Exam III: Hernias and Urolithiasis Flashcards
What are the three openings of the diaphragm from ventral to dorsal?
Caval foramen, esophageal hiatus, aortic hiatus
What are the three different types of diaphragmatic hernias?
- Pleuroperitoneal (DH)
- Peritoneo-pericardial (PPDH)
- Hiatal hernia
What is a common cause of acquired diaphragmatic hernias?
Trauma
What congenital condition can lead to a hiatal hernia?
Upper airway disease
What factors determine whether a diaphragmatic hernia is a surgical emergency?
- Extent of cardiopulmonary dysfunction
- Degree of respiratory compromise
- Presence of organ entrapment
- Response to medical therapy
What can occur if there is a delay in surgery for a diaphragmatic hernia?
Life threatening hypoventilation from compression of the lungs
What are some complications associated with diaphragmatic hernias?
- Re-expansion Pulmonary Edema (cats)
- Recurrence
- Cardiac arrhythmias
- Cardiac Arrest
- Pneumothorax
- Pleural effusion
What is the mortality rate associated with older studies of diaphragmatic hernias?
48%
What muscles make up the pelvic diaphragm?
- External anal sphincter
- Levator ani muscle
- Coccygeus muscle
Where does a perineal hernia usually occur?
Between the levator ani and external sphincter
What is a predisposing factor for perineal hernias in males?
Intact males may have weakness due to relaxin hormone
What conditions can lead to an increased risk of perineal hernias?
Any condition that increases intraabdominal pressure and tenesmus
What is the preferred treatment method for perineal hernias?
Internal Obturator Muscle Transposition
What are common incisional complications associated with perineal hernia surgery?
- Inflammation
- Edema
- Seroma
- Infection
What could happen if sciatic nerve entrapment occurs after perineal hernia surgery?
Extreme pain and additional surgery may be required
What percentage of cases may experience fecal incontinence after bilateral surgery for perineal hernia?
<15%
What additional complications can arise from a perineal hernia?
- Tenesmus
- Rectal prolapse
- Urinary abnormalities
Fill in the blank: The muscles that comprise the pelvic diaphragm are the external anal sphincter, the levator ani muscle, and the _______.
Coccygeus muscle
What are the indications for a cystotomy?
If stones are retropulsed into the bladder
Surgery should be performed from the ventral midline.
When is a urethrotomy indicated?
If you can’t retropulse stones.
In which situation is a urethrostomy indicated?
If you are a cat or have had multiple obstructions and have done a urethrotomy in the past.
What anatomical structure should be dissected to during a urethrostomy in a cat?
Bulbourethral glands.
Describe how to perform retropulsion of urethroliths in a dog.
With a finger in the rectum, occlude the ureter dorsally, flush from the urethra side, then release the rectum finger hold.
What is the preferred location for a urethrostomy in a dog?
Scrotal urethostomy.
What is the preferred location for a urethrostomy in a cat?
Making the urethral opening bigger and dissecting to the level of the bulbourethral glands.
What are the basic principles behind cystotomy?
Caudal midline approach, four stay sutures, pack for urine contamination, visualize the entire bladder, perform retrograde and normograde flush of urethra, close full thickness.
What is the holding layer when closing a cystotomy?
Submucosa.
What is the most common complication associated with cystotomy?
Superficial incisional complications (4%).
What is the complication rate for uroabdomen due to suture failure?
<1.5%.
What percentage of cases experience self-resolving hematuria & dysuria after cystotomy?
37-50%.
What is the complication rate for incomplete urolith removal?
14-20%.
What should be done if there is incomplete urolith removal?
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