Friday 13 April

0830-1010, Hall 4

Planning fracture surgery and avoidance of problems

An important prerequisite for the planning of successful fracture surgery is the patient evaluation, including history taking and physical examination combined with adequate radiographic examination. After analysis of the fracture configuration, we can put together a ‘fracture assessment’ that helps to guide our decisions on the method or technique of fracture treatment. However, this process is just the beginning for ensuring a successful fracture treatment. There are many other skills and proficiencies that are needed for a trouble-free outcome, and there is often no substitute for experience.

As a surgeon you can improve your level of technical proficiency by taking courses, reading, practising dissection on cadavers, ‘scrubbing-in’ with more experienced surgeons, reviewing your atlas of surgical approaches and doing a ‘dress rehearsal’ for elective surgical procedures. In addition, you can make video recordings of your operative performance. Just like an elite athlete, a surgeon can make lots of small improvements to their surgical skills by review of actual technique and critique of postoperative radiographs. Mental and emotional preparation for a surgical procedure is also critical to success. The surgeon should be able to focus on the patient, and not be distracted by worries such as emotional domestic upset or interruptions by non urgent telephone enquiries.

Due to its dynamic nature, problems and complications during surgery are a fact of life. The key to overcoming unexpected events is firstly to recognize and acknowledge that a problem has occurred, and secondly to have plans and contingencies in place to overcome the event. The better your pre-surgical planning, training and preparation, the less likely it is that you will have a problem and, if one occurs, you will be better equipped to deal with it.

The three most challenging facets of a fracture surgery are the surgical approach, the fracture reduction, and the contouring of the plate. These tasks can be made easier and better by practising the approach on a cadaver, learning strategies for obtaining the reduction, and contouring the bone plate the day before surgery.

1105-1245, Hall 4

Challenging cutaneous reconstructions, Bryden J. Stanley

Upon presentation of a case with extensive wounding, it is important to develop a reconstructive plan and preferably have another plan as backup should the initial plan fail. All options of wound management and reconstructive procedures should be considered, including second intention healing, tension-relieving techniques, flaps and grafts. Staged reconstructions, partial closures and use of the delay phenomenon should also be contemplated. In many cases, there may be several options that would result in successful wound closure, and it is always interesting to discuss how different surgeons would approach the same case.

This interactive case-based session will provide an opportunity to see a variety of wounds and discuss the pros and cons of various wound management and closure methods. Challenging cases will be followed chronologically, as the wound progresses through to the definitive reconstructive effort and final outcome. Wounds from a variety of aetiologies will be presented, including bite wounds, burns, envenomizations, neoplastic resections and vehicular trauma.

1415-1555, Hall 4

Heart sounds and arrhythmias: interpreting the ‘lub dub’, Oriol Domenech

Cardiac auscultation is one of the cheapest diagnostic tools that offers the possibility to identify a cardiac disease as well as the possibility to create an appropriate list of differential diagnoses.

The hallmark of a left to right shunting PDA is a continuous murmur over the left 3rd intercostal space. The point of maximal intensity (PMI) is in the left axillary area, which means that we have to stress the auscultation (sometimes pulling the forelimb forward) in order to interrogate this cranial region adequately, otherwise it is very easy to miss this murmur. A palpable thrill can be felt in the cranial thorax, especially in those cases with a large PDA. When the PDA is very small, the murmur may be very localized and a thrill may not be palpable.

Neonatal or older dogs with a very large left to right shunt and equalizing diastolic pressures (elevated pulmonary artery pressure) have only a systolic rather than a continuous murmur. Dogs with large shunts may also have mitral regurgitation secondary to annular dilatation with a consequent systolic murmur at the left apex. Dogs with pulmonic stenosis have a left basilar systolic ejection murmur over the pulmonic valve that radiates to the left craniodorsal cardiac base and in some cases it can also radiate to the right craniodorsal base.

In general, the intensity of the murmur increases with the severity of obstruction. Rarely, a diastolic murmur of associated pulmonic insufficiency can also be heard, resulting in the presence of a to-and-fro murmur. In dogs with mild or moderate subaortic stenosis, a grade 1-4/6 systolic murmur can be heard best in the left 4th to 5th intercostal spaces at the costochondral junction. Severely affected dogs usually have a grade 4-6/6 systolic murmur, often with precordial thrill.

In small ventricular septal defects, because blood is forced through a small defect during systole, a loud systolic murmur over the right sternal border often associated with a precordial thrill will be present. Atrial septal defects are not normally associated with velocities high enough to produce a murmur. Audible murmurs are associated with large septal defects and are a consequence of increased flow through the pulmonic valve, causing a ‘relative pulmonic stenosis’. These murmurs are soft, systolic and are auscultated in the left basilar thoracic wall corresponding to the location of the pulmonic valve. Gallop rhythm occurs when, in addition to S1 and S2, the 3rd or the 4th heart sound or these two sounds have merged. This rhythm is perceived as three heart sounds during tachycardia with similar intensity, similar to the sound of a galloping horse.

The presence of a gallop rhythm in a small animal indicates further evaluation of the patient. Hypertrophic cardiomyopathy is the most common cause of gallop rhythm in cats. The detection of a gallop rhythm in dogs with chronic valvular disease or dilated cardiomyopathy is usually a sign of late stage disease.

1650-1830, Hall 4

Radiological interpretation of the respiratory system, Robert Kirberger

This interactive session will interpret a number of thoracic case studies to illustrate basic and advanced principles of radiological interpretation of the respiratory system. This will include trachea, bronchi and lung patterns, and diseases causing these plus how to differentiate them where possible. Participants will actively partake in the questions asked and will be able to compare their responses to those of their peers.

