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255 Cards in this Set
- Front
- Back
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The inflammatory stage of wound healing lasts how many hours?
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0-12 hrs
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The debridement stage of wound healing occurs when?
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6 hrs - 3 days
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The proliferative stage of wound healing occurs when?
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4-21 days
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The maturation stage of wound healing occurs when?
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21 days to 2 years
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Describe the vascular phase of the inflammatory stage of wound healing.
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Initial vasoconstriction
Platelet aggregation Vasodilation Increased permeability Fibrocellular clot Protection of tissue |
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What is the purpose of initial vasoconstriction in wound healing?
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Body's way of stopping hemorrhage - first 5-10 mins
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Why does vasodilation and vascular permeability eventually occur in the process of wound healing?
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So that inflammatory mediators can move into the wound
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How does a fibrocellular clot help in wound healing?
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Hemostasis
Provides initial cover over wound Scaffold for further elements coming to wound Stabilization of wound edges |
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What occurs during leukocyte emigration during the inflammatory stage of wound healing?
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Activated platelets
Chemoattractants Diapedesis Increased venous permeability |
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Describe why PMNs are not essential for wound healing.
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In clean wounds there are no neutrophils present compared to contaminated wounds
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Will lymphopenia affect the wound healing process?
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Probably not, b/c neutrophils are not involved in the wound healing process
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When would you see PMNs in a contaminated wound site?
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Within 24-48 hours; they predominate initially
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What is the purpose of PMNs in a contaminated wound?
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Phagocytize bacteria
Release proteases (lysis) Remove tissue debris |
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Which is essential for normal wound healing, macrophage or neutrophil?
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Macrophage
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What is the predominant cell type present 3-5 days after a wound is created (be it surgical or contaminated)?
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Macrophage
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Why are macrophages essential in the wound healing process?
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Produce a wide variety of mitogenic factors that will help in wound healing (this is done in addition to phagocytosis and protease activity)
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What causes a fibroblast to undergo differentiation in wound healing?
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Macrophage mitogenic factors
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Do you see lymphocytes more often in surgical wounds or infected wounds?
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Infected wounds - their role is unclear though
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Which stage of wound healing is most able to be influenced by the veterinarian?
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Debridement stage
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The debridement stage depends on:
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Amount of necrotic tissue
Amount of debris |
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How can we as vets influence the debridement stage of wound healing?
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Via removal of necrotic tissue (makes less work for PMNs and macs)
Lavage wound Special bandaging (wet to dry commonly used) |
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What types of leukocytes predominate during the debridement stage of wound healing?
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PMNs and macs
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When does fibroblast influx start to occur in wound healing?
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At the end of the debridement stage
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What cell population regulates fibroblasts?
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Monocytes
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Peak influx of fibroblasts occurs how many days after a wound occurs?
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14-21 days
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Why do we remove skin sutures in 10-14 days?
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Fibroblast influx is at its peak at 14-21 days; the wound is contracted and decreased in size; this is the point where the skin starts getting its tensile strength back
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During what stage of wound healing does collagen deposition occur?
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Proliferative stage
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What is the role of tropocollagen?
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Binds mature collagen
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Wound strength peaks on days ____ to ______.
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14 to 21
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True/false: collagen allows for contraction of the wound.
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True
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True/false: Eventually collagen lines itself up according to the lines of tension of the wound; this provides strength.
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True
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Granulation tissue formation occurs during which stage of wound healing?
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Proliferative stage
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How will hypoproteinemia affect wound healing?
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Because collagen is a protein, collagen deposition and granulation tissue formation will be slower to occur
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What occurs during granulation tissue formation?
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Angiogenesis
Fibroblasts Ground substances - made by fibroblasts Collagen content increases |
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Production of granulation tissue begins how many days following injury?
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3-4 days
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Why does granulation tissue tend to be resistant to infection?
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Because of its large vascular supply
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What replaces a clot?
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Granulation tissue
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True/false: Granulation tissue helps protect underlying tissue.
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True
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During what stage of wound healing does epithelialization occur?
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Proliferative stage
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Epithelialization peaks when following injury?
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48-72 hrs
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What is 'contact guidance' in wound healing?
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When epithelial cells migrate over granulation tissue, they do so moving towards the center of the wound, basically following one another
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What is 'contact inhibition' in wound healing?
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Epithelial cells migrate over granulation tissue towards the center of a wound until they come into contact with each other - this is when migration ceases
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True/false: Epithelialization occurs over the granulation tissue but under the initial clot.
