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Eq ACVS Phase 1 > Ch.40 Abdominal Hernias > Flashcards

Ch.40 Abdominal Hernias Flashcards

1
Q

Difference between inguinal rupture and ruptured inguinal hernia?

A

In an inguinal rupture the viscera protrude through a rent in the peritoneum adjacent to the vaginal ring and lie outside the vaginal process.
In a ruptured inguinal hernia, viscera enters the subcutaneous tissue through a rent in the vaginal process.

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2
Q

The deep inguinal ring is formed by

A

Cranial - Caudal edge of internal abdominal oblique

Ventromedial - Rectus abdominis m. and prepubic tendon

Caudolateral - Inguinal lig.

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3
Q

By what age should a small manually reducible inguinal hernia resolve in foals.

A

6 months

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4
Q

What fraction of acquired inguinal hernias affect the left side?

A

2/3

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5
Q

What is the reported success rate of manual reduction of acquired inguinal hernia?

A

82.5%

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6
Q

What is the reported % of horses requiring small intestine resection following successful manual reduction of acquired inguinal hernia?

A

12.5%

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7
Q

What direction should the vaginal ring be incised to facilitate reduction of herniated intestine and why?

A

Craniolateral to avoid the caudal epigastric

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8
Q

What size vaginal ring necessitates closure?

A

2 fingers or more

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9
Q

What size mesh in used in vaginal ring closure?

A

8 x 6cm

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10
Q

How large a flap should be made when closing the vaginal ring with a peritoneal flap?

A

6x10cm

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11
Q

What size endohernia staples are used in the peritoneal flap approach to closure of the vagina ring

A

4.8mm

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12
Q

Coverage of which aspect of the vaginal ring is critical to prevent herniation

A

Caudal

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13
Q

Hernias characterized by incarceration of only the anti mesenteric aspect of the intestine

A

Richters or Parietal

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14
Q

Only considered a true hernia if

A

Protrudes through a normal aperture

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15
Q

Protrusion of viscera through an acquired opening is called a

A

False hernia or rupture

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16
Q

Diff between true and false hernia

A

True
- viscera protrudes through a normal aperture
-sac is lined with peritoneum

False
- Acquired opening
- Not lined with peritoneum

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17
Q

Which gender are congenital umbilical hernias most prevalent in

A

Female

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18
Q

In which breeds are congenital umbilical hernia most prevalent

A

TB AQH

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19
Q

Umbilical hernias developing between which weeks are less likely to spontaneously resolve

A

5-8weeks

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20
Q

Umbilical hernias of what size may resolve spontaneously by the time the foal reaches 6-12mo

A

3cm or less

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21
Q

Elastrator rings can be used for hernias up to what size

A

8cm

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22
Q

Premature dislodgement of the hernial clamp may result in

A

Evisceration

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23
Q

Activity following herniorraphy consists of

A

30-60 days stall confinement with hand walking followed by 30 easy small paddock turnout

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24
Q

When does acute total dehiscence usually occur

A

In recovery

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25
Q

Delayed total disruption of the ventral incision usually occurs within what timeframe

A

3-8 days

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26
Q

What is used for secondary closure of a dehisced abdomen? Suture, pattern, distance between sutures and edges

A

18-22 gauge stainless steel wire
Through and through interrupted vertical mattress
2.5cm apart
Far - 5cm from edge of wound
Near - 2.5cm from edge of wound

27
Q

When wiring an abdomen post dehiscence, which layers should the wire engage

A

Near - all layers minus the retroperitoneal fat and peritoneum or just skin and subcutaneous

Far - Skin, fascia and rectus abdominus

28
Q

Following wiring of a dehisced abdomen for how long should the horse be confined to a stall?

