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SURGERY - Coggle Diagram

- - - - eyeglobe + its appendages
    - - transparent media + 3 concentrically superimposed layers --> outer tunic (fibrous), middle tunic (vascular), inner tunic (nervous, photosensitive)
    - - upper eyelid, lower eyelid, TE (or nictitating mb) and conjunctiva
    - - extraocular musculature of eyeglobe
    - - structures with a role in production of tears (lacrimal gland + accessory lacrimal glands)
    - - arterial supply of eyeglobe + eyelids, venous circulation
    - - oculomotor (III), trochlear (IV), abducens (VI), palpebral branch of facial nerve (VII), trigeminal (V) (supraorbital + nasociliary)
  - - - direct (naked eye) / indirect methods (devices, tests or dyes)
    - - leave patient free in consultation room, w nb of objects + carefully monitor their behavior --> sees / doesn't see but recently lost sight / never seen
    - - Cotton ball test
      - Menace response
      - Ocular cytology + collection of conjunctival secretions for laboratory exams
      - Exam of anterior pole of eye
      - Exam of eyeglobe by direct methods - with naked eye
      - Exam of the eyeglobe by indirect methods
      - Using a light source
      - Using cPLR device
      - Using a magnifying loupe
      - Rose Bengal test
      - Fluorescein test
      - Jones test
        
        for permeability of nasolacrimal ducts
      - Schirmer tear test
        
        semi-quantitative method to measure amount of tears that reach cornea (precorneal tear film)
      - Indirect + direct ophthalmoscopy
      - Tonometry
        
        intraocular P° (IOP)
      - Gonioscopy
        
        for irido-corneal angle (camerular)
      - Ocular ultrasound
      - Electroretinography (ERG)
        
        for electrical potentials produced when a light stimulus of a certain intensity, duration and wavelength reaches retina
      - Radiographic exam of orbit
      - Computed tomography (CT) + magnetic resonance imaging (MRI)
      - Bacteriological, virological, mycological and parasitological testing (labo)
      - Cytology + ocular biopsy
  - - - Eye drops solutions (collyres)
      - Ointments
      - Gels
    - - Antibiotics
        
        penicillins, cephalosporins, chloramphenicol, aminoglycosides, tetracyclines, azithromycin, fluoroquinolones
      - Antifungals
        
        natamycin, azoles, flucitosin
      - Antifungals
        
        famciclovir
      - Anti-inflammatory drugs
        
        corticosteroids, NSAIDs
      - Immunosuppressive medication
        
        azathioprine, cyclosporine, tacrolimus
      - Antihistamines
      - Hyperosmotic agents
        
        mannitol, sodium chloride
      - Mydriatics (atropine, tropicamide and adrenergic agents)
        
        atropine, tropicamide, adrenergic agents
      - Miotics
      - Glaucoma medication (antiglaucoma drugs)
      - Anaesthetics
      - Analgesics
      - Opioids
        
        morphine
      - Atropine
      - Enzymes + enzymatic inhibitors
        
        tissue plasminogen activator, protease inhibitors (metalloproteinases)
      - Tear substitutes (artificial tears)
      - Antiseptics
        
        benzalkonium chloride
      - Vitamins (A, B2, B6, B12, C, E)
      - Ophthalmic dyes
      - Antiparasitics
      - Therapeutic contact lenses
  - - - Anophthalmia
        
        total abs of eyeglobe, unilateral or bilateral, by genetic or teratogenic factors
      - Cryptophthalmia
        
        rudimentary dvlp of eyeglobes partially or completely covered by eyelids (ankyloblepharon)
      - Cyclopia
        
        congenital malformation --> single eye, in median plane of head by complete or incomplete fusion of orbits
      - Microphthalmia
        
        abnormality of eye globe dvlp --> significant or moderate decreased size, but still visual
    - - Exophthalmos
        
        prominence in palpebral fissure
      - Enophthalmos
        
        retraction of eyeglobe into orbit --> unchanged size of eyeglobe
      - Phtisis bulbi
        
        change in size of eyeglobe: decrease in volume --> animal not visual
  - - - Orbit
        
        cone-shaped bony cavity w eyeglobe, extraocular muscles, blood vessels, optic nerve and lacrimal gland
      - Orbital fascia
        