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True
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If a wound is large, epithelialization may be thin or never complete in the center. In this case, you would consider:
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Grafting
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Wound contraction occurs during the proliferative stage of wound healing. Describe this process.
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Myofibroblasts are activated fibroblasts that contain actinomyosin fibers. Collagen overlapping occurs and strengthens the wound. Skin margins continue contracting and contact inhibition occurs
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What occurs during the maturation stage of wound healing?
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Collagen remodeling
Reorientation |
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How does reorientation occur in wound healing?
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Collagen reoriented parallel to the tension lines of the wounds
Randomly oriented fibers are digested by collagenase |
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True/false: You will never regain full tension strength at a wound site.
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True
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Is a scar weaker than normal tissue?
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Yes
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Is tension important in the remodeling of collagen?
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Yes
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What provides early wound strength (first 4-6 days)?
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Suture material
Clot (So not much!!!!) |
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The highest rate of collagen content increase occurs between days ___ and ___ in wound healing.
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5 and 12
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Late wound strength comes from:
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Collagen remodeling
Tension |
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Wound classification is primarily related to:
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Degree of contamination
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What is a clean wound?
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Nontraumatic/surgical wound
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Would you use perioperative antibiotics with a clean wound?
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No, unless you are going to place a pin or plate
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What does it mean to be a clean wound?
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Without inflammation
No breaks in asceptic technique Luminal organs not entered |
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What does it mean to be a clean contaminated wound?
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Luminal organs entered
No significant spillage of contents Resection and anastamosis Gastrotomy Cystotomy |
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True/false: Clean contaminated wounds require perioperative antibiotics.
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True
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You are in the middle of surgery and notice that there is a small hole in your glove. What type of wound are you now dealing with?
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Clean contaminated
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You are doing a cystotomy. What type of wound is this?
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Clean contaminated
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Describe a contaminated wound.
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Major break in surgical technique
Gross spillage of GI contents Fresh traumatic wounds Entrance of urinary or biliary tract when infection is present |
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You are present with a dog who was HBC. There are many lacerations present. What types of wounds are these?
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Contaminated
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You are doing a spay and manage to cut into the small bowel, spilling its contents into the abdomen. What type of wound is this now?
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Contaminated
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Describe a dirty wound.
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Gross infection present at surgery
Traumatic wounds with devitalized tissue Intestinal perforation - peritonitis |
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What are the four types of wound healing?
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Primary closure
Second intention healing Delayed primary closure Secondary closure |
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What is a primary wound closure?
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Immediate closure of wounds by surgical intervention
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What is an advantage of a primary wound closure?
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Decreased healing time
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What is second intention healing?
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Leaving wound open to heal without surgical intervention
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What is the advantage of delayed primary wound closure?
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Can manage the wound to decrease the contamination level before closure
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True/false: Delayed primary wound closure occurs prior to the formation of granulation tissue.
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True
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How is delayed primary and secondary wound closure different?
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Delayed primary wound closure is before granulation tissue forms; secondary wound closure occurs after granulation tissue forms
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Why might you use secondary wound closure?
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Decrease risk of infection
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What are the two main reasons elective sterilization (OVH) are performed?
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Population control
Estrus in the female |
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Ovariohysterectomy can be used to prevent which diseases?
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Mammary neoplasia (age of OVH important)
Vaginal hyperplasia Pseudopregnancy Pyometra |
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What diseases can be treated with OVH?
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Uterine/ovarian neoplasia
Diabetes mellitus Epilepsy Generalized demodex Subinvolution of placental sites (SIPS) Pyometra Mammary tumors |
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If you are doing a spay and need to remove mammary tumors at the same time, what is your order of operations?
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Do the spay first and then mastectomy, this way you don't accidentally seed tumor cells into the abdomen
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OVH is traditionally performed at what age?
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6 mos
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Do you need to postpone spaying if animal is in heat?
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NO
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True/false: There is evidence of detrimental effect in prepubertally spayed dogs.
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False! No detrimental effects
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What is the advantage to shelters doing prepubertal OVH in canines?
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Safe
Easy Removes concern of owner compliance |
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Is there an increased risk of fracture or bone deformity in animals spayed before 12 wks?
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No
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What is there an increased risk of in animals spayed before 12 wks?
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Increased prevalence of urinary incontinence
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True/false: A spay is a major abdominal surgery.
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TRUE
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What are some things you should look for on the PE of a patient about to undergo OVH?
