hernia and body wall

- resect sac and circumferentially a thin strip of hernial ring- adhesions

- lengthen ting

close bodu wall

- simple interrupted, horizontal over top for big uns

- pre place sutures and then tighten both ends

- eliminate dead space using subcut tissues

Front 117

ddx umbilical mass calf

Back 117

history- since sx? painful? sick?

palpate- reducible, heat pain

ultrasound

1. hernia

2. abscess

3. infected umbilical vein- serious- liver abscessation, septis

Front 118

types and aetiology of rectal prolapse in production animals

Back 118

incomplete- mucosa only with surrounding tissue oedema

complete- total eversion with serosal rectal surfaces involved

1. severe enteritis- coccidia/salm in calves

2. sudden high protein intake with D+- sheep

3. severe straining- vaginal prolapse, urolith

4. severe ruminal tympany

5. high oestrogen intake- relaxation of ischiorectal fossa

Front 119

reduction of rectal prolapse in calves

Back 119

epidural

lube up

- replace

- purse string- enough for poo- 2 fingers in 2mo calf

- leave 3-4 days

antiinflamms

tx underlying cause

Front 120

resection of rectal prolapse in calves

Back 120

stair step amputation

- syringe casting into lumen

- needles through casting to stabilise

- circumferential incision cranial to necrotic area- dont cut inner mucosa and submucosa

- complete incision 3cm caudal

- suture mucosa together

rectal ring method

- tubing- anchor with vicryl and suture a tourniquet- rectum sloughs 10d later

predrill hole in the tube- make sure the needle threads through it

simpler to do- effective

not an immediate result

Front 121

principles of treating abscesses

Back 121

1. if difficult to localise- need to come to a head- dont give ABs

2. s/c local infusion over softest area- enter abscess and expolore

3. establsh drainage at lowest point

4. use gauze to keep open a few days

5. flush liberally with hose and dilute iodine

pop her on ABs if its a big one- not manditory

usually A pyogenes or Necrophorum

Front 122

removal of 3rd eyelid

Back 122

Sedate cow

Prep and clean
• Infiltrate 5 ml of 2% lignocaine into base of
eyelid
• +/- auriculo– palpebral block
• draw third eyelid out by traction using forceps

when theyre really big- sharp scissors- pull and cut
• excise eyelid deep to cartilage with curved
scissors
• Ensure remove all of cartilage- make sure no rubbing on eye
• Prophylactic topical +/- parenteral antibiotics

Front 123

indications and procedure for uthrethrostomy (13)

Back 123

Salvage operation: permanent urethra
fistula
1. Caudal epidural analgesia
2. Routine skin preparation: anus to scrotal neck & 10 cm each side of midline

3. dorsal recumbency or standing

4. 10-15cm incision over distal sigmoid flexure

5. blunt dissection through elastic tissue to penis

6. traction using clamp to expose penis

7. ID retractor penis mm to locate ventral surface

8. locate calculus

9. dissect penis away from dorsal artery and vein then transect- leave 10-12cm stump- allow enough to pull out and have in correct direction

10. Anchor penis with sutures through corpus cavernosum, skin and tunica albuginea

direct penis caudoventrally

11. Dont compress lumen or bend stump

12. close dead space and suture

13. make incisions lateral to penis to allow urine to drain if urethra has ruptured

Front 124

Eye ablation aftercare

Back 124

may recur if aggressive

dont put straight back in with the other cows- will attack them if theyre bloody

topical and systemic ABs

Front 125

Layers of teat wall

Back 125

mucosa

submucosa

CT- highly vascular

muscle

skin

all tightly adherent

Front 126

Anaesthesia of teat

Back 126

xylazine

teat cistern infusion

ring block

inverted v block

Front 127

suturing the teat

Back 127

if its a vertical laceration just bandage

1. mucosal layer- continuous 4-0 or 5-0 polygalactin vicryl

2. submucosa- CT and m- continuous 4-0 round body

3. skin- simple interrupted or horr mattress

2-0 or 3-0 prolene

include the sm layer for extra support and to eliminate dead space

cannula for milk let down- down put in machine

bndage with vet wwrap, change every milking

Front 128

indications for gastrointestinal surgery in the cow

when does it carry a poor px

Back 128

1splashing or pings consistent with LDA
2not rumenating

3tachycardia >100

4. dilated organ on rectal palp

5. green discharge from nose (obstruction)

