large animal surgery amy fayette november 2005 equine respiratory sx guttural pouch diseases
TRANSCRIPT
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Large Animal Surgery
Amy FayetteNovember 2005
Equine Respiratory SxGuttural Pouch Diseases
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What are the indications for surgery
Exercise intolerancePoor performanceAbnormal resp noiseMucopurulent nasal dischargeSerosanguineous nasal dischargeExternal distortion of facial region
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What is the most common respiratory tract diagnostic technique
Endoscopy
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What is your diagnosis for this soft fluctuant mass
Epidermal inclusion cyst
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How can you treat an epidermal inclusion cyst
Aspiration or surgery
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What is the problem with using aspiration
Recurrence
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What kind of noise is expected with redundant alar folds
Expiratory
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How do you diagnose redundant alar folds
Place large temporary mattress sutures and see if the noise disappears
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What is the treatment for redundant alar folds
Surgery
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What is the most common complication of surgery for redundant
alar foldsHighly vascular-> hemorrhage
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How can you help to decrease the hemorrhage produced by this
procedureLarge carmaltsIce cold saline
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What is your diagnosis
Wry nose
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What are the clinical signs of diseases of the nasal septum
Decreased or complete obstructionStridorDischarge Facial distortion
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What are the preop considerations before operating on the nasal septum
Collect 4-8 L of bloodTracheotomy
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What is the aftercare required for surgery of the nasal septum
5-6 days systemic ATBs10 days NSAIDSRemove packing 2 days post opRemove tracheostomy tubeClean and flush with saline
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What is your diagnosis
Ethmoid hematoma
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What are the CS of progressive ethmoid hematomas
Epistaxis Serosanguinous nasal exudateStridor
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What is the suspected cause of ethmoid hematomas
Nasal gastric tubing
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What is this instrument
Funnel screw
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What is this instrument
Trephine
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What is the main post op complication for surgical removal of
ethmoid hematomasHemorrhage
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What is an ethmoid hematoma made up of on histopath
Outer: resp epitheliumCentral: hemosiderin-filled macrophages
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What is an alternative treatment for ethmoid hematomas
Chemical ablation with formalin
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What is the cause of primary sinusitis
UR tract infection
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What is the causes of secondary sinusitis
Dental diseaseFacial fxCystsNeoplasia
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What are the CS of sinusitis
Nasal discharge: serosanguineousCoughingFacial deformity
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What is the treatment for sinusitis
Sinusotomy (trephination)
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What is the aftercare instructions for sinusotomy
Leave open and flush dailyATB and NSAIDS
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What is the prognosis for sinusitis after sinusotomy
Good-excellent
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What is this instrument
Cribbing strap
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What is cribbing
Grasp object with incisorsContract neck musclesPull backward
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What is another name for cribbing
Windsucker
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What are the causes of cribbing
BoredomConfinement Isolation Lack of roughageLearn from others??Genetic??
