ABDOMINAL WALL 84

Question 1

define the term PERITONEALIZATION

Answer 1

new formation of peritoneal sac over the contens of chronic traumatic or incisional hernias

Question 2

MUSCLES THAT COMPOSE THE ABDOMINAL WALL

Answer 2

from ext to int:
OBLIQUUS EXTERNUS ABDOMINIS
OBLIQUUS INTERNUS ABDOMINIS
TRANSVERSUS ABDOMINIS

RECTUS ABDOMINIS. fibers from aponeurosis of previous muscles passes superficial or deep to the rectus abdominis.

ARCUATE LINE: line where aponeurosis from OB. INT. and TRANS ABD passes superficial to the rectus (more cranially they passes under)

Question 3

SUBSTERNAL MIDLINE DEFECTS

Answer 3

are epigastric hernias

usually associated with congenital peritoneal-pericardiac diaphragmatic hernias.

Question 4

INGUINAL HERNIAS

Answer 4

are caudal abdominal hernias

usually in female uterus because tethering effect of round ligament

Question 5

MOST COMMON ABDOMINAL HERNIAS

Answer 5

FROM CRANIAL TO CAUDAL

SUBXIPHOID
PARACOSTAL
UMBILICAL
INGUINAL
FEMORAL
CRANIAL PUBIC LIGAMENT RUPTURE
SCROTAL 

DORSAL LATERAL HERNIA

Question 6

DESCRIBE THE LOSS OF DOMAIN EFFECT

Answer 6

OCCURS WHEN ABDOMINAL WALL HAS BECOME ACCUSTOMED TO A RELATIVELY SMALL INTRAABDOMINAL VOLUME

STRATEGY TO GAIN TISSUE EXPANSION:

PROGRWSSIVE PNEUMOPERITONEUM
INFLATABLE SILASTIC EXPANDERS
MESH TO AUGMENT THE ABDOMINAL WALL

Question 7

DIFFERENCE IN PROGRESSION BEETWEN STRANHULATED INTERNAL AND EXTERNAL HERNIAS

Answer 7

STRANGULATED HERNIAS RELEASE VASOACTIVE SUBSTRANCES (arachidonic acid, cytochines, leukotrienes, kinins).

EXTERNAL HERNIAS ARE MORE ISOLATED FROM HIGHLY ABSORBANT PERITONEAL CAVITY, SO THEY CAN DEVELOP CLINICAL SIGNS AND SIGNS OF SHOCK LATER COMPARED TO INTERNAL HERNIAS

Question 8

ABDOMINAL HERNIA REPAIR PRINCIPLES

Answer 8

VIABILITY HERNIA CONTENTS
HERNIA CONTENTS TO THEIR NORMAL LOCATION
OBLITERATE REDUNDANT HERNIA SAC TISSUE
TENSION FREE SECURE PRIMARY CLOSURE OF THE DEFECT

Question 9

ABDOMINAL HERNIA SURGICAL PRINCIPLES

Answer 9

ANIMAL IS SYMPTOMATIC
ANIMAL-OWNER QUALITY OF LIFE
RISK FOR ORGAN OBSTRUCTION

Question 10

CONDITIONS ASSOCIATED WITH UMBILICAL HERNIAS

Answer 10

FOCUSIDOSIS
ECTODERMAL DYSPLASIA
CRYPTORCHIDISM

Question 11

HOW LARGE MIDLINE UBILICAL AND SKIN DEFECTS ARE CALLED

Answer 11

OMPHALOCELES

Question 12

PREVALENCE OF UMBILICAL HERNIAS RUBLE 1993

Answer 12

0.6% DOGS WITH NO SEX PREDILECTION IN GENERAL, BUT MORE FEMALE IN PREDISPOSED BREED

Question 13

DOES SMALL UMBILICAL HERNIAS CLOSE SPONTANEOUSLY?