6. no faeces or scouring

7. colic- in conj with other signs

poor px for RDA, vagal indigestion, bradycardic animals

Front 129

things to check in cow ex lap

Back 129

1. position of the abomasums- move omentum, find rumen, feel for LDA/RDA

2. size/ consistency of rumen

3. root of mesentery- torsion

4. intestines- tight bands, dilations or oedema

5. liver and gall bladder

6. stage of gestation- uterine torsion after 5m- check both blood vessels running abaxially

7. left kidney- on midline

Front 130

Richt paramedian surgical incision for abdominal surgery in the cow

Back 130

10-15cm in right paralumbar fossa

5-10cm behind the last rib, following curvature (as close to rib as possible for LDA)

dont go too low- guts will fall out

excise external obliquus

bluntly divide transversus and internus

TAIL JACK open peritoneum by blunt dissection

Front 131

methods for sx treamtent LDA

Back 131

1. Right flank laparotomy and omentopexy

2. left flank and fixaion of the rumen to the ventral wall

3. suturinng the omentum or abomasums to the ventral floor

4. bilateral laparotomy and omentoplexy

5. roll and toggle

Front 132

which LDA surgery to choose

Back 132

- mutliple studies comparian laparotomy techniques with roll and toggle techniques- not a convincing winner- probably experience of the surgeon and facilities available will dictate best choice.

toggle has higher post op death but is cheaper

cant do toggle over 5m

Front 133

things to warn farmer about before LDA surg

Back 133

increased time to conception- NEB- mosre important in seasonal calving due to narrow indow to get back into calf

poor px if cachexic or LDA of 4-6 duration

Front 134

reasons for post op deaths

Back 134

concurrent disease associated with deth and increased culling

abomasal ulcers

liver failure secondary to lipomobilisation due to anorexia

partial pyloric obstruction post toggle

Front 135

procedure for Grymer/sterner Toggle

Back 135

1. Xylazine

2. cast into right recumbency

3. roll onto back with right upmost slightly

4. tie back legs to immoveable object

5. Surgeon on right of cow. auscultate the abomasum about 10-15 cm caudal to xyphoid. put knee into the abdomen in front of the right udder. Pushed abomasum against ventral body wall

6. place caudal toggle first- trochar-cannula with push rod inside 10-15cm caudal to the xiphoid and 5-7 cm to right of midline

7. perforate abdo with one swift downward push of trochar- shoudl smell abomasal gas, can take a sample of fluid- ph2-3

AVOID LARGE S/C VEINS- mark if necc- place simple interrupteds if theyre perforated

8. remove handle and push hold toggle with arod from trochar needle, place the first toggle suture into the needle and use push rod to move thorought he length of the needle

9. use artery forceps to pull up abomasum

10. second toggle 4-7cm cranial

- before releasing trochar needleplace pressure on the abomasum to release gas and reduce pressure on sutures

11. LOOSELY tied with 10-12 throws, 8-10 cm from body wall

12. roll cow clockwise onto left side and then into sternal

13. sutures out 2 weeks

Front 136

RDA surgery technique

Back 136

1. Right flank incision

2. determine the rotation

- initial dorsal displacement of the greater curvature, followed by counter clockwise 180-360 degree torsion

3. deflate if larger

4. to rotate- put base of hand on caudoventral abomasum and push dorsolateral

when corrected pylorus will be above abomasum and close to incision

fasten with omentoplexy- include omentum in transverse closure

Front 137

sx approach coecal torsion

Back 137

Right flank, exteriorise coecum

drain

untwist and replace with omentoplexy

Front 138

intestinal volvulus in cow- sx approach

Back 138

twist at the root of mesentry that can be felt just anterior to the anterior pole of the left kidney

identify direction and untwist- difficult to tell wehn. might feel pulse in distal arteries

avoid exteriorising, poor px if intestines extremely distended and decrotic and difficult to untwist inside cow

fair x if caught early- per rectum and transudate

Front 139

ddx intestinal obstruction

Back 139

trichobezoar

phytobezoar

intussusception

torsion of ileo-jejunal flange

Front 140

Procedure for rumenotomy

Back 140

L block or paraventral

sedaation

5cm caudal to last rib- 20cm incision following the line of curvature

stay sutures

evacuate rumen

suture rumen to skin using continuous inverting suture

Front 141

signs of retrobulbar cellulitis

Back 141

periorbital swelling

prominent 3rd eyelid

keratitis from lagopthalamous

chemosis, hyperemia

wanting to eat but not being able to

pain on opening mouth

pyrexic

normal lnn

leucocytosis

Front 142

medical and surgical therapy of retrobulbar celullitis

Back 142

Oral ABX- anaerobes and gram neg

- clav, cephalexin

Oral steroids

Analgesia- tramadol

Sx

establish drainage

incise mucosa and used closed haemostats to push through pteryoid, avoid extrnal maxillary artery

