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SA DX & TX I > Final Exam - Hernias > Flashcards

Final Exam - Hernias Flashcards

1
Q

what is an abdominal hernia?

A

any defect in the external abdominal wall that may allow protrusion of the abdominal contents

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2
Q

what is a congenital hernia?

A

defect that is present at birth although they may not herniate until later

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3
Q

what is an acquired hernia?

A

defect secondary to a primary cause such as trauma, surgery, & degeneration

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4
Q

what is an internal hernia?

A

hernia that is within the body cavity, diaphragmatic

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5
Q

what is an external hernia?

A

body wall herniation

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6
Q

in regards to hernia definitions, what is a ring?

A

the actual defect

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7
Q

in regards to hernia definitions, what is contents?

A

the organs & the tissues in the hernia

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8
Q

in regards to hernia definitions, what is a sac?

A

the tissue holding the contents - may or may not be present

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9
Q

in regards to hernia definitions, what is a true hernia?

A

mesothelium lines the sac of the hernia

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10
Q

in regards to hernia definitions, what is a false hernia?

A

no mesothelium lining, so there is no sac - acute or acquired & more at risk for adhesions

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11
Q

in regards to hernia definitions, what is a reducible hernia?

A

free to move in & out of sac

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12
Q

in regards to hernia definitions, what is an incarcerated hernia?

A

hernia that has contents stuck in the sac - non-reducible

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13
Q

in regards to hernia definitions, what is a strangulated hernia?

A

hernia with obstruction of blood supply that leads to necrosis - emergency

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14
Q

what are some clinical signs of hernias?

A

a bulge from the body wall that shouldn’t be there that may or may not be painful (strangulation of contents causes pain)

dysfunction of entrapped organs

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15
Q

how are hernias diagnosed?

A

rads, ultrasound, palpation, auscultation, & exploration

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16
Q

what is the general surgical treatment for hernias?

A

use an abdominal approach for traumatic hernias - return viable contents to normal position & remove non-viable contents (do not untwist!)

remove the hernia sac & close the ring using the patient’s own tissue working to minimize tension - can use mesh or autologous graft

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17
Q

what are some complications of hernia surgery?

A

recurrence, too much tension, poor closure, inadequate tissue, primary cause still present, & infection

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18
Q

what is the pathophysiology of hernias?

A

loss of abdominal domain *

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19
Q

what does the success/prognosis of a patient with a hernia depend on?

A

severity of functional alterations, cause of hernia, location of hernia, & contents of hernia

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20
Q

what are the 3 categories given for pathophysiology of hernias?

A
  1. space occupying - diaphragmatic
  2. obstruction - normal function altered, luminal obstruction (bladder, intestines, uterus)
  3. strangulation - decreased blood supply leading to necrosis
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21
Q

where do ventral hernias occur? what generally causes them?

A

occur on or adjacent to midline - traumatic or congenital

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22
Q

what is the most common abdominal hernia?

A

umbilical hernia

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23
Q

what causes an umbilical hernia?

A

inherited

results from failure of the umbilical ring to close completely - may be associated with other congenital defects such as cryptorchidism

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24
Q

how should you position an animal with a suspected umbilical hernia for palpation & reduction?

A

dorsal recumbency

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25
Q

when can you use conservative treatment for an umbilical hernia?

A

small hernias in young dogs - may close up to 6 months of age

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26
Q

when do you need to use surgery for an umbilical hernia?

A

if the hernia is large enough for a loop of intestine to pass through it - about 1 cm

resect & invert hernial sac

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27
Q

when is umbilical hernia repair typically performed? what suture & pattern is used?

A

on an elective basis concurrently with an OHE

monofilament in simple interrupted appositional or tension relieving pattern - can use synthetic mesh or releasing incisions on large defects if needed

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28
Q

what is an example of a cause of an anatomic inguinal hernia?

A

inguinal canal is larger & shorter in females

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29
Q

what is an example of a hormonal cause of an inguinal hernia?

A

estrogen may enlarge & weaken the inguinal rings

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30
Q

what is an example of a metabolic cause of an inguinal hernia?

A

obesity

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31
Q

what type of inguinal hernia is more common, direct or indirect?

A

indirect

32
Q

what is the difference between a direct & indirect inguinal hernia?

A

direct inguinal hernia - shows a bulge from the posterior of the inguinal wall

indirect inguinal hernia - hernia passes through the inguinal canal & into the groin

33
Q

what runs through the inguinal canal?

A

vaginal process/tunic

spermatic cord

genitofemoral nerve

external pudenal artery & vein

34
Q

what is the process of a surgical repair for an inguinal hernia?

A

incision parallel to flank fold or ventral midline - ventral midline allows for evaluation of both rings & avoids dissection of mammary tissue

expose the sac, evaluate contents, reduce contents, ligate & amputate sac, close defect

don’t obstruct vessels with closure at caudomedial aspect of ring

35
Q

what is a scrotal hernia?

A

subcategory of indirect inguinal hernia that affect males where the hernia contents lie within the scrotum - rare

36
Q

T/F: in scrotal hernias, strangulation of contents is common

A

true

37
Q

what is associated with scrotal hernia repair?

A

increased incidence of testicular tumor development - hernia repair should not compromise normal structures

38
Q

what are some potential locations of traumatic hernias?

A

inguinal, prepubic, or paracostal - will occur at the site of the trauma, & there may be multiple sites if the hernias are the result of bite wounds

39
Q

what are some causes of traumatic hernias?

