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A&S - Week 5
Dentistry & Alimentary Tract Surgery
| Question | Answer |
|---|---|
| What Structures Make Up The Crown Of The Tooth? | -Enamel -Dentin -Pulp -Gingival sulcus |
| What Structures Make Up The Root Of The Tooth? | -Gingiva -Lateral canal -Cementum -Periodontal ligament -Alveolar bone -Blood vessels and nerves |
| Define Periodontal Disease | -Inflammation and destruction of the four periodontal tissues: Gingiva Cementum Alveolar bone Periodontal ligament |
| List The Stages Of Periodontal Disease | 1.Plaque formation 2.Deepening of gingival sulcus 3.Proliferation of sub-gingival plaque 4.Toxins build up and tissue damage 5.Attachment loss 6.Tooth loss |
| What Are The Predisposing Factors Of Periodontal Disease? | -Breed -Developmental abnormalities -Genetics (wet food not as effective at cleaning teeth than dry) -Diet -Behaviours (chewing – wears down teeth) -Disease |
| What Can Vet Nurses Do Under Schedule 3 In Relation To Dentistry? | -Scale and polish -Dental charting -Dental extractions (wobbly teeth with fingers) -Dental imaging -Dental assessment |
| Why Can't Vet Nurses Remove Teeth With Instruments? | -Potential complications including: Haemorrhage Oronasal fistula Orthopaedic fracture Tooth fracture |
| What Dental Instruments Are Commonly Used As Part Of A Dental Assessment? | -Dental mirror -Probe & shepherds crook -Hand scaler -Gracey curette -Tartar forceps |
| List Some Ways In Which A Dental Machine Can Be Kept In Good Condition | -Regular servicing -Hand pieces to be wiped with trigene wipes after each patient -Change rubber prophy head for each patient -Daily cleaning -Monthly sterilise with milton solution |
| What Equipment Is Required For Dental Extractions? | -Luxators -Elevators -Extraction forceps -Periosteal elevators -Suture kit |
| How Is Hand Scaling Used To Remove Tartar In Dentals? | -Tartar forceps used to remove large pieces -Many instruments used for supragingival -Universal or gracey curette used for sub-gingival -Instrument to be held at a 45-90 degree angle -Pull firmly downward to tooth tip to remove tartar |
| How Is Electronic Descaling Used To Remove Tartar In Dentals? | -Use a modified pen grip -Place the side of the scaler tip onto the tooth of interest (never use right angles) -Ensure water is flowing -Sweeping action and light touch -Max 10secs per tooth to avoid damage from heat |
| How Is Polishing Used In Dentals? | -The descaling process results in minor defects in the enamel surface = polishing smooths out these defects -Polishing paste is used on a rubber polishing cup -Use slow speed with sufficient pressure to flare the end of the cup -10 secs per tooth |
| What Are The Pre-Op Considerations For Dental Patients? | -Pre-operative tests (bloods, dental radiography) -Fluid therapy -Analgesia – pre-emptive local blocks |
| What Are The Intra-Op Considerations For Dental Patients? | -Lateral or dorsal recumbency, head angled downward to allow drainage -Airway management (cuffed ET tube, throat pack?) -Care with mouth gags – don't use spring loaded in cats -Thermal support -Placement of monitoring devices -Haemostasis |
| What Are The Post-Op Considerations For Dental Patients? | -Monitoring – signs of aspiration, bleeding -Analgesia -Temperature control -Nutrition – soft food |
| What Should Be Taken As Part Of A Medical History During Dental Assessment? | -General demeanour -Appetite -Halitosis -Salivation -Discharge – oral or nasal -Habits – chewing, etc -Other underlying disease -Previous dental history |
| What Parts Of A Dental Assessment Can Be Performed Conscious? | -Overall appearance -Palpation -Retraction of the lip -Intra-oral assessment -Lymph nodes -Smell |
| What Are The Three Steps Of Dental Assessment? | 1.Primary assessment (number of teeth, check for masses, pigmentation, foreign bodies) 2.Calculus (plaque) assessment and removal (hand or electronic descaling) 3.Visual assessment (check for gingivitis) and probing (assessment of periodontal pocketing) |
| What Is GDV? | Dilation and twisting of the stomach leading to a build-up of trapped gas. |
| What Effects Does GDV Have On The Body? | -Decreased venous return to the heart - reduced blood pressure -Hypoperfusion of the myocardium -arrythmias -Compression of cauda vena cava -Increased pressure on abdomen - hypoventilation -Splenic compromise -Acute kidney disease -Shock |
| What Are The Predisposing Factors Of GDV? | -Large deep chested breeds -Genetics -Nervous temperament -Exercising after meals -Being fed once a day -Eating too quickly -Eating from elevated bowls -Being fed larger kibbles |