Front 143

sympathetic innervation tot he eyelids

Back 143

mullers muscles arise from under the surface of levator palpebrae superiori muscle

interruption causes tonosis of upper eyelid

Front 144

treatment for congen entropion

Back 144

tack up aniaml is a bit older for sx

Hotz Celsus

blepharectomy

Front 145

eyelid surgery preop post op

Back 145

analgesia

NSAID at induction

systemic ABs best due to great blood supply

warm compress to encourage blood flow

E collar

Front 146

how can blood vessels of conj reflect ocular dz

Back 146

superfical vessel engorgement- extraocular disease

tortuous- blanch with epineph

moveable

deep vessel engorgement- intraocular disease

straighter, thicnker, wont blanch, not readily moveablec

Front 147

causes of primary conjunctivitis and dx

Back 147

chlamydia

calicivirus

mycoplasma

herpes

good hx

PCR, IFAT

fluorescin, rose bengal stains

Front 148

causes of keratoconj sicca

Back 148

congenital aplasia, hypoplasia

breed auto immune

hyperT

hyperA DM atopy lupus EPI

sulfonamides

damage to parasympathetic branch of CNVII

anaesthesia dn atropine typedrugs

CDV

Front 149

first line ABs for corneal ulcer

Back 149

chloramphenicol

ciprifloxacin

moxifloxacin

tricin/ neomycin- not cats

Front 150

treatment for ulcers

Back 150

1. ABs- topicals, if well vascularised systemics

2. pain relief- NSAIDS PO, gabapentin, tramadol

3. mydriatics- careful- can push into glaucoma

4. protease inhibitor- serum, doxy PO, acetylcysteine

5. surgical intervention- flap

Front 151

how to approach horse fracture

Back 151

stabilise the horse- fluids, quick PE

sedation- short acting- xyla and but

stabilise the fracture site- clean wounds- dilute bedatine, dress, Robert jones, splint 1 joint above and below

administer tetanus and ABs if open

Front 152

splinting a dorsal forelimb #

Back 152

Includes, cannon bone, long and short pastern bones and
sesamoid bone
 The goal of splinting is to align the bony column and protect the
soft tissues in the fetlock and pastern from excessive
compression
 A dorsal splint should cover the entire foot and extend to the
upper portion of the cannon bone
 Kimsey – leg saver
 Should never end at a joint – end just below carpus

Apply a bandage of medium thickness from the coronary band to the upper
portion of the cannon bone
 Place a board or other rigid material against the front lower portion of the
limb and secure it with non elastic tape or casting material. It is important to
include the entire foot within the splint to avoid causing more trauma at the
fx site
 A kimsey leg saver can be applied in place of the dorsal splint

Front 153

mid forelimb fracture

Back 153

Includes cannon bone, knee and forearm
 The goal of splinting is to realign the bony column and prevent
the lower limb from moving in 4 directions. This is best
achieved by applying 2 splints placed at right angles: a caudal
splint placed from the ground to the top of the olecranon and a

pplying a bandage of moderate thickness from the coronary band to the
highest pt of the elbow. Typically three levels of bandages are required to
reach the elbow
 Place a caudal splint extending from the ground to the pt of the elbow
against the limb and secure it with non elastic tape
 Place a lateral splint extending from the ground to the elbow joint against the
limb and secure it with non elastic tape
 The entire foot should be included in the splint to increase stability
lateral splint placed from the ground to the elbow
 Kimsey is too low – may causes a non displaced fx to become
displaced

Front 154

radial fracture

Back 154

High chance of becoming an open #

Includes the forarm (radius) above the knee, below
the elbow
 The goal of splinting is to realign the bony column ,
prevent movement in all directions and protect the
skin on the inside of thee limb from being lacerated
by the sharp bone ends.
 Two splints should applied at right angles: caudal
splint placed from the ground to the top of the
olecranon and a lateral splint placed from the
ground to above the shoulder to prevent lateral
movement of the limb
Splint application
 Apply a bandage of moderate thickness from the coronary band to the
highest pt of the elbow . typically it will require three levels to stack the
bandage to the elbow
 Place the caudal splint from the ground to the highest pt of the elbow and
secure it with non elastic tape
 Place the lateral splint from the ground to above the shoulder joint and
secure with non elastic tape
 Secure the highest portion of the splint to the trunk, as shown, by wrapping
elastic bandage material around the neck and chest, through the forelimbs ,
over the withers, and under the girth in a figure of 8 pattern