        Periorbita
        
        from orbital fissure where it is contiguous with dura mater of optic nerve, lines orbit + envelops eyeglobe, extraocular muscles, nerves and vessels of orbit
        
        Extraocular muscle fascia
        
        from apex of orbit + fuses with Tenon’s capsule anteriorly
        
        Tenon’s capsule (eyeglobe fascia)
        
        thin mb that covers eyeglobe from optic nerve to limbus
    - - Orbital trauma
        
        Orbital fractures
        
        fracture of zygomatic bone
        
        Proptosis + avulsion of eyeglobe
        
        proptosis = displacement of eyeglobe from orbit, through palpebral fissure, with functional preservation of vascular-nervous cord
      - Orbital cellulitis, orbital abscess (retrobulbar) and orbital foreign bodies
      - Orbital tumors
  - - - Eyelid muscles
        
        orbicularis oculi, levator palpebrae superioris + Müller , small levator of eyelid, malar
      - Eyelid physiology
    - - Congenital anomalies of eyelids
        
        Ablepharon (eyelid agenesis)
        
        rare eyelid malformation, congenital --> total abs of eyelids, replaced by membranous folds
        
        Poliblepharon
        
        very rare malformation (dogs + foals) --> supernumerary eyelids
        
        Blepharophimosis
        
        abnormality of eyelid opening, palpebral fissure reduced, unilateral or bilateral
        
        Ankyloblepharon
        
        abnormality of eyelid opening, palpebral fissure abs after birth, unilateral or bilateral
        
        Eyelid coloboma
        
        congenital anomaly due to an embryogenetic defect --> abs of a portion of eyelid
        
        Palpebral dermoid
        
        ectopic skin island that contains cilia, mostly in conjunctiva and/or cornea + also eyelid
      - Anomalies of growth + implantation of eyelid cilia
        
        trichiasis
        
        abnormal direction of upper cilia towards eyeglobe, congenital or acquired by eyelid injuries
        
        districhiasis
        
        2 rows of cilia, posterior one: abnormal growth, implantation and direction towards eyeglobe > corneal lesions of ≠ degrees
        
        ectopic cilia
        
        hairs that grow erratically on eyelids margin or in palpebral conjunctiva
      - Changes in position of eyelid margins
        
        Entropion
        
        abnormal eyelid position (lower, upper or canthal region) on a certain area or along its entire length, congenital or acquired --> inturning of eyelid margin
        
        Entropion
        
        change in position of (lower) eyelid, constitutional or acquired (cicatricial + senile) --> outward rolling of eyelid margin
      - Eyelid wounds
      - Eyelids inflammation (blepharitis)
        
        Localized blepharitis
        
        Hordeolum
        
        acute inflammation of glands on eyelid margin
        
        Chalazion
        
        chronic inflammation with distension of Meibomius glands (tarsal)
        
        Generalized blepharitis
        
        Bacterial blepharitis
        
        Mycotic blepharitis
        
        Parasitic blepharitis
        
        Allergic blepharitis
      - Eyelid tumors
  - - - Fcts of TE
      - Exam methods
    - - Everted tarsal cartilage
        
        scrolling + eversion of TE margin, unilateral or bilateral
      - Hyperplasia + prolapse of TEG
        
        TEG protrusion = hyperplasia = adenoma = "cherry eye"
      - TE wounds
      - Inflammation of TE conjunctiva
      - TE tumors
  - - - Vascularization
      - Physiology
      - Semiology
        