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The gender of the patient
Cleft pallet Cryptorchid in males |
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What is our lab minimum data base for healthy animals about to undergo an OVH?
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PCV
TP Azostix Chem panel if older patient |
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How long before OVH should you withold food from an adult?
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12 hrs
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You are going to spay a young toy poodle, how long should it fast?
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4-8 hrs
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Describe the perioperative surgical preparation for a canine OVH.
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Xyphoid to pubis and laterally to the skin/flank folds
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Where do you do your spay incision in a dog?
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From umbilicus just cranial to the pubis
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Where is the ovarian artery located?
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Coarsing from the aorta; it lies in the mesovarium (fat)
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Another name for broad ligament:
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Mesometrium
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Another name for the proper ligament:
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Utero-ovarian ligament
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Where does the suspensory ligament attach?
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To the first or second to last rib
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Which ligament do you strum or cut to enhance visualization of the ovary and vascular pedicle?
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Suspensory
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Which animal has an ovary located in the ovarian bursa - dog or cat?
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Dog
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The ovary is readily available in which animal - the dog or cat?
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Cat
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Which ovary is most likely to be accidentally left behind?
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Right ovary due to anatomy (it is more cranial)
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Which has a more cranial incision for ovarian exposure, dog or cat?
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Dog
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Which has a more caudal incision for uterine exposure, dog or cat?
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Cat
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What structure marks the midline on a spay incision?
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Linea alba
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Why don't you want to do a lot of SQ undermining when doing your spay incision?
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Creates a lot of dead space - this will lead to a seroma
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Do you want to do a paramedian incision to spay?
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NO
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True/false: When using the spay hook, if you are pulling really hard, you should let go b/c you probably don't have the uterine horn.
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True
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Once you find the uterine horn, what do you do next?
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Clamp the proper ligament
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Once you clamp the proper ligament, what do you do next?
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Strum the suspensory ligament
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What type of clamp technique are we using for the ovarian pedicle?
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Modified 3 clamp technique
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Describe the ligation we do for the ovarian pedicle?
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Double ligation with absorbable suture
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When ligating the ovarian pedicle, what do you have to remember to do before tying down your square knots?
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Flash the hemostats (whether they be Kellys or Carmalts)
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When would you ligate the broad ligament?
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If vascular (in heat)
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How do you ligate the uterine body?
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2 mass ligatures (if a very young, small animal)
1 mass ligature and individually ligate vessels |
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Strength of abdominal closure is:
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External fascia of the rectus abdominus muscle
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True/false: muscle has little strength for suture.
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True
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I am ready to close the linea. My dog is between 10 and 40 pounds. What size/type of suture do I want to use?
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Absorbable 2-0
Usually PDS |
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Usually you close the linea w/ what suture material?
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PDS
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What type of suture pattern do you use to close the linea?
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Simple continuous
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My dog is < 10 lbs, what size suture would I use to close the linea?
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3-0 absorbable, usually PDS
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How close should your sutures be in a simple continuous closure of the linea?
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No more than 1 cm apart
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SQ closure has how much strength?
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Very little
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What is the purpose of SQ closure?
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Obliterate dead space
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What is the point of doing an intradermal suture to close up a spay?
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Skin apposition
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Should skin sutures be loose?
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Yes, to allow for swelling
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OVH suture removal should occur when in the K9?
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7-10 days
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When should OVH suture removal occur in a feline?
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10-14 days
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What are some sources for post-op hemorrhage in the canine OVH?
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Ovarian pedicle
Uterine pedicle Broad ligament vessels Abdominal wall muscle SQ tissues |
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What are some reasons for uteral ligation complications?
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Poor technique
Small incisions Full urinary bladder Hemorrhage and poor visualization where clamp is applied |
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What are some long term complications of canine OVH?
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Obesity
Behavioral changes Urinary incontinence Orthopedic problems Osteosarcoma Coat issues (more shedding) Recurrent estrus Fistulous tracts Vaginal hypoplasia |
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What can cause fistulous tracts as a long term OVH complication?
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Using the inappropriate suture material (e.g. Braunamid)
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After an OVH, what can cause recurrent estrus?
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Ovarian remnant
Must submit tissue to pathologist when you reoperate to be sure you got the whole thing |
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Pyometra is a disease of __________.
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Diestrus
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What does the CL secrete?
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Progesterone
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When would you expect to see pyometra?
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8-12 wks after estrus (diestrus)
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What bacteria are typically involved in canine pyometra?
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E.coli
Staph Strep Klebsiella |
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What are the signs of a pyometra?
