common abdominal hernias Flashcards
Common abdominal hernias include:
o Umbilical, inguinal, diaphragmatic, peritoneal-pericardial, scrotal, perineal, hiatal
What is a hernia?
a protrusion of an organ through the wall of its cavity
o Composed of ring (muscle), sac (peritoneum), and contents
Key principles when repairing a hernia:
- ensure the viability of entrapped hernia contents
- reduce the hernial contents to normal location
- achieve primary closure of the hernia defect
Hernia repair / Herniorrhaphy -Terminology
Strangulation:
Incarceration:
- strangulation - entrapment of viscera and obstruction of blood supply
- incarceration - Contents are irreducible and contraction of scar tissue at the hernia ring may result in delayed signs +/- Strangulation
Umbilical Hernia
- etiology
- concurrent conditions?
- who gets it?
- Congenital
- Hereditary
- +/- Cryptorchidism
- Umbilical ring fails to close
- Young animals, any breed
umbilical hernia clinical signs / diagnosis
- Soft, round mass or swelling at umbilical scar
- Obvious with large hernias
- Depending on size > Acute GI signs – think incarcerated viscera
- Look for other congenital defects!
umbilical hernia - treatment for a simple hernia
- May close spontaneously < 6 months
- Skin incision over hernia
- Return contents (usually just fat)
- Debride edges and suture
- Delay until time of spay or neuter
umbilical hernia - treatment for a complicated hernia
- If GI signs related to hernia, consider early intervention
- Full exploratory
- Check intestinal viability
- Close hernia at time of abdominal closure
Inguinal Hernia
- prevalence vs umbilical
- what is it?
- etiology? who gets it?
- Less common than umbilical
- Defect in inguinal ring allows organs to herniate
<><> - Congenital > male dogs
<><> - Acquired (most common) > Middle, aged, intact bitches (Toy breeds and Shar Pei)
> Herniated uterus could occur at time of pregnancy
Inguinal Hernia Clinical signs, diagnosis
o Painless, bi- or unilateral inguinal mass; >left vs right
o Incarceration: vomiting, painful to touch, febrile
o Suspected on historic and physical exam findings, confirmed by manual reduction of hernia and palpation of hernia ring
inguinal hernia surgical treatment
- Ventral midline incision (or right over hernia if prepuce is in the way) to allow for inspection of both inguinal rings (other ring will likely be affected as well)
-Allow for access to abdominal cavity for complicated hernias - Ensure vessels and nerve exiting inguinal ring not constricted!!
<><><>
o Amputate and close sac with PDS, or push back in > when closing ensure vessels and nerves exiting the inguinal ring aren’t constricted (do not completely tie off, must leave space)!
inguinal hernia repair prognosis? post-op instructions?
- Prognosis is very good for uncomplicated hernias with surgical intervention
- Post-operative exercise restriction
Diaphragmatic Hernia (DH)
- etiology
- character of the hernia
- Most commonly traumatic (~85%), rarely congenital
- Caused by a sudden increase in intra-abdominal pressure, usually due to trauma
o Herniation of viscera immediate
o No hernial sac
o Adhesions of organs can occur with chronicity (makes repair challenging)
Diaphragmatic Hernia -Clinical Signs
- There is a wide range of presenting signs, from no clinical signs to respiratory distress
<><> - In chronic diaphragmatic hernias, see acute to chronic GI signs, such as anorexia/vomiting
- as just a regular family pet thats not working too hard, they may not even show that many signs even with a quite bad hernia
diaphragmatic hernia diagnosis
Diagnosis via thoracic/abdominal radiographs +/- contrast study
o Will see hollow, viscous structures in the thorax and no diaphragm silhouette
o Can also use thoracic ultrasound or CT