A

HBC, kicked, fell - no mesothelium lined sac

40
Q

what should you do if you have an animal present with a traumatic hernia?

A

look for other injuries - cardiovascular, orthopedic, respiratory, gi, & urinary

41
Q

what is the physiology of a prepubic tendon rupture?

A

avulsion of the prepubic tendon off of the cranial aspect of the pubis usually due to blunt abdominal trauma

42
Q

how is a prepubic tendon rupture corrected surgically?

A

repaired through a ventral midline incision with the rectus abdominis muscle attached to the pubis using polypropylene through predrilled holes in the pubis

43
Q

what is the number one cause of incisional hernias? what are some other causes?

A

technical error

infection, steroids, fat, increased pressure

44
Q

what is an incisional hernia?

A

any factor that increases pressures or weakens the suture line predisposed the incision to herniation

45
Q

how can you reduce the risk of incisional hernias?

A

use appropriate suture material, placement, & post-op care

46
Q

what is the exception where you should take an animal to surgery immediately with a diaphragmatic hernia?

A

if the stomach is in the thorax causing respiratory distress - need to decompress stomach with a needle through the thoracic wall

47
Q

what should you do if you have an animal present with a diaphragmatic hernia?

A

not necessarily an emergency - treat shock & give supplemental oxygen if needed

48
Q

how is a diaphragmatic hernia diagnosed?

A

radiographs - 97% have loss of line of diaphragm, obscured/displaced cardiac silhouette

viscera in the thorax is diagnostic - can also use ultrasound

49
Q

how should the patient be prepped for surgical repair for a diaphragmatic hernia?

A

minimize anesthetic time - surgeon ready in OR & elevate the patient head/thorax during prep/induction/surgery

50
Q

what is the repair procedure for a diaphragmatic hernia?

A

contents are reduced carefully

enlarge diaphragmatic rent if needed incise away from viscera/vessels

intrathoracic liver may be friable

adhesions may present because it is a false hernia

51
Q

what complications may be associated with a diaphragmatic hernia?

A

adhesions, may extend into a thoracotomy (median sternotomy), great vessels are involved, & a partial lung or liver lobectomy may be necessary

52
Q

how should you close an acute diaphragmatic hernia?

A

begin dorsally, proceed ventrally in a continuous suture pattern

evacuate air from the thorax using a chest tube transdiaphragmatically

53
Q

how should you close chronic diaphragmatic hernias?

A

diaphragmatic advancement - circumcostal sutures

patch with omentum, muscle, mesh

freshen edges of rent

may see re-expansion pulmonary edema, so leave air in thorax & remove over 8-12 hours through a chest tube

54
Q

what type of hernia is a PPDH?

A

congenital - affects dogs & cats

55
Q

what is the pathophysiology of PPDH?

A

abnormal development of transverse septum that herniates into the pericardial sac

56
Q

how is PPDH diagnosed?

A

rads

57
Q

what clinical signs may be seen with PPDH?

A

CS specific to any obstruction

can develop at any age

respiratory compromise & cardiac tamponade

58
Q

what are some concurrent abnormalities seen with PPDH?

A

sternal defects

cranial midline abdominal wall hernia, umbilical hernia, cardiac defects, & pulmonary vascular disease

59
Q

what treatment can you do for an asymptomatic PPDH patient?

A

conservative treatment but they will never get more stable

60
Q

what surgery is recommended for a symptomatic PPDH patient?

A

ventral midline celiotomy

61
Q

what causes perineal hernias?

A

weakness & separation of the pelvic diaphragm - dilation/deviation of the rectum & herniation of abdominal organs

62
Q

what is the most common anatomic location of perineal hernias? where is it?

A

caudal - between leviator ani, coccygeus, & external anal sphincter m.

63
Q

where is a sciatic perineal hernia located?

A

between coccygeus m. & sacrotuberous ligament

64
Q

where is a dorsal perineal hernia located?

A

coccygeus & levator ani m.

65
Q

where is a ventral perineal hernia located?

A

between ischiourethralis, bulbocavernosus, & ischiocavernosus m.

66
Q

what clinical sign may be suggestive of a perineal hernia involving the bladder?

A

inability/straining to urinate

bladder retroflexion

67
Q

what is the etiology behind perineal hernias?

A

hormones - intact male dogs

straining to defecate - prostatic disease, cystitis, urinary tract obstruction

68
Q

for abdominal hernias, presentation & diagnosis depends on what?

A

etiology, location, & tissues involved & their status

69
Q

T/F: regardless of etiology, most hernias will present as a subcutaneous swelling or mass with diaphragmatic defects being different

A

true

70
Q

what are some differentials for abdominal hernias?

A

abscess, cellulitis, hematoma, seroma, neoplasia, granuloma, & muscle avulsion

71
Q

what are the basic principles of hernia repairs?

A

excise devitalized tissues

return viable contents to normal location

repair the defect

use the patient’s own tissues when possible

72
Q

what does the prognosis of a patient with a hernia depend on?

A

etiology, patient status (metabolic & concurrent injuries), & status of hernial contents

73
Q

what is a femoral hernia?

A

herniation through the femoral canal - palpate swelling on medial thigh caudomedial to the femoral vessels

74
Q

what can cause a femoral hernia?

A

blunt trauma to the abdomen

75
Q

what should you be careful with in repair of a femoral hernia?

A

avoid compromising nerves & vessels

76
Q

a femoral hernia looks similar to what other hernia type?

A

inguinal hernia

SA DX & TX I (59 decks)

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