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Anorexia
PU/PD +/- vaginal discharge Fever Systemically ill bitch or queen |
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How do you diagnose a pyo?
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Clinical diagnosis
Rads Ultrasound |
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What are the lab findings associated with a pyo?
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Leukocytosis
Anemia UTI Azotemia Renal disease may be secondary or pre-renal azotemia may be present; be careful with fluids |
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How do you treat a pyo?
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OVH
Antibiotics Fluids, acid-base Prostaglandins |
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How quickly do you have to correct fluid and acid-base balance in a dog with pyo?
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Quickly - within hours
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How is the incision for a pyo OVH different from a regular OVH?
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The incision extends cranially to the umbilicus
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Why is tenting the abdomen important in a pyo OVH?
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You do not want to rupture the pyo; if you do rupture, flush abdomen with saline to decrease contamination
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True/false: Ovarian pedicles are usually more friable with a pyo.
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True
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When doing an OVH pyo, why do you pack off the uterine body with lap sponges?
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This way if there is contamination, you can remove it
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Should you do a uterine oversew when doing an OVH pyo?
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No, it just creates an area for abscessation
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How should you ligate the uterine body in an OVH-pyo?
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Do a circumferential and 2 stick ties
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What are some reasons you might have to do a c-section?
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Uterine inertia
Oversized, malpositioned feti Small pelvis |
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If you are thinking about doing a c-section, how long should you try oxytocin first?
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For an hour or two
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What is the minimum lab database for a c-section?
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PCV
TP Chems desirable |
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When is a c-section elective?
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Brachycephalic breeds
Pelvic fracture non-unions |
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What could be some complication in a bitch who needs a c-section?
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Dehydration
Hypoglycemia Hypocalcemia |
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What is the goal for c-section anesthesia?
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Minimize fetal depression
Reversal when possible |
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Two important questions to ask an owner when doing a c-section:
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Whats more important, the bitch or the puppies?
Do you want her spayed? |
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Why do you pack a c-section uterus off with lap pads?
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To minimize contamination
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What type of placenta do dogs have?
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Zonary
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When doing a c-section, where do you make your incision to start removing the puppies?
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Into the uterine body, then gently milk each fetus to incision and remove
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What do you do once you have removed a puppy from the uterus in a c-section?
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Open amniotic sac with index finger, clamp umbilicus with two mosquitoes and cut
Hand off neonates for resussitation and narcotic reversal Gently remove the placenta |
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How do you close a uterus from a c-section?
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3-0 or 4-0 absorbable suture in a continuous appositional pattern or cushings
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What is an En Block OVH c-section?
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Double clamp each ovary and double clamp the uterine body
Remove Puppies delivered on the table |
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Once the pups from a c-section are removed and resuscitated, what do you do after narcotic reversal?
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Clear the airway, nares
Ligate the umbilical cord Check for congenital abnormalities |
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If you do an OVH at the time of c-section, what do you have to remember to do?
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Maximize fluids for the bitch
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Once the pups are out, how do you close the abdomen following a c-section?
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Abdominal closure
Intradermal closure NO SKIN SUTURES |
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A large part of preoperative management is client education. What should this include?
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Cost estimate
Owner expectation Course of events Client communication Patient anesthesia and pain care |
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When it comes to surgery, what is the biggest reason there are client complaints and law suits?
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Lack of communication and client education
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If it is an elective surgery, how long should you withold food from a healthy adult dog prior to surgery?
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12 hrs
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Before doing surgery on a cat, what should be included in the bloodwork?
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FIV/Felv test
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You are about to do a spay on a Dobie. What should be included in the pre-op bloodwork?
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PCV
TP Clotting factors Azostix |
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For oncology and traumatic cases, why would you want to do pre-op radiographs?
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Oncology - make sure there is no metastasis to the lungs (or elsewhere)
Trauma - make sure you know what you're getting yourself into |
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You have an ASA class I dog that you are going to do a spay on - what does this mean and what bloodwork should you perform?
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Dog is normal - no systemic disease
Do PCV, TP |
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A class 2 ASA designation means what? What bloodwork should you do?
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There is mild systemic disease
CBC, BUN, U/A |
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What does a class 3 ASA classification mean? What bloodwork should you do?
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Systemic disease is more severe than class 2; anemia or fever is present.
CBC, chems, U/A, rads |
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What does a class 4 ASA classification mean? What bloodwork should you do?
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Severe systemic disease is present; cardiac or renal failure
CBC, chems, U/A, rads, blood gas, EKG |
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What does a class 5 ASA classification mean?