Front 155

Dorsal hindlimb fracture

Back 155

Distal hindlimb fractures
 Includes lower canon bone, sesamoid bone and long and short pastern bones
 The goal of splinting as with the
forelimb is to align the bony column
and protect the soft tissues in the
fetlock and pastern from excessive
compression. This is best
accomplished by applying a board or
other rigid material to the lower back
aspect of the limb. It is very important
to incorporate the entire foot in the
flexed position to avoid causing more
trauma to the fracture site
 A kimsey leg saver splint is as
effective as a planter splint

Front 156

hind cannon bone #

Back 156

Hind limb
 Cannon bone: distal metatarsus to proximal metatarsus
o Apply bandage to level of the stifle o Two splints
 Stabilise with plantar splint to the level of the calcaneus and
lateral splint up to the stifle

Front 157

tibial #

Back 157

 Proximal metatarsus to stifle
o Tibial fracture results in overriding of fx fragments with
flexion of the stifle without hock flexion
o Apply a RJ bandage to lvl of the stifle
o Stabilise with an extended lateral splint
o Similar to radius – have to be splinted – can easily become open as no mm btw skin and tibia

Front 158

femur fractures

Back 158

Include femur fractures
 Almost non weight bearing
 Distal muscular attachment makes them
more stable than upper forelimb fxs
 Surrounding muscles provide support
 No coaptation necessary and could make the fx worse
o Can be very hard to dx - painful but no obvious crepitus, swelling etc
o Don’t have to splint as so much mm in areas > provides stabilisation
and cant do it anyway

Front 159

px for limb #

Back 159

Patient condition and temperament o e.g. unbroken 2yo stallion > lot more difficult to treat as require daily
monitoring , assessment , tx, multiple procedures
 Location of fx
o Lower limb > better
 Patient size
o Smaller > better
 Open fracture grade
o no matter what > guarded px due to fast onset of osteomyelitis
 Severity of the fx
o More communited - cant make horses lie down need to be able to
stand on all for limbs
 Cost of treatment
o Can escalate quickly

Front 160

indications for lateral ear canal resection, vertical ear canal ablation, total ear canal oblation

Back 160

lateral- improve drainage, facilitate meds, remove neoplasia

vertical ear canal - disease and stenosis of the vrtical canal- horizontal normal, improve drainage and ventilation, enable medication

total ear canal ablation- remove diseased, non healing and stenotic ear tissue. Should be performed with ventral bulla ostectomy if there is concurrent otitis media

Front 161

procedure for lateral ear canal resection

Back 161

1. mark a site 1/2 the length of the vertical canal BELOW the horizontal canal

2. make 2 parallel incisions either side of the vertical canal- tragus to marked site

3. connect incisions ventrally at marked site

4. reflect skin flap dorsally

5. cut vertical canal with mayo scissors

6. reflect cartilage flap distally to inspect horizontal canal

7. resect distal half od the cartilage flap to make a drain board

8. place sutures from epithelial tissue to the skin

Front 162

Vertical ear canal ablation procedure

Back 162

1. make a T shaped incision with the horizontal component parallel and below the upper edge of the tragus

2. make a vertical incision from the midpoint of the T to the level of the horizontal canal

3. reflect skin flaps and reflect loose CT

4. dissect around the vertical canal and release it from its mm attachments

5. transect 1-2cm dorsal to the horizontal canal

6. incise remnant vertical canal cranially and cudally

7. reflect ventral flap down and suture to the skin for drainboard

8. reflect dorsal flap up and suture to skin, close subcut tissues and skin dorsal to this

Front 163

Procedure for total ear ablation

Back 163

1. make a T shaped incision with the horizontal component parralell and just below the upper edge of the tragus. extend the ventral incision to just below the level of the horizontal canal

2. retract the skin flaps, reflect loose CT and espose the lateral aspect of the vertical canal

3. continue the horizontal incision around the external auditory meatus with a scalpel

4. dissect around the vertical canal and release it from its mm attachements

5. excise the horizontal canal attatchemtn to the external acoustic meatus with a scalpel, rongeur or mayo scissors. Carefully curette any remaining secretory tissue that is adherent to the bone