| What Are The Clinical Signs Of GDV? | -Depression -Restlessness -Unproductive retching -Distended abdomen -Salivation -Flank watching -Collapse -Tachycardia, tachypnoea -Signs of shock |
| How Can GDV Be Diagnosed? | Single right lateral x-ray. |
| How Can GDV Patients Be Stabilised Before Surgery? | -IVFT -ECG to check for arrythmias -Gastric decompression (orogastric intubation, trocar/needle decompression) |
| What Equipment Is Needed For Orogastric Intubation (To Attempt To Decompress The Stomach In GDV Patients)? | -Wide-bore stomach tube -7.5cm wide roll of adhesive bandage with a plastic core -Funnel -Bucket -Warmed saline/hartmann's/tap water |
| What Equipment Is Needed For Trocar/Needle Decompression (To Attempt To Decompress The Stomach In GDV Patients)? | -Surgical prep equipment -16-18G over-the-needle IV catheter -Lateral or sternal recumbency |
| What Are The Aims Of GDV Surgery? | -Decompress the stomach -Return the stomach to its normal position -Evaluate organs for viability e.g. stomach, spleen and pancreas -Perform a gastropexy |
| Define Gastropexy? | Suturing the stomach to the abdomen wall to prevent it from twisting again. |
| What Are The Pre-Op Considerations For GDV Surgery? | -Imaging -Intravenous access -Stabilisation -Oxygen supplementation -Patient monitoring -Preparation of emergency equipment -Patient preparation |
| What Are The Intra-Op Considerations For GDV Surgery? | -Positioning – dorsal recumbency -Patient monitoring -High risk period when stomach has been corrected (toxins freed and enter circulation) -Careful tissue handling |
| What Are The Post-Op Considerations For GDV Surgery? | -Monitoring, ECG, urine output, bloods -IVFT -Nutrition (gradual, little, and often) -Analgesia |
| What Are The Potential Complications That Can Arise Following GDV Surgery? | -Wound infection -Seroma formation -Dehiscence (of abdominal wall) -Peritonitis -Intestinal ileus -Recurrence |
| How Can GDV Be Prevented? | -Feed more than one meal a day -Do not exercise after meals -Encourage slower eating -Avoid stressful events -Prophylactic (preventative) gastropexy |
| What Are The Clinical Signs Of Foreign Bodies In The Alimentary Tract? | -Persistent or intermittent vomiting -Anorexia -Dehydration -Abdominal discomfort |
| How Are Foreign Bodies Diagnosed? | Radiography/ultrasound. |
| What Different Ways Can Foreign Bodies Be Removed? | -Endoscopic removal -Surgical removal (exploratory laparotomy/midline celiotomy) |
| What Surgery Must Be Carried Out If The Foreign Body Is In The Stomach? | Gastrotomy |
| What Surgery Must Be Carried Out If The Foreign Body Is In The Intestines? | Enterotomy |
| What Procedure Is Carried Out To Remove Necrotic Intestine And What Procedure Is Carried Out To Rejoin The Intestines? | -Enterectomy -Anastomosis |
| What Is Wrapped Around The Operation Site Following Enterotomy/Enterectomy To Bring Macrophages To The Site? | The omentum. |
| What Is A Linear Foreign Body And What Can They Cause In The Intestines? | -Foreign body such as a piece of string anchored to a site (e.g., mouth and then rest of foreign body in GI tract) -Causes concertina of intestines |
| What Are The Pre-Op Considerations For Exploratory-Laparotomy? | -Stabilisation -IVFT -Careful handling due to discomfort in abdomen -Monitoring -Ventral abdomen skin prep |
| What Are The Intra-Op Considerations For Exploratory-Laparotomy? | -Positioning - dorsal recumbency -Care of exposed mucosa - keep moist -Careful tissue handling -Abdominal lavage |
| What Are The Post-Op Considerations For Exploratory-Laparotomy? | -IVFT -Nutrition – small, soft, bland meals, little and often -Patient monitoring – peritonitis? -Analgesia |
| Define Intussusception | When part of the intestine slides into another part of the intestine. |
| What Can Cause Intussusception? | -Bowel hypermotility secondary to diseases such as: Enteritis Intestinal parasites Intestinal foreign bodies Intestinal masses Previous GI surgery |
| What Are The Clinical Signs Of Intussusception? | -Vomiting -Diarrhoea -Anorexia -Dehydration -Abdominal pain -Tenesmus -Sometimes palpable on abdominal examination |
| How Is Intussusception Treated Surgically? | -Exlap -Milk out to manually release intestines -Enterectomy and anastomosis -Enteroplication - intestines sutured in place |
| Why Is Abdominal Lavage Important In Abdominal Surgery? | -Reduces level of contamination -Decreases inflammatory mediators -Warms the patient |
| What Are The Steps Of Abdominal Lavage? | -Warmed, saline isotonic fluids poured into the abdomen -Suction to remove -Repeat until clear *Waterproof drapes prevent strike-through* |
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