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RUSVM Small Animal Surgery 1 > Hernia > Flashcards

Hernia Flashcards

1
Q

What is a hernia?

A

Protrusion of a tissue/ organ through a defect in the wall of of the anatomical cavity

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2
Q

True vs false hernia?

A

True: anatomical hernial sac

False: lacks hernial sac —> traumatic hernias are initially false hernias

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3
Q

What makes a complicated hernia?

A

Strangulation

Obstruction

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4
Q

What is a incarcerated and strangulated hernia?

A

Strangulation = Blood supply compromised leading to ischemia and potentially necrosis.

—> incarceration between two tissue planes

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5
Q

How does loss of domain lead to hernia?

A

Normal location of tissues is to small to accommodate contents —> compartment syndrome

Chronic hernia, especially diaphragmatic

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6
Q

What are the internal hernias?

A

Diaphragmatic
Hiatal
Mesenteric
Intercostal

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7
Q

What are the external hernias?

A 
Paracostal 
Ventral 
Inguinal 
Femoral 
Prepubic 
Intercostal
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8
Q

What are the 4 principles of herniorraphy?

A

Return contents to normal location
Secure ring closure
Tension free closure
Utilize patient tissues

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9
Q

What type of suture should you use if your patient has a recurrent hernia or has an underlying disease like diabetes or cushings?

A

Non-absorbable

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10
Q

How can true hernias be treated?

A

Open —> hernial sac incised and removed, freshening edges by removing the hernial ring is NOT necessary and avoided if possible

Closed —> invert sac and contents without opening the hernial sac

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11
Q

What are causes of abdominal hernias?

A

Congenital
Developmental
Traumatic
Incisional

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12
Q

T/F: umbilical hernias may close spontaneously up to 6 months

A

True

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13
Q

How do umbilical hernias develop?

A

Failure of fusion of rectus abdominis muscle at umbilicus

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14
Q

Breeds predisposed to umbilical hernias?

A

Airedales, Pekingese, basenji, pointers, Weimaraner

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15
Q

Clinical signs of umbilical hernias?

A

Soft round mass at umbilical scar

Often reducible
If viscera is entrapped, may be hard and painful (will often have GIT signs if obstructed)

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16
Q

How do we treat a small (<3mm) or large (>2.5cm) umbilical hernia??

A

Little risk of strangulation
Treat conservatively
Patient <6months may close spontaneously

Repair during elective procedures

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17
Q

T/F: if you have an umbilical hernial the size of a finger you can treat this conservatively and only repair surgical during elective procedures

A

False

— this tissue is at increased risk for strangulation, do not wait to repair

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18
Q

You are going to correct a umbilical hernia in a dog during a spay.. how would you do this?

A

Incision extended cranially over hernial (or can make elliptical incision over hernia

If incarcerated—> enlarge ring and dissect sac free and them examine contents

Dissect sac and ever into abdomen (closed) or ligate sac at next and transection (open)

DO not freshen edges —> routine closure

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19
Q

Breed predisposed to inguinal hernias?

A 
Basenji
Basset hound
Carin terrier 
Cavalier King Charles 
Chihuahua 
Cocker spaniel 
Dachshund 
Maltese 
Pekingese 
Poodle 
Pomeranian 
West highland white terrier
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20
Q

What are the multifactorial causes of an inguinal hernia?

A

Genetic
Obesity
Trauma
Estrogen - estrus/pregnancy

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21
Q

What is a direct inguinal hernia?

A

Occurs through inguinal musculature

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22
Q

What is an indirect hernia?

A

Occurs through vaginal ring (scrotal hernia)

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23
Q

What is the surgical approach for an inguinal hernia?

A

Female - ventral midline (can correct both sides)

Male - inguinal approach directly over hernia

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24
Q

What structures must you make sure to preserve when closing inguinal rings ?

A

Pudendal artery and vein

Genitofemoral nerve

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25
Q

Major complications of inguinal hernia surgery?

A

Seroma/hematoma

26
Q

Scrotal hernias are usually seen in what age dogs?

