10. Bloody Ear, Wound Puss and Stinky Butt

How do you diagnose Aural Hematoma??

Visual/palpable

What is the etiology of Aural Hematoma

trauma to the pinna secondary to head

shaking or fighting

What are the THREE things that the treatment is based on?

- based on the size of the hematoma

- the health of the animal

- the costs of procedures

Any of the above treatment options may lead to what TWO things?

fibrosis or scarring

What are the FOUR treatment options for aural hematoma? What is the cost?

• Oral steroids (typically small) $

• Drain only $

• Drainage and steroid injection into hematoma after

drainage (typically small) $</p><p>• Surgical drainage using various techniques of suture</p><p>placement (typically larger)$$

What is the treatment that the majority of veterinarians are using to treat aural hematoma?

Drain plus local steroids

What are the THREE different ways to fix a hematoma?

- Linear incision with sutures:

- Sutures with stents

- S-shaped incision with sutures

How do you drain a hematoma?

you stab that hoe with a butterfly catheter and drain it, you can use topical lidocaine

What are the surgical techniques for aural hematomas?

- Drain/cannula

- using biopsy and letting it heal with second intention

- slit with sutures

How do you do the common hematoma surgery?

• Anesthesia

• Clip and clean the ear

• Place a cotton ball into the ear canal

• Incise the hematoma with a "s" shaped or

linear incision

• Drain and evacuate the hematoma

• Tack the ear with 3-0 non-absorbable

sutures using full-thickness placement

Suture placement (parallel/perpendicular) to the suspected blood supply

parallel

What are the THREE branches that you need to watch put for when suturing auricular hematoma?

- Medial auricular branches

- Lateral auricular branches

- Intermedial aurical branches

What part of the ear is most likely to become necrotic and die if you oclude the blood supply?

distal end of the pinna

When will the sutures be removed?

14-21 days

T/F You can use a long acting Otic externa infection to help stop the head shaking and leave it in post surgery

True

What are some of the common medications used for aural hematomas? (3)

• Gabapentin

• Trazodone 2

• Oral prednisone

T/F Otitis externa may be associated with ear without hematoma

True

Warn the owner that ____ and ____ may occur even with early treatment; however, they are more common when treatment is delayed

fibrosis, scarring

T/F Post-surgical appearance is unpleasant, and owners

should be warned

True

What is typically associated with bite/ fight/ trauma?

bite wound abscess

What TWO things that is essential to achieve in the bite wound abscess?

drainage and lavage

What is the typical presentation of a bite wound abscess?

- Acute onset of lethargy and anorexia.

- Pe: Febrile (T 105.1)

- Swelling

How do you treat a bite wound abscess?

• Sedation.

• Clip and clean wound/ explore draining tract.

• Lavage abscess with dilute betadine solution.

• Place Penrose drain for 3-5 days.

• Antibiotics and nsaids to go home

A foreign body can cause an abscess, what is it sometimes referred to as?

draining tract

Draining tracts will likely return once ____ are completed until the

foreign body is removed

antibiotics

What disease is realatively common in dogs and can include impaction, sacculitis, abscessation, and fistulation?

Nonneoplastic anal sac disease

What are the possible etiologies of an anal sac abscess?

- thick secretions

- poor muscle tone

- change in stool consistency

- abnormal anal sac ducts

In anal sac abscess, bacteria associated with infection can be either

___ or __

anaerobic or aerobic

What dog breeds are more commonly affected by anal sac abscess?

toy breed

What is the presenting complaint for anal sac abscess?

• Typically, owner notices either blood or drainage

around or near the rectum.

• Scooting may be noted or licking prior to owner

noting the swelling and drainage

How do you diagnose an anal sac abscess?

visual during the examination

What is the physical exam of an anal sac abscess?

wnl/ visible swelling

noted around the rectum

with drainage

What is the plan of an anal sac abscess?

sedate, clip and clean. Drain abscess and infuse topical antibiotic

and steroid into abscessed area

Type or read: Treatment at a glance

• Anal sac material should be expressed.

• Cytologic evaluation of anal sac content is

recommended.

• A 20-gauge catheter tip or a 3.5-French catheter may be

inserted into the anal sac opening for

impaction/sacculitis or the fistula for abscesses with

fistulation.

• Sterile saline flush should be repeated until flush from

the sac/fistula is clear.

• Infusion with a corticosteroid/antibiotic/antifungal

ointment after sterile saline flush has been anecdotally

recommended.

• Anal sacculectomy can be considered in patients with

poor response to medical management

What is important that you do with all of these conditions?

treat the underlying issue so they do not reoccur