        Color changes
        
        anemia
        
        hyperaemia
        
        bright red conjunctiva due to congestion of superficial conjunctival vessels
        
        conjunctival or subconjunctival ecchymosis
        
        jaundice
        
        Surface changes
        
        conjunctival chemosis (conjunctival oedema)
        
        conjunctival synechiae
        
        adhesions that connect palpebral conjunctiva to bulbar one or cornea
        
        Secretory changes
        
        conjunctival xerosis (dryness of conjunctiva)
        
        conjunctival hypersecretion in exudate form
    - - Congenital anomalies
        
        Dermoid
        
        ectopic skin island, which adheres to deep layers, contains sebaceous glands + hairs
      - Traumatic lesions
        
        Traumatic ecchymosis
        
        Emphysema
        
        Wounds
        
        Foreign bodies
      - Burns
      - Inflammatory conditions (conjunctivitis)
        
        Bacterial
        
        Viral
        
        Mycotic
        
        Parasitic
        
        Allergic
        
        By Mycoplasma spp
        
        By Chlamydia spp
        
        Follicular
      - Tumors
  - - - Secretory component
      - Tear drainage pathways
      - Semiology
      - Methods of exam
    - - Congenital anomalies
        
        Imperforation of tear puncta
      - Injuries to lacrimal gland + lacrimal drainage pathways
      - Foreign bodies in tear drainage system
      - Inflammation of lacrimal gland + lacrimal sac
        
        Dacrioadenitis
        
        inflammation of lacrimal gland
        
        Dacryocystitis
        
        inflammation of lacrimal sac, chronic
      - Kerato-conjunctivitis sicca
        
        "the disease with a thousand faces = "dry eye"
      - Tumors of lacrimal system
  - - - Histology
        
        5 layers: anterior corneal epithelium / Bowman mb = basement mb / stroma, parenchyma or cornea substantia propria / Descemet mb / corneal endothelium = posterior corneal epithelium
      - Physiology
      - Semiology
    - - Congenital abnormalities
        
        Microcornea
        
        cornea w smaller-than-normal diameter, doesn’t affect visual acuity
        
        Dermoid
        
        ectopic skin island containing sebaceous glands + hairs, in cornea frequently at temporal angle of eye, may involve sclero-corneal limbus
      - Injuries
        
        Superficial wounds
        
        Deep wounds
        
        Penetrating wounds
      - Chemical burns
      - Dystrophies
        
        Lipid dystrophy
        
        Calcium dystrophy
        
        Feline corneal sequestrum
      - Inflammations (keratitis)
        
        Ulceration
        
        Indolent ulcer
        
        Melting ulcer
        
        corneal lesion w loss of corneal substance of variable extent + depth
        
        Kerato-conjunctivitis with Moraxella in cattle
        
        Kerato-conjunctivitis with Thelazia spp
        
        Chronic superficial keratitis of German Shepherd dog (pannus)
        
        Feline herpes keratitis
        
        Feline eosinophilic keratitis
      - Tumors
  - - - Ratios
      - Histology
        
        capsule (= crystalloid), anterior epithelium, fibers
      - Chemical composition
      - Nutrition
    - - Congenital anomalies
        
        Anomalies of shape + position
        
        Aphakia
        
        congenital abs of lens
        
        Microphakia
        
        lens smaller than normal, but animal visual
        
        Spherophakia
        
        spherical lens, but visual acuity pz
        
        Anterior or posterior lenticonus
        
        outbulging of anterior or posterior lens capsule, at poles, lens capsule much thinner + friable
        
        Lens coloboma
        
        abnormality in dvlp of zonular fibers of suspensory ligament > more or less deep depression of lens equator
        
        Crystalline lens ectopia
        
        lens abnormality, usually bilateral, w abnormality in dvlp of zonular fibers
        
        Abnormalities of transparency
        
        Congenital cataract
      - Changes in transparency
        
        Cataract
        
        opacification of lens
      - Changes in position (dystopias)
        
        Lens subluxations + lens luxations
        
        -partial tearing of suspensory ligament > partial lens displacement from hyaloid fossa
        -complete tearing of suspensory ligament (anterior, posterior, or vertical) > total lens displacement from hyaloid fossa
  - - - Iris
      - Ciliary body
      - Choroid
    - - Congenital anomalies
        
