Exam 3 Study Points and Review Questions

What position is the patient placed in for an abdominal exploratory surgery?

Dorsal Recumbency

What is the **primary** indication for an ovariohysterectomy?

Reproductive sterilization

What dog breed has an increased risk of dystocia?

Bulldogs

During which procedure is the uterus removed?

Ovariohysterectomy

What retractor is routinely used in abdominal exploratory surgeries?

Balfour

Balfour retractors are used to:

Hold open the abdomen for better visualization

Evisceration puncture of the abdomen to obtain fluid is called an:

Abdominocentesis

Which patient would be more likely to develop gastric dilation volvulus?

Doberman Pinscher

What is considered the most painful part of the ovariohysterectomy procedure?

Plucking the suspensory ligament

Which drug is used to stimulate respirations for resuscitation of newborns after a cesarean section?

Doxapram

What is dystocia?

Difficult birth

What are two ways we can deal with dystocia?

\-Medical therapy to stimulate contractions if birth canal is normal size, cervix is open, and fetus is not too large

\-C-section (may suggest OHE at this time)

What is involved with an ovariohysterectomy (OHE)?

\-clip xiphoid to pubis

\-dorsal recumbency

\-surgical excision of the ovaries and uterus

What is involved with a cesarean section?

\-delivery of fetus or fetuses by incision through the abdominal wall and uterus

\-indicated by dystocia

\-extra help must be available for fetuses along with a lot of hemostats for cords

What is involved with an exploratory laparotomy (ex lap)?

\-clip from mid sternum to pubis and laterally to edge of ribs

\-surgical exploration of the abdominal cavity

\-balfour retractor to allow full exposure

What is a Gastric Dilatation Volvulus (GDV)?

\-distended stomach that has rotated on it own axis (this is a surgical emergency)

\-common in deep chested large breed dogs

What is the treatment for a GDV?

1\. IV catheter (in both cephalics)

2\. decompress stomach (via trocar or orogastric tube)

3\. surgical correction (after patient is stable)

Dystocia Stage 1

Nesting stage

Several hours

Ends with dilation of cervix

Dystocia Stage 2

Dilation of cervix

Fetus enters birth canal

Rupture of fetal membranes

Abdominal contractions

Normal up to 4 hours for first fetus

Up to 2 hours btw each fetus

Dystocia Stage 3

Passage of placenta

Gastrotomy

Incision into the stomach

Enterotomy

Incision into the small intestine

\-Foreign body removal

\-Biopsy of small bowel

R&A

Excision of a segment of bowel followed by reestablishment of the two remaining segments

Gastroplexy

Permanent fixation of stomach to body wall

Cystotomy

Surgical incision into bladder

\-some indications include cystic calculi, biopsy, correct congenital abnormalities

\-may need a bladder spoon in surgery

\-monitor for signs of uroabdomen

When is the best time to spay?

Ideally before the first heat cycle

What procedure would be considered an elective orthopedic procedure?

Correction of medial luxating patella

An example of an external coaptation would be placement of:

Modified Robert Jones Bandage (or any splint/cast)

Salter-Harris fractures always involve the:

Physis

Physis

Growth Plate

An external fixator would be contraindicated in the treatment of a fracture of the:

Ilium

Which type of fixation device can be adjusted throughout the healing period?

External Fixator

Splints should only be employed for for fractures distal to the:

Stifle and Elbow

Grade 1 **Open** Fracture:

Small skin puncture, bone is no longer visible; minimal soft tissue damage

Grade 2 **Open** Fracture:

Larger puncture/tear and more soft tissue damage

Grade 3 **Open** Fracture:

Large tears, +/- loss of skin; soft tissue damage may due to bone fragmentation, shearing injuries, bone exposed

Closed Fracture

Skin is not broken, no puncture/tear, soft tissue damage may be mild to severe

Open Fracture

Bone has broken through the skin

Transverse Fracture

Bone is broken perpendicular to the long axis

Spiral Fracture

Break due to a rotating or twisting force

Comminuted Fracture

Bone is broken in fragments

Impacted Fracture

A fracture where the broken end are forced into each other

Greenstick Fracture

Incomplete break- similar to transverse but just not broken all the way through

Oblique Fracture

Fracture line is not perpendicular to long axis of the bone

Osteomyelitis

Bone infection

What are fractures in juveniles called?

Salter-Harris fractures; growth plates are involved and they can result in angular limb deformities

Articular Fracture

A fracture that goes through a joint surface; this joint will likely have arthritis later

What are some methods of internal fixation?

\-bone plates/screws

\-interlocking nails

\-intrameduallary pins

\-orthopedic wires

What is involved in the process of bone plates/screws?

Soft tissue and muscle dissection, expose the fracture, and plate/screw placement

What is involved with interlocking nails?

In the medullary cavity; screws at proximal and distal aspects with no extensive soft tissue dissection

What is involved in placing IM pins?

In the medullary cavity; open or closed technique; they can migrate if not recovered appropriately

What is involved with orthopedic wires?

Cerclage; fragment reduction and fissure protection; can use full cerclage or hemicerclage

What are some examples of external fixation?

\-casts, rigid splints, SK fixation

\-linear and circular fixators

\-ring fixator

What do linear and circular fixators do?

Threaded cross pins attached to bars or rings; removed when fracture is healed

Ring fixators

Different sized rings, various pin types; pin is placed under tension

What should be done to recover a patient after internal fixation?

