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surgical procedures
WK 16
| Question | Answer |
|---|---|
| cruciate disease predisposition and signalment | can be genetic and some breeds predisposed can be mechanical could be biological, gradual gegeneration could be trauma medium large and giant breeds more at risk 4yrs old = peak age |
| cruciate disease history = | sudden onset of lameness |
| clinical presentation | - lameness - orthopaedic exam - Also have an abnormal sit |
| cruciate disease treatment = | - Non surgical (suitable for smaller dogs) = weight loss, physiotherapy to build up muscle -surgical managment= lateral suture, TPLO, TTA |
| Lateral suture - | 15kg below, more suitable for smaller dogs, outcomes might not be as good, can be done in first opinion, cheaper |
| TPLO | Alters angle of joint, requires more equipment and training |
| TTTA | alters angle of joint, requires more equipment and training, neither is better than the other, surgeons preference |
| TPO, patient preparation | Analgesia IVFT radiography clip prep positioning ABs |
| TPLO, surgical equipment | standard surgical kit gelpis saw and curved blades mini driver/drill diathermy TPLO plate curette scrub nurse needed, fluid on saw to prevent bone getting too hot, role to hold the limb |
| TPLO, pst op | usual post op anaesthesia cryotherapy- 10-15 mins no more than 20 sling outside to give additional support IVFT analgesia - pain score feeding ABs |
| Total Hip Replacement - | only done in referral settings vs has to perform on total number of cadavers first developed during puppy stage ligaments of joint fail to stabilise socket becomes more like a saucer older dogs tend to develop OA |
| Total Hip Replacement is primarily genetic but | obesity and too much exercise doesnt help |
| Total Hip Replacement, Signalment = | Abnormal gate bunny hopping may swing reluctant to use stairs stiffness cam be hard to identify in younger dogs clinical exam will get pain response in hip flexion |
| Total Hip Replacement, treatment options | conservative managment (NSAIDS, paracetamol, weight loss physio) femoral head and neck excision total hip replacement |
| Total Hip Replacement, Patient preparation = | analgesia IVFT radiography epidural clip prep positioning ABs |
| Total Hip Replacement, complications | aseptic loosening implant loosens femoral fracture damage to sciatic nerve infection complication rates are low |
| Total Hip Replacement, post op | ○ Usual post-op care post anaesthesia ○ Cryotherapy ○ Sling outside to give additional support ○ IVFT ○ Analgesia – Pain Score! ○ Feeding Abs |
| Total Hip Replacement, Discharge | - Need to have very controlled lead walk for 4-6 weeks post op - Crate rested -Once stitches out can have physio and hydro therapy |
| Spinal Surgery, IVDD presentation | Grades 1-5 grade at presentation very much determines outcome |
| IVVD, presentation | may have paralysis weakness unable to move hindlimbs knuckling |
| Grade 1 - | patient has pain but no neurological issues |
| Grade 2 - | patient and weakness in one or 2 limbs |
| Grade 3 - | unable to walk can still move legs when supported |
| Grade 4 - | unable to walk and move legs but do have feeling in toes or may or may not be able to urinate |
| Grade 5 - | Paralysed total loss of deep pain unable to urinate |
| Spinal surgery, patient preparation | § Analgesia § IVFT § MRI § Clip § Prep § Positioning ABs |
| Spinal surgery, special equipment | minos spinal bur periosteal elevator rongeurs gelpis |
| Spinal surgery, post op | - Usual post-op care post anaesthesia - Regular turning - Cryotherapy - IVFT - Analgesia – Pain Score! - Feeding - Abs - Bladder care very important in these patients!!! -Assisted walking necessary |
| Thoracotomy, Acute = | trauma stick injury oesophageal foreign body (raw fed dog bones) |
| Thoracotomy, Chronic = | phyothorax removing tumours pericardectomy |
| Thoracotomy, | oxygen therapy masks, cages, oxygen tent need bloods, imaging, chest draining |
| Thoracotomy, patient preparation | § Analgesia § IVFT § Clip § Prep § Warming devices ABs |
| Thoracotomy, Anaesthetic Monitoring = | Spo2 Capnography Blood pressure Pulse ox Mechanical or manual ventilation chest open so animal cannot breath - IPPV |
| Thoracotomy, special equipment | have longer handles may use rib retractors may need saw to cut through sternum |
| Two surgical approaches | in the side lunglovectomy (dont have much of a surgical view) |
| Thoracotomy, post op | § Usual post-op care post anaesthesia § Regular turning § IVFT § Analgesia – Pain Score! § Feeding § Abs Care of drains!!! |
| BOAS, signs = | noisy laboured breathing struggle in heat regurgitation and vomiting sleeping with head up and toy in mouth sleep apnoea may wake up several times and change position takes 3 years off their life quality of life affected |
| BOAS, conservative managment | weight loss exercise restriction not walking in heat avoid stress |
| BOAS, problems | primary factors = anatomical features secondary factors = compensation because of it |
| BOAS problems | overlong soft palate stenotic nares hypertrophy or nasal turbinate's hypoplastic trachea hypertrophy of the tongue |
| BOAS, secondary factors die to increase in negative pressure of air moving through airways = | laryngeal collapse (die to increase effort of restriction) hypertrophy of tonsils (tonsils getting bigger, creates more resistance to air flow) GI disease more likely to regurgitate aspiration pneumonia syncope |
| BOAS, anaesthetic considerations | IV access premedication pre oxgyenation eye lubrication good selection of et tubes capnography and other monitoring exubation |
| BOAS, surgical treatment | stenotic nares laser assisted turbinectomy soft palate - staphylectomy/folding flap palatoplasty tonsillectomy restriction of laryngeal saccules laryngeal tieback permanent tracheostomy hiatal hernia repair |
| Gastric Dilation Volvulus GDV - | emergency bloating of stomach -/+ twisting (GD OR GDV) |
| GD = | stomach filled with gas - can try medication managment before |
| GDV = | stomach filled with gas and twisted - surgical only |
| GDV ? | common in large breed dogs stomach extends beyond normal amount twist normally clockwise entry to oesophagus normally blocked cannot empty stomach stomach expands with no outlet increases pressure in abdomen |
| DGV ? | heart cannot fill patient normally in shock can get necrosis in stomach has a high fatality rate 1 in 5 dogs die |
| Gastric Dilation Volvulus, Clinical signs | retching with no vomiting unproductive vomiting acute abdominal distension acute lethargy signs of shock |
| Treatment GDV = | IVFT bolus bloods radiography, right lateral view will allow to see stomach gastric decompression, done by stomach tube or trocar +/- surgery |
| technique varies depending on surgeon | incisional gastropexy circumcostal gastropexy belt loop gastropexy |
| GDV, post op | Analgesia bloods IVFT +/- supplementation proton pump inhibitors ECG monitoring |
Created by:
lucy.fox