Answer 13

YES, IF <2-3 MM, AS LATE AS 6 MONTHS

Question 14

SURGICAL TREATEMENT OF VENTRAL ABDOMINAL HERNIAS

Answer 14

DEBRIDEMENT OF WOUND EDGES

MAYO MATTRESS SUTURE IS CONTROVERSIAL (MORE APPOSINF TISSUE BUT MORE TENSION)

FASCIAL RELEASING INCISIONS: AT LEAST 2 CM FROM THE DEFECT AND ONLY ON EXSTERNUS RECTAL FASCIA

Question 15

INGUINAL HERNIAS

Answer 15

INDIRECT: THROUGH VAGINAL PROCESS

DIRECT: THROUGH INGUINAL RING

Question 16

NAME THE STRUCTURES THAT PASSES THROUGH INGUINAL RINGS (OE+OI)

Answer 16

GENITOFEMORAL NERVE, ARTERY, VEIN
EXTERNAL PUDENDAL VESSEL

MALE: CREMASTER+SPERMATIC CORD
FEMALE: ROUD LIGAMENT UTERUS

Question 17

FACTORS INVOLVED IN INGUINAL HERNIA FORMATION

Answer 17

ANATOMIC: OPEN CANAL IN DOMESTIC ANIMALS+ SHORTER IN BITCHES COMPARED TO MALES

HORMONES: FEMALE PREDISPODED DURING ESTROUS OR PREGNANCY

METABOLIC: NUTRITIONAL OR METABOLIC STATUS es: obesity

Question 18

INGUINAL GERNIAS ARE MORE COMMON IN MALES OR FEMALES?

Answer 18

FEMALES: TWO CASE SERIES ONLY 8-11% WERE MALES. MALES WERE YOUNGER THAN FEMALES. STRANGULATION OF CONTENTS MORE COMMON IN MALES

Question 19

MONOLATERAL INGUINAL HERNIAS: WHAT SIDE IS MORE COMMON?

Answer 19

left side

Question 20

SURGICAL APPROACH TO INGUINAL HERNIAS

Answer 20

parallel to flank fold, lateral to swelling

midline approach

milk the sac or if not reducible open sac and enlarge opening.

CRANIAL SARTORIUS FLAP for large defects

Question 21

SCROTAL HERNIAS: WHAT’S RECOMMENDED?

Answer 21

castration to prevent offspring (figliazione) and recurrence

Question 22

FACTORS INVOLVED IN CREATION OF IATROGENIC FEMORAL HERNIAS

Answer 22

transection origin pectineus muscle

misdirect dissection during during approach to ventral coxofemoral joint

Question 23

RADIOGRAPHIC SIGNS of abdominal hernia

Answer 23

loss of abdominal strip

absence of abdominal organs from their normal location

Question 24

fascial releasing incision in abdominal wall muscles: good option for large defects?

Answer 24

in humans with defects >7-10 cm is not a good choice

Question 25

MUSCOLAR FLAPS for large defects

Answer 25

CRANIAL SARTORIUS
EXT ABDOMINAL OBLIQUE
RECTUS ABDOMINIS

LATISSIMUS DORSI FOR TORAX OR VENTRAL-LATER CRANIAL ABDOMEN

Question 26

DESCRIBE “external abdominal oblique myofascial flap”

Answer 26

ARTERY: cranial branch of the cranial abdominal artery . accompanied by cranial hypogastric nerve and satellite vein

SUBXIPHOID-PARACOSTAL DEFECTS

Question 27

DESCRIBE “cranial sartorius musce flap”

Answer 27

branch of femoral artery and vein – exit at the proximal third of the muscle

Question 28

DESCRIBE “rectus abdominis flap”

Answer 28

two vascular pedicles: cranial and caudal epigastric (more important)

Question 29

synthetic mesh fixation

Answer 29

in a porcine study no benefit in fixztion vs no-fixation, with fascia only closed over the mesh material

Question 30

best method beetween

onlay mesh
interpositional mesh
underlay mesh

Answer 30

underlay mesh has lowest rate of reherniation and wound complications