A

Young <2yrs

—> weakness of vaginal ring orifice

27
Q

T/f: cryptorchidism predisposes animals to scrotal hernias

A

True

28
Q

Presentation of scrotal hernia?

A

Usually unilateral
Painful swelling
Risk of strangulation

29
Q

How can you surgically repair scrotal hernia?

A

Incision over ring
Reduce contents and closure ring

Castrate —> facilitate repair and decrease recurrence

30
Q

Most common hernia associated with HBC trauma?

A

Abdominal hernia

31
Q

Clinical signs of traumatic abdominal hernia?

A

Bulging mass
Asymmetric abdomen
Reducible contents
Palpable ring

32
Q

Treatment of acute abdominal hernia repair?

A

Ventral midline

  • can explore abdomen
  • repair organ injury
  • difficult to reconstruct
  • 2/0 monofilament
  • tension relieving pattern vs continuous pattern (horizontal mattress vs vertical mattress)
33
Q

Treatment of chronic abdominal hernia?

A

Approach over hernia

  • > less likely concurrent injuries
  • > better anatomic closure

Can perform both approaches for exploration and better closure

34
Q

Hernias at the prepubic tendons are usually associated with what pathology that can complicate repair?

A

Pubic/pelvic fractures

35
Q

How will you position your patient when repairing a prepubic tendon hernia?

A

Dorsal recumbency with hindlegs in frog leg position with pelvis raised on towels

36
Q

How can you surgically repair prepubic tendon hernias?

A

Prepubic tendon attaches rectus abdominals to pubis

Reattach the free edge of the abdominal wall to the cranial pubic ligament with a simple interrupted crutiate/mattress (non-absorbable)

Can use a mesh if large defect

37
Q

What is an acute vs chronic incisional hernia?

A

Acute -> Hernia that occurs through a surgery site within 7 days of surgery

Chronic —> weeks/months/years later

38
Q

What are risk factors for incisional hernias?

A 
Inappropriate surgical technique 
Altered tissue strength 
Suture failure 
Patient condition 
Poor owner compliance
39
Q

Diagnosis of incisional hernias?

A 
Exaggerated swelling 
Serosanguinous discharge 
Reducible 
Radiographs 
US
40
Q

DDX for incisional hernia?

A

Hematoma/seroma

Abscess

41
Q

Treatment for incisional hernia?

A

Determine underlying factor

Approach original incision
Culture if open
Anatomic closure

Long lasting suture
Repair evicerated tissue

42
Q

What hernia results from weakness and separation of the pelvic diaphragm components?

A

Perineal hernia

43
Q

What organs could be herniated in the perinum?

A

Prostate, bladder, intestine

44
Q

What anatomy makes up the perineal diaphragm ?

A

External anal sphincter/rectum

Sarcotuberous ligament

Levator ani and coccygeous m

Ischial arch/internal obturator m

Prudendal artery, vein and nerve

45
Q

What are the types of perineal hernias?

A
  1. Lateral—> between coccygeus and sarcotuberous ligament
  2. Dorsal —> between coccygeus/levator ani
  3. Caudal (most common) —> between levator ani, external anal sphincter and internal obturator
  4. Ventral (sciatic) -> blubo/ischio muscles
46
Q

Signalment for perineal hernia?

A

Older intact males
7-9yrs

Pekingese, boston terrier, corgi, boxer

Can be uni or bilateral

47
Q

What are predisposing factors for perinal hernias?

A

Shorted tailed dogs -> underdeveloped levator ani and coccygeus m

Hormonal -> intact make dogs more predisposed

Females at less risk -> levator ani is larger, broader, and stronger

Relaxin -> prostatic dz or prostate located near diaphragm

Neurogenic atrophy -> straining from prostatic dz, traction on nerves of sacral plexus
Nerve damage and atrophy of levator ani and coccygeous muscles

Chronic straining —> constipation, cystitis, prostatitis

48
Q

Clinical signs of perineal hernia?

A

Perineal mass — usually non painful and reducible

Tenesmus/Dyschