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What are the lung lobes of dogs?
- Left: left cranial with cranial and caudal portions, caudal
- Right: cranial, middle, caudal, accessory
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Describe the access provided by the intercostal thoracotomy approach.
- incision b/w ribs
- good access to dorsal and ventral structures in region (but no access to cranial or caudal regions; no access to contralateral thoracic cavity)
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What layers do you incise for intercostal thoracotomy? (10)
- skin
- subQ
- cutaneous trunci
- latissimus dorsi
- serratus ventralis
- +/- scalenus (cranial to 5th rib)
- +/- ext abdominal oblique (caudal to 5th rib)
- external intercostal
- internal intercostal
- pleura
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What vascular structure do we need to avoid ventrally with intercostal thoracotomy technique?
internal thoracic artery (deep to intercostal muscles)
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What are important aspects of intercostal thoracotomy closure? (5)
- chest tube
- circumcostal sutures (painful)
- close each muscle layer individually
- close SQ
- close skin
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Describe the access provided by the median sternotomy approach to the thorax. (3)
- access to entire thoracic cavity
- good for exploratory, multifocal dz
- it is more difficult to access dorsal thorax
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What layers do you incise for the median sternotomy approach? (4)
- skin
- subQ
- pectoralis muscle
- sternum
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What are the important aspects of median sternotomy closure? (6)
- chest tube
- cerclage wire in figure 8 around sternebrae
- manubrium or xyphoid should still be intact
- close pectoralis muscles
- close subQ
- close skin
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What are the approaches to thoracoscopy?
- transdiaphragmatic
- intercostal
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What are indications for partial lobectomy? (2)
- biopsy for distal lunch lesions
- distally isolated disease
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What suture pattern is used to close a partial lobectomy?
- continuous overlapping hemostatic-pneumostatic
- oversew
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What intercostal space should you enter to repair a PDA?
left 4th intercostal space
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What is the suture technique for a complete lobectomy?
- triple ligate pulmonary artery and vein to that lobe
- mattress suture and oversew bronchus
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How much lung volume can you remove and sustain life?
50% of lung volume (left lung is 42%, right lung is 58% of lung volume)
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What are clinical signs of lung neoplasia? (7)
- +/- asymptomatic
- dyspnea
- exercise intolerance
- cough
- non-specific- weight loss, anorexia, lethargy, fever
- vomiting and regurgitation (cats esp)
- lameness (hypertrophic osteopathy- periosteal proliferation on long bones)
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How do you diagnostically approach possible thoracic neoplasia?
- 3 radiographic views- make sure to eval caudal lobes!
- CT, abdominal US, FNA
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What animals do lung lobe torsions occur most commonly in?
- PUGS
- cats
- yorkies
- large breed dogs with deep narrow chests
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What lungs most commonly torse?
left cranial and right middle lung lobes
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What are clinical signs of lung lobe torsion? (6)
- dyspnea
- lethargy
- coughing
- weight loss
- anorexia
- hemoptysis
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What might you see on radiographs with a lung lobe torsion? (4)
- alveolar pattern
- air bronchograms
- blunted bronchus
- pleural effusion
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How do you treat a lung lobe torsion?
lobectomy- DO NOT UNTWIST
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What are the classifications of pneumothorax?
- spontaneous: primary- bullae, bleb, cyst; secondary- neoplasia, pneumonia, FB
- traumatic: open (sucking chest wound), closed skin intact)
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What are clinical signs of traumatic pneumothorax? (5)
- acute trauma
- dyspnea
- tachypnea
- increased abdominal effort
- restrictive breathing pattern
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What are methods of managing or treating traumatic pneumothorax?
- most resolve with medical management- chest tube and supportive care
- surgery- lung lobectomy, mattress/ lembert/ everting pattern; test for air leaks
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What are causes of spontaneous pneumothorax? (3)
- cysts- lined by epithelium
- bleb- fibrous wall b/w parenchyma and pleura\
- bullae- fibrous walls within parenchyma
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How are spontaneous pneumothorax treated?
- medical- chest tube and thoracocentesis
- surgical- thoracic explore and lung lobectomy
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What are causes bronchoesophageal fistula?
- congenital- RARE
- acquired- FB pressure necrosis
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What are clinical signs of bronchoesophageal fistula? What breeds are commonly affected?
- saliva and food get access to airway and induce pneumonia
- weight loss
- fever
- cough associated with eating
- toy breeds, terriers
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What is the best treatment for bronchoesophageal fistula?
- intercostal thoracotomy
- lung lobectomy
- fistula closure in esophagus
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Describe causes and factors leading up to pulmonary abscesses.
- pneumonia secondary to FB, bacterial/ fungal infection, parasites
- penetrating wounds
- vascular obstruction
- central necrosis from neoplasia
- may result in pyothorax or pneumothorax
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Pulmonary abscesses are most common in _______.
cats
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What are clinical signs of pulmonary abscesses? (7)
- coughing
- chronic signs
- varying grades of dyspnea
- tachypnea
- exercise intolerance
- hemoptysis
- lethargy/ fever
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How might you diagnose pulmonary abscesses?
- auscultation- moist rales, friction rub, muffled heart/ lung sounds from effusion
- leukocytosis
- thoracic rads- consolidation
- thoracocentesis
- CT
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Describe treatment of pulmonary abscesses.
- medical- pleural drainage and lavage, aggressive antibiotics, supportive care
- surgery- median sternotomy, lobectomy, remove FB or tumor
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What are causes of hypoxemia in a patient with thorax surgery? (5)
- decreased FiO2
- hypoventilation- drugs, pain, pleural space dz
- diffusion impairment
- V/Q mismatch- lateral recumbency and atelectasis, blood flowing to down lung, pneumonia
- shunt
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How does pain affect ventilation?
- prevents full excursion of chest wall- hypoventilation
- catecholamine release- vasoconstriction, poor perfusion, tachycardia
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