A

60 days

29
Q

Incidence of herniation after midline celiotomy

A

8.1-16%

30
Q

When do incisional hernias usually become apparent

A

2-3 months post discharge from hospital

31
Q

How soon after identifying an incisional hernia should a repair be attempted and why

A

3-4 months to allow time for local inflammation/infection to resolve and for hernial ring to mature making it more apparent and capable of holding suture

32
Q

What are the 5 techniques of primary closure using mesh

A

1- Onlay
2- Inlay
3- Retrorectus sublay
4- Peritoneal sublay
5- Underlay

33
Q

Benefit of primary closure of an incisional hernia without the use of mesh

A

1- Decreased risk of SSI
2- Shorter sx time
3- Cheaper
4- Eliminates risk of adhesion btw mesh and viscera
5- Shorter hospitalisation
6- Shorter return to exercise

34
Q

Cons of primary closure of an incisional hernia without the use of mesh

A

Multiple small gaps

35
Q

Up to what length and width has primary closure with suture been reported for repair of an incisional hernia

A

28cm long or 18cm wide

36
Q

How far beyond the hernial ring is the subcutaneous tissue dissected in incisional hernia repair

A

4-5cm

37
Q

% rate of short term complications reported in incisional hernia repair when a mesh was not used in primary closure

A

11%

38
Q

% rate of long term complications reported in incisional hernia repair when a mesh was not used in primary closure

A

4%

39
Q

when performing onlay mesh placement how far cranial and caudal to the hernia ring should the incision be extended

A

6-8cm

40
Q

How much of the external sheath of the rectus abdominis m. is exposed in the onlay mesh placement

A

6cm

41
Q

Where is the mesh placed in a rectorectus sublay technique

A

Between rectus abdominis m. and its internal sheath

42
Q

Where is the mesh placed in a peritoneal sublay technique?

A

Between internal sheath of rectus abdominis and peritoneum

43
Q

What complications were reported in a retrospective study of 13 horses undergoing repair of an incisional hernia with preperitoneal sublay technique

A
  1. All - Mild to moderate abd pain <24hrs post op
  2. All - Seroma or hematoma formation
  3. 8 - developed incisional drainage
  4. 3 - Tear of internal abdominal oblique near mesh tissue interface
44
Q

Material of mesh advised for laparoscopic underlay mesh repair for incisional hernia

A

Poly tetra fluoro ethylene

45
Q

Why use a polytetrafluoroethylene mesh

A

Prevents adhesion formation between the mesh and the viscera

46
Q

In a report of 11 equids undergoing repair of a lateral abdominal wall hernia what was their recovery period?

A

2 weeks stall,
4 weeks small paddock,
Back to work 42-56 days

47
Q

The prepubic tendon attaches where?

A

Cranial border of the pubis including iliopubic eminences

48
Q

What muscles does the republic tendon serve as the tendon of insertion for?

A
  1. External sheath of rectus abdominis m.
  2. Gracilis m.
  3. Pectineus m.
49
Q

Which horses most commonly experience prepubic tendon rupture

A

Aged draft horses during late pregnancy

50
Q

Stance of mare with republic tendon rupture

A

Saw horse, marked lordosis, elevation of tail and tuber ischia.

51
Q

How to confirm diagnosis of republic tendon rupture

A

Discontinuity of of abdominal wall cranial to pubis on transcutaneous ultrasound

52
Q

Treatment for term or near term mares with republic tendon rupture

A

Induce parturition with 75IU Oxytocin in 1L saline over 1 hour

53
Q

Why are diaphragmatic hernias commonly false hernias

A

Often lack a hernial sac

54
Q

Where are acquired diaphragmatic hernias most often located?

A

Musculotendinous portion of the diaphragm

55
Q

Where are congenital diaphragmatic hernias most often located?

A

Left dorsal tendons portion of the diaphragm

56
Q

Causes of congenital diaphragmatic hernia?

A

1 - Trauma in utero
2 - Trauma in parturition
3 - Failure of the embryonic components of the diaphragm to fuse

57
Q

Where is a morgagni hernia located

A

Retrosternal diaphragmatic hernia
Right ventral aspect of diaphragmatic musculature

58
Q

How/why do (Morgagni) retrosternal diaphragmatic hernia occur

A

Failed fusion of the septum transversum and the pleuroperitoneal folds

59
Q

What is the hernial sac of the retrosternal hernia made up of?

A

Peritoneum and pleura

60
Q

At what age do retrosternal hernia become clinically apparent

A

1 year

61
Q

What % of horses with diaphragmatic hernia have auscultatable borborygmi in the thorax?

A

80%

62
Q

When repairing a diaphragmatic hernia how is the celiotomy incision extended to best visualise the lesion

A

Finochetto rib retractor

63
Q

When performing a standing thoracoscopy to repair a diaphragmatic hernia, through which intercostal space was the scope introduced

A

10th

Eq ACVS Phase 1 (72 decks)

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