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Moribund or terminal - do same workup as with class 4
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True/false: The more critical the case, the more diagnostics you have to do before surgery.
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True
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What does it mean to do an elective surgery?
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That it is optional - generally don't do elective surgery on animals that are systemically ill
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Name some elective surgeries:
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Spay/neuter
Orthopedics Soft tissue |
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True/false: You should never push the limit during surgery.
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True - never want to say/think...can I get away with doing this
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True/false: Emergent surgery has fewer options than with elective surgery.
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True
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What might you do to stabilize a patient for emergent surgery?
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Replace fluid deficits
Correct acid-base electrolyte imbalances Blood products needed? Thoracostomy tube needed? Nutritional needs Treat a disease that may respond Basically, can you improve this animal prior to anesthesia or surgery |
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Are antibiotics required for spay/neuter?
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No
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When is the high risk period post-operatively?
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Between the last suture being placed to extubation - this is when everyone gets lax about watching the animal
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Why should you turn a post-operative patient frequently?
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To prevent atelectasis
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What does the owner look at post-operatively?
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How clean is this wound?
How do the sutures look? |
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After surgery, you want to clean the incision area so that it looks nice for the owner. What should you use?
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Soapy water - never use H202
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How long does it take for a seroma to form?
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5-7 days
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Prior to seroma formation, what occurs?
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Hematoma - this is the initial swelling
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If left untreated, what occurs w/ a seroma?
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Becomes a granuloma
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What is the biggest thing people worry about as a post surgical complication?
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Fever
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A post-operative fever is anything over what temperature?
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102.5
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How long does it take post-operatively for an incision to become infected?
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48 hrs
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What are some differential diagnoses for a post-operative fever?
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Inflammation (tissue trauma)
Local infection Systemic infection Fungal Viral Neoplasia Immune mediated Drugs |
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What drug can cause an increase in body temp in cats due to a reset of the thermoregulatory center?
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Ketamine
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What is the first thing you think about in a post-op animal with a fever?
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ASPIRATION PNEUMONIA
The second is catheter |
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You spayed a cat a few hours ago and now it has a fever. What should you do as part of your physical exam?
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Check the incision
Palpate the abdomen Auscult (remember negative finding does not RO pneumonia) Consider CBC Examine catheter sites Consider other diagnostics |
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True/false: You cannot always diagnose aspiration pneumonia due to surgery via auscultation. You may have to do chest rads.
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True
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How does aspiration pneumonia occur w/ surgery?
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Aspiration leads to a secondary bacterial infection
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If a dog post-operatively starts chewing or licking at the sutures, what should you be thinking?
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There might be an infection or the sutures were placed incorrectly
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When should you do callbacks after surgery?
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48 hours - this is when problems will likely be seen
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What is the difference between a laparotomy and a celiotomy?
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A laparotomy occurs in people - the incision is not made on the ventral midline (could be anywhere). A celiotomy is done in animals on the ventral midline.
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What diagnostic technique has decreased the amount of celiotomies necessary for diagnosis?
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Ultrasound
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What are the celiotomy goals?
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Complete and thorough exploration of the abdomen
Biopsy appropriate tissues Culture when appropriate |
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What is the maintenance fluid rate?
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10 ml/kg/hr
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What antibiotic is typically used for a celiotomy (especially a clean contaminated one)?
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Cefazolin - it is a broad spectrum AB
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Why is exposure of what you are trying to look at in a celiotomy a huge issue?
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Because often people make their incision too small - should be complete exploration xyphoid to pubis
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What should you ALWAYS count before doing a celiotomy?
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Sponges
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When doing a celiotomy, what special approach do you have to use in a male dog?
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Skin incision needs to swing wide around the prepuce
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When doing a celiotomy, what do you have to excise cranial to the umbilicus to enhance visualization of structures and to gain proper closure?
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Falciform ligament
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What types of self-retaining retractors might you have to use during a celiotomy?
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Balfour
Frazier |
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True/false: Moist tissues are happy tissues.
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True, so when you wet sponges with saline, don't go overboard, just put a little on and apply the sponge
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True/false: When doing a celiotomy you should ignore the obvious in favor of complete exploration (unless there is a hemorrhage or GIT contents leaking).
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True
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If you do an exploratory and can't find anything, what should you do?
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Don't just close, grab some biopsies!
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When doing an exploratory, what will help you do a thorough/complete exploration every time?