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What are the consequences of cribbing
Colic ??Abnormal wear of incisorsWeight loss
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What are some non surgical treatments for cribbing
Remove fixed objectsBitter tasting substancesCribbing strapsAcupunctureShock- aversionNaloxon
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What is the possible surgical treatments for cribbing
Removal of sternomandibularis, sternothyroideus, omohyoideusNeurectomy of the ventral branch of accessory nerve
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What aftercare should be followed after surgery for cribbing
ATB and NSAIDSChange the environment
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What dose of NSAIDS should be given
Should be a bit painful if they try to repeat the behavior so low doses
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What is the most common cause of noise
Recurrent laryngeal hemiplegia
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What is Recurrent laryngeal hemiplegia
Progresive neurogenic atrophy of the recurrent laryngeal nerve
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What is the signalment for Recurrent laryngeal hemiplegia
1-10 years oldLarge breed horsesHereditary
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What causes Recurrent laryngeal hemiplegia
Perivascular injectionGuttural pouch mycosisTraumaStranglesOP toxicityPlant poisoningLead toxicityCNS disease
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What is the typical history for Recurrent laryngeal hemiplegia
NoiseExercise intolerance
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How is Recurrent laryngeal hemiplegia diagnosed
PalpationSlap testEndoscopy during treadmill exercise
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What is the slap test
Slap withers during endoscopyObserve adduction of the contralateral arytenoid cartilage
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What is the most common surgical treatment for recurrent laryngeal hemiplegia
Laryngoplasty (Tie back)
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What are some potential complications with the tie back
procedureSeromaCough Dysphagia
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What should be done if an animal is coughing following tieback
Remove sutures
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How can you decrease dysphagia after tie back
Feed off the ground
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What other surgical procedures can be performed for recurrent laryngeal
hemiplegiaVentriculectomy Reinervation of cricoarytenoid muscleArytenoidectomy
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What instrument is this
Roaring burr
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What are the complications of ventriculectomy
Granuloma formationMucoceleLaryngeal web
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How do you know that you excised enough of the ventricle
Place on the finger tip---should be as big as your distal phalanx
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What is arytenoid chondritis
Inflammation and thickening of the arytenoid cartilage
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What is the treatment for arytenoid chondritis
Arytenoidectomy
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What is a partial arytenoidectomy
Arytenoid body and corniculate process removed
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What is a total arytenoidectomy
Arytenoid body, corniculate and muscular process
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What is the px for a partial arytenoidectomy
50% of racehorses return to racing
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Is partial or total arytenoidectomy recommended
Partial
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What is the colloquial term for DDSP
Choking up
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What is DDSP
The soft palate is displaced over the epiglottis
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What are some treatments of DDSP
Tongue tieStaphylectomyMyectomyEpiglottic augmentationLaser cauterization
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What is a staphylectomy
Cutting part of the soft palate
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Is epiglottic augmentation commonly done
No because the epiglottis is often normal in size
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What is your diagnosis
Guttural pouch tympany
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What is guttural pouch tympany
Air filled guttural pouch
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What are the causes of guttural pouch tympany
Idiopathic Upper airway infectionPersistent coughingMuscle dysfunction
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What are the clinical signs of GP tympany
Nonpainful DyspneaDysphagiaInhalation pneumoniaSecondary empyema
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What are the treatments for GP tympany
Needle aspirationIndwelling catheterSurgery for recurrent problems
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Which approach to the guttural pouch is illustrated below
hyovertebrotomy
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What are the problems with the hyovertebrotomy approach
No ventral drainage
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Which approach to the guttural pouch is illustrated below
Viborgs triangle
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What are the borders of viborgs triangle
Sternomandibular muscleLinguofacial veinCaudal border of vertical ramus of the mandible
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Which approach to the guttural pouch is illustrated below
Whitehouse
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Which approach to the guttural pouch is illustrated below
Modified Whitehouse
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Why might it be a bad idea to use a laser in the guttural pouch
Less control than a scalpel and there are a lot of vessels and nerves in it
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What are the causes of GP empyema
Upper resp tract infectionAbscessation of the retropharyngeal lnnFx of the stylohyoid bone
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Is GP empyema usually uni or bilateral
Unilateral
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What is the treatment for GP empyema
Indwelling catheterSx
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What makes treatment of GP empyema difficult
The presence of chondroids
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What is the most common complication following GP sx
Dysphagia
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What is your diagnosis
GP mycosis
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What are the CS of GP mycosis
EpistaxisDysphagia
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Which structure in the GP is most commonly affected by mycosis
Internal carotid artery
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Why can you not ligate the carotid artery to stop bleeding
Blood will still come from the other side via the circle of willis
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Can you ligate both carotid arteries
Hypothetically yes if the animal has a really good supply from the basilar artery but often will kill the animal
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What are the treatments for GP mycosis
Arterial ligationFlush guttural pouch with antifungals with horse under GA