        Persistent pupillary mbs (PPM)
        
        partial or abs resorption of papillary mbs > remnants: adhere to pupillary edge of iris, posterior face of cornea, or anterior face of lens
        
        Dyscoria
        
        abnormal shape of pupil
        
        Correctopia
        
        eccentric pupil
        
        Polycoria
        
        pz of >1 pupil
        
        Aniridia
        
        abs of iris, unilateral or bilateral, rare abnormality (in Persian cats)
        
        Iris coloboma
        
        holes in thickness of iris, due to abs of iris tissue
        
        Iris heterochromia
        
        anomaly of pigmentation that can affect entire iris or only certain areas of it
        
        Iris cysts
        
        Iris melanosis
        
        pigmentation of iris surface, localized or diffuse
      - Inflammation (uveitis or irido-cyclo-choroiditis)
        
        Equine recurrent ophthalmia
        
        chronic, immune-mediated inflammation of uveal tract
      - Uveal tumors
  - - - Histology
        
        10 layers
      - Pathophysiology
    - - Congenital disorders
        
        Retinal dysplasia
        
        congenital condition --> abnormal retinal dvlp
        
        Progressive atrophy (PRA)
      - Acquired disorders
        
        Nutritional retinopathies
        
        Taurine deficiency in cats
        
        Thiamine deficiency in cats
        
        Hypovitaminosis A in pigs + cattle
        
        Toxic retinopathies
        
        Drugs
        
        Plants
        
        Retinopathy of storage
        
        Inflammation (retinitis)
        
        Secondary systemic infections (Carre disease, fungal, FIP)
        
        Retinal detachment
        
        Secondary to cardio-vascular diseases
        
        separation of retina from choroid > interrupts nutrition of nervous tunic of eye
  - - - neurological entity w dysfunction of sympathetic innervation responsible for innervation of upper eyelid, lower eyelid, TE and pupil (common)
    - - degeneration of nervous cells of autonomic nervous system
- - - - Sero-haemorrhagic cyst (traumatic cyst)
        
        2nd degree contusion --> detachment of SC connective tissue from skin (by mechanical traumatic agent acting tangentially) + formation of a cavity incompletely filled with serous secretion
      - Haematoma
        
        2nd degree contusion --> accumulation of a collection of blood in tissues
      - crushing tissues without solution of continuity in skin
    - - Process of wound healing
        
        Scarring by adhesion (sanatio per primam intentionem)
        
        surgical or accidental superficial
        
        Scarring by suppuration (sanatio per per secundam intentionem/scarring by budding)
        
        accidental trauma + significant haemorrhage w considerable tissue destruction, large newly formed cavities
        
        Healing by secondary sutures (sanatio per tertiam intentionem)
        
        no clear delimitation btw healthy + nonviable tissues
        
        Healing by plastic skin surgery (sanatio per quatram intentionem)
        
        massive skin losses, cicatricial keloid or hypertrophic scars, burn wounds
        
        Mixed scarring
        
        surgical using a drain tube
        
        Scarring under crust
        
        superficial
        
        Factors that influence wound healing
        
        General wound therapy
        
        Surgical antisepsis
        
        Wound therapy according to etiological agent
        
        Wounds by stinging
        
        Wounds by cutting
        
        Contusion wounds
        
        Bite wounds
        
        Wounds by plucking, laceration and breaking
        
        Granular wounds (= summer wounds)
        
        Gunshot wounds
        
        Wound complications
        
        Aseptic complications of wounds
        
        haemorrhages
        
        cardio-respiratory arrest
        
        traumatic syncope
        
        SC emphysema
        
        traumatic shock
        
        Abnormal wound healing
        
        Pathological scars
        
        retractable scar
        
        metaplastic scar
        
        painful scarring
        
        adhesions
        
        Atonic wounds
        
        Hypertrophic wound (excessive scarring/excessive budding)
        
        Cicatricial keloid (Kelis spuria/sarcoid)
  - - - dehydration + hardening of tissues due to insufficient blood supply
    - - tissue mortification by massive infiltration > putrefaction