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Perform the same technique each time
E.g. by systems, by quadrants, whatever |
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When examining the liver, you should look at all lobes. What are they?
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Left lateral
Left medial Quad Right lateral Right medial Caudate |
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You want to examine the gall bladder and bile duct. Where can you find the bile duct?
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Transverses the hepatoduodenal ligament
Terminates on major duodenal papilla in proximal duodenum |
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When you inspect the diaphram, what are you looking for?
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Integrity
Metastasis |
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From the gall bladder, the cystic duct leads to which duct?
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The bile duct
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True/false: hepatic ducts are variable in number.
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True
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What comprises the biliary system?
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Liver
Gall bladder |
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When you examine a stomach during celiotomy, what are you looking for?
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Ulcers
Foreign bodies |
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What happens to the pylorus when palpated?
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It contracts - its easy to believe there is a lesion when there isn't one
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What structure prevents exteriorization of duodenum and pylorus?
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Hepatoduodenal ligament
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Know the anatomy of the stomach:
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Cardiac portion
Fundus Body Pyloric antrum Greater and lesser curvatures |
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Where can you find the right limb of the pancreas?
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At the descending duodenum
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Where can you find the left limb of the pancreas?
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Caudal to stomach; runs dorsally in mesentery
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What ligament is avascular and can be cut to mobilize bowel during a celiotomy?
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Duodenocolic ligament
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How common is it for post-op pancreatitis to occur following palpation or biopsy?
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Uncommon
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How would you biopsy the pancreas?
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Divide the lobules out with a mosquito hemostat
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Most of small bowel is what?
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Jejunum
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What lymphatic tissues will you find in the small bowel?
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Peyers patches
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When examining the small intestine via celiotomy, what should you start with?
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Start with the ileo-cecal-colic junction and work retrograde
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What lymph nodes should be at the ileo-cecal-colic junction?
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Mesenteric
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What vein can be found at the ileum?
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Antimesenteric vein
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What percentage of small intestinal ressection is possible (depending on location)?
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70%
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Excisional biopsy of mesenteric lymph nodes can lead to what? What is your alternative?
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Can disturb blood supply of small intestine
Better do incisional biopsy |
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True/false: A foreign body that has made it to the large intestine/colon needs to be removed before it gets stuck.
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False - if its made it that far it will most likely pass
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What intestinal features are near the right kidney and adrenals?
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Duodenum
Mesoduodenum |
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What intestinal features are near the left kidney and adrenals?
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Colon
Mesocolon |
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What percentage of cardiac output do kidneys receive?
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25%
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Where is the renal artery located?
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Dorsal and rostral
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What is most obvious when you approach the kidney, the renal vein or artery?
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Renal vein
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True/false: the renal artery is palpable.
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True
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The hepatorenal ligament is on the right or left side? Why might you excise it?
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On the right
It is avascular, so you can excise it for exposure |
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The right adrenal is partially obscured by what?
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Vena cava
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Why do you have to use caution when doing an adrenalectomy?
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Because it can result in disturbing the renal artery and require a nephrotomy
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Why would you palpate the urinary bladder during a celiotomy?
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For mass or calculi
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Papillae + urethra =
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Trigone of bladder
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Where do ureters terminate at the bladder?
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On papilla on dorsal-caudal wall
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Where is the prostate normally found?
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In pelvic cavity; when diseased it may be more abdominal
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When doing a biopsy or surgery on the prostate, what should you do to protect the urethra?
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Pass a urethral catheter
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What are the three methods to doing an 'open' liver biopsy?
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Guillotine method (quick, easy and safe)
Wedge technique Biopsy punch |
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How do you close a liver biopsy punch?
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Use a small plug of gelfoam in biopsy defect
OR Cruciate or mattress suture in defect for tissue apposition |
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How thick should an intestinal biopsy be?
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Full thickness
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How would you close an intestinal biopsy?
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Simple interrupted or continuous suture (w/ PDS or Maxon)
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How do you test if your closure of an intestinal biopsy is adequate?
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Leak test with saline under moderate pressure
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What are the two ways you can perform a kidney biopsy?
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Tru-cut needle (requires one suture)
Incisional (requires closure w/ cruciate or mattress) |
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When you do a splenic biopsy, how do you close it?
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Oversew w/ double layer continuous
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Describe how you would do a celiotomy closure:
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Lavage w/ warm saline
Sponge count Use simple continuous (either PDS or Maxon) External rectus fascia ONLY requires closure SQ - Monocryl (3/0 in dogs) Skin - staples (3/0 in dogs) |