Strict confinement for 6-8 weeks, e-collars, sling support, suture removal, follow-up radiographs, pain management, PT/rehab protocol

What is involved when recovering a patient with external fixation?

Periodic visit (cleaning, clamp tightening), rads every 4 weeks, restrict activity; infection is more of a risk with external fixation

Non-union

Bone doesn’t heal at all

Malunion

Bone heals incorrectly

Delayed union

Takes a really long time to heal

Aseptic loosening

Implant gets loose or shifts but no infection is involved

What types of surgeries are considered elective ortho procedures?

Cranial cruciate ligament tears, medial patella luxation repairs

What are the components of fracture assessment (how ortho injuries are diagnosed/repaired)?

\-bone location

\-open or closed fracture

\-location of fracture on the bone

\-type of fracture

\-reducible or nonreducible fracture

What are some guidelines when applying splints/casts/bandages?

\-anesthesia is required

\-radiographs to ensure proper alignment before and after coaptation

\-splints work well on small, young, fasting healing animals and injuries that are distal to stifle and elbow

\-casts need to be checked every 1-2 weeks

\-must be kept clean/dry and checked for slippage/mutilation (swelling toes and malodor needs to be monitored for)

\-confinement is necessary

Ortho injuries heal faster in what type of animals?

Younger animals’ bones heal faster than older animals

Cranial Cruciate Ligament Rupture

Most common orthopedic surgery

\~ 50% of dogs will rupture other CCL w/i 1 year

Which of the following is a disadvantage when performing a fine needle aspirate?

Low diagnostic yield

What type of minimally invasive procedure is used on cut surfaces and ulcerated surfaces of tumors?

Impression smear

Which biopsy technique involves complete removal of a mass?

Excisional biopsy

How does physical exam help us evaluate masses?

Map location of size of masses; evaluate lymph nodes; perform orthopedic/neurologic exams depending on mass

What does a good history tell us about a mass?

How long it has been there, if it has been changing in size, color, etc. (basically any significant details the owner will give us)

How can clinical pathology help us evaluate masses?

FNA for biopsy

How can diagnostic imaging help us evaluate masses?

CT, radiographs (can help stage/evaluate for metastasis), ultrasound, and MRI can all help us better plan how/if we should remove the mass

What type of tissue sampling can help us evaluate masses?

Impression Smears

What do we do in surgery to evaluate masses?

Removal and/or biopsy

What is incisional removal of a mass?

This is for a mass that is large and you don't know what they are; take a piece of it with a piece of adjacent tissue

What is excisional removal of a mass?

For tumors that treatment did not change the tumors; the treatment and diagnosis is surgery

What is radical removal of a mass?

Removal of an entire affected tissue compartment (ex: amputation)

What is wide excision removal of a mass?

Removed with a margin of normal tissue surrounding the tumor

What is a marginal removal of a mass?

Removed at the margin of the tumor with the capsule intact

What is intracapsular removal of a mass?

Removal from within a capsule or pseudo capsule; used in debulking

What are the locations for bone biopsies?

\-proximal humerus

\-illial wing

\-proximal femur

\-proximal tibia (young dogs only)

For radiographs of masses, what views should be taken?

3 view thoracic study and 2 view abdominal study; at least 2 views for a limb

What are you looking for when evaluating stage?

Evidence of metastisis

What are indications for a biopsy?

\-treatment will differ depending on tumor (type and behavior)

\-may help plan for surgical resection

\-diagnosis might change owner's desire to treat

What are the indications for a needle-core biopsy?

\-no diagnosis with FNA or impression smear

\-need more tissue for characteristics

What are indications for a punch biopsy?

\-cutaneous masses

\-focal organ masses

\-intestinal biopsies

What is a margin?

The amount of normal tissue removed with a tumor

What are the margins for cutaneous carcinomas?

1 cm

What are the margins for mast cell tumors?

2-3 cm

What are the margins for cutaneous sarcomas?

3-5 cm

Dry-to-dry Bandage

Dry mesh gauze directly applied to an open wound with embedded foreign material or necrotic tissue

Wet-to-dry Bandage

Used with open wounds that have embedded foreign material, devitalized tissue, and viscous exudates

Lavage

The procedure of forceful rinsing of a wound

Debridement

The removal of adhered debris and dead tissue from the wound

Steps for Wounds

1\. Prevention of further wound contamination

2\. Debridement of dead and dying tissue

3\. Removal of foreign debris and contaminants

4\. Provision of adequate wound drainage

5\. Promotion of a viable vascular bed

6\. Selection of appropriate method of closure

Povidine-Iodine Lavage Solution

1% Povidone Iodine

(1:10 or less)

* 100ml in 1L
* Residual activity 4-6hr

\

Chlorhexidine Lavage Solution

0\.05% Solution (1:40 dilution)

* 25ml in 1L
* Activity less affected by organic material
* Long residual activity
* Increases with repeated applications
* Side-effects rare

\

Contact layer

\-conform to body contours

\-allow drainage to pass to secondary layer

\-minimize pain

\-nontoxic, non-irritating

Intermediate/Secondary Layer

-bulk of bandage

\-holds drainage

\-provides support are/or immobilization

\-decrease dead space and reduces edema

\-must cover primary layer

\-must be thick enough to absorb all fluid