At the end of the session, participants will feel more confident in making thoracic radiographs in practice as they will have a greater understanding of the respiratory changes seen on thoracic radiographs. The emphasis will be on respiratory thoracic pathology as the rest of the thorax will be covered in a masterclass session the next day.

Saturday 14 April

0830-1010, Hall 4

How to manage trauma cases, Michael M. Pavletic

Open wounds enter veterinary practices with variable degrees of contamination, tissue injury, and circulatory compromise. Wound management precedes wound closure. Wound closure is dependent on establishing a healthy wound in which closure is likely to be successful. The method of closure is dependent on several factors, including the size and location of the wound.

This interactive session will present a variety of trauma cases to demonstrate the three basic components of managing traumatic wounds, including: (1) wound assessment and classification; (2) surgical and medical intervention; and (3) establishing a plan for successful wound closure. At the completion of this session, participants will have a greater understanding of these three basic steps of successful wound closure and how to address potential complications associated with wound care.

1105-1245, Hall 4

Breed-related eye disease, Simon Petersen-Jones

Breed-related eye disease in dogs is very common, and ranges from those conditions that have a simple mode of inheritance to those that are related to conformation of the head, adnexa and globes. Simply inherited conditions include retinal dystrophies, such as the progressive retinal atrophies, some cataracts, lens luxations and glaucomas. Certain breeds are more prone to particular conditions because of their breed-related head conformation. This can include lid abnormalities such as entropions and ectropions and the development of corneal disease such as ketatitis and ulceration. It is likely that the conformation-related conditions have a more complex inheritance pattern.

Small animal veterinary practice will include many patients with breed-related eye disease. This interactive session will take a case presentation style with individual patients for the audience to ‘work up’. Emphasis will be on diagnosis and management, with inclusion of the relevant background physiology, pathology and pharmacology and therapeutics. This should improve the participant’s confidence in approaching these conditions.

1415-1555, Hall 4

Disorders of hypercalcaemia: how much should I react?, Dennis J. Chew

Patients with various types, magnitudes and underlying causes of hypercalcaemia will be presented, followed by audience responses to a series of questions. Questions will focus on determination of whether the hypercalcaemia is important, what the most-likely diagnosis is, what further diagnostics should/could be considered, what the definitive diagnosis is, and what treatment(s) should be considered and implemented.

Hypercalcaemia is often underappreciated for its diagnostic and pathophysiological importance in veterinary medicine, so we will develop a scheme to allow the clinician to know when it is important to react to the discovery of ‘hypercalcaemia’. The potential causes for any patient with hypercalcaemia will be developed, with emphasis on how this list differs between cats and dogs. A shortlist of the most likely causes of hypercalcaemia will be featured. Discovery of hypercalcaemia will differ depending on the use of total calcium or ionized calcium measurements – the diagnostic discordance between these two methods will be explored during this session.

A logical diagnostic approach will be developed for patients in which the diagnosis is not obvious following history, physical examination and evaluation of a minimum database (CBC, serum biochemical profile, and urinalysis). A pivotal first step is to determine whether the hypercalcaemia is ionized or not, and whether it is parathyroid gland dependent or parathyroid gland independent – this requires measurement of ionized calcium and parathyroid hormone (PTH) at the same time for proper interpretation. Measurement of circulating PTHrP and vitamin D metabolites (25(OH)-vitamin D and 1,25(OH)2-vitamin D) is sometimes helpful in making a definitive diagnosis for the cause of hypercalcaemia.

Treatment of severe hypercalcaemia often requires some combination of IV fluids, furosemide, calcitonin, and bisphosphonates. Idiopathic hypercalcaemia (IHC) is a common diagnosis associated with chronic hypercalcaemia in cats but not dogs. A treatment scheme for IHC in cats will be developed using dietary change, prednisolone and/or oral bisphosphonates.

1650-1830, Hall 4

How to manage the dog and cat ‘off its legs’, Björn Meij

Dogs and cats with neurological deficits are common patients in a busy general practice. These deficits commonly affect the limbs and can lead to a variety of clinical presentations involving one or more limbs. Even slight disturbances in neuro-locomotion and coordination may cause the dog or cat to go off its legs. Progression of clinical signs can be insidious or dramatically acute, and animals may present without pain or with pain that may be responsive or refractory to routine analgesic medication. Causes may be degenerative, vascular, infectious, traumatic, anomalous or neoplastic. A range of patients with disorders in these causative categories will be presented. Therapies that will be discussed include medical, surgical and supportive treatments.

In this interactive lecture the audience will participate in solving these cases using a push button voting system, responding to a list of differential diagnoses or choosing the best available diagnostic modality. The audience will participate in the management of the patient by decision making, leading ultimately to the correct diagnosis and treatment.

The cases will be discussed in detail, illustrated with imaging and other diagnostic findings, and followed up with the long-term results of treatment. The statistics that result from the voting system will be the basis for discussion of pros and cons for the choice of diagnostic modalities, differential diagnosis and installed therapies.

This interactive lecture is aimed at veterinary surgeons in general practice with no specialist expertise. The lecture will deliver basic information on disorders that may lead to dogs and cats going off their legs. In this interactive lecture you will develop basic skills to: assess the neurological patient quickly; list a differential; advise the owner of diagnostic modalities and realistic treatment options; and determine the prognosis.