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