6. place a penrose ddrain if necessary

7. close the subcut and skin- start ventrally and cranially and cudally until incision meets in the middle as a T

Front 164

S Hx and CS nasal polyp

Back 164

young cat under 2

dysphagia

resp signs- stertor, nasal discharge, sneezing, voice change, dyspnoea

neuro- head tilt, nystagmus, vestibular imbalance

Front 165

surgical treatment of nasal polyps

Back 165

ventral bulla osteotomy

dorsal recumbency

prepare generous area around the angle of the mandible

landmarks

- line between rami

- line along long axis of head

2-5cm incision parallel to long axis, offst 2cm to the affected side from where the 2 imaginary lines meet

incise the platysma muscle

dissect the digastricus off the hypoglossal and styloglossal muscles

use self retaining retractors to spread the muscles and retrct the from the bulla

use a steinmann pin to make an opening in the ventral aspect of the bulla

enlarge opening using rongeurs

examine the inside for neoplasia, inflammatory nebris, neoplastic tissues and take a sameple for culture

flush cavity and insert drain if there is infection

Front 166

complications of ear surg

Back 166

horners- ptosis, miosis, reduced sweating- BO

facial paralysis- TECA, BO

Front 167

preop considerations for thyroid dz

Back 167

bad candidates if hypertensive

methimazole or carbimazole for 6-12 weeks prior to sx

beta blocekrs if there is tachycardia

monitor kidnet fx

Front 168

throidectomy techniques

Back 168

extracapsular thyroidectomy- sacridices the parathyroid glands- dogs with maligant tumours

intracapsular- preserves extracapular parathyroid- cats with hyperT

modified extracapsular

Front 169

thyroidectomy relevant surrounding structures

Back 169

caudal and cranial thyroid arteries

parathyroid glands

carotid artery

left recurrent laryngeal n

Front 170

Modified extra cap and intracap thyroid surgery

Back 170

mod extra used fine tupped bipolar cautery forceps to cauterise the thyroid capsule approx 2mm from the external parotid gland.Use fine scissors to cut away the gland from the cauterised area and remove from the parathyroid

intraacapsular- incision on the caudoventral surface of the gland in an avascular area and extend it cranially with small scissors- blunt and sharp dissection to remove thyroid from the capsule

Front 171

signs and dx of primary hyperparathyroidism

Back 171

hypercalcaemia

ddx (rule out)

- lymphosarcoma- thoracic and abdo rads

- chronic renal failure- elevated iCa and PTH

- hypoA

- granulomatous dz

- hypervitaminD

PUPD

serum PTH

uroliths

V

weakness

ultrasound- enlarged >4mm suspicious

biochem

Front 172

parathyroidectomy consideration

Back 172

if intracapsular PT are affected- requires complete thyroidectomy. Spare extracapsular PT if possible

complications could include post op hypoCa- chronic negative feedback and circualting PTH only has a half life of 20 mins

abnormal parathyroid can be visualised using infusion of methylene blue- beware- could cause haemolysis

if neoplastic- might need full thyroidectomy and removal of draining lnn

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causes of aural haematoma

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chronic irritation of the ear

otitis extrerna

foreign body

insect bites

immune mediated disease

vasculitits/ hyperA

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treatment of aural haematoma

Back 174

needle aspiration

local/systemic GCSs

surgery:

1. S shaped incision

2. debride

3. close with mattress sutures- full thickness, longitudinal, 1-1.5cm spaced

monofilament

4. bandage the ear afterwards

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cleft palate

Back 175

te = congenital oronasal fistula
- It is an abnormal communication between the oral and nasal cavities
involving the soft palate, hard palate, premaxilla, and/or lip
- The 1° palate = lip and premaxilla
o Incomplete closure = 1° cleft or cleft lip (hare lip)
- The 2° palate hard and soft palates

may also have a uni or bilateral failure of the soft palate to fuse with the lateral nasopharyngeal wall

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CS of cleft palate

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o Difficulty suckling because they can’t create negative pressure to
suck milk due to oral cavity being open to the nasal cavity (+
outside)
o Nasal discharge
o Concurrent cleft lip sometimes
o Aspiration pneumonia

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ear neoplasia types and tx

Back 177

SCC most common

esp cats

often aroudn ear margin

diagnose by cytology or bx

check lnns

cryosurg or pinnectomy- partial or complete

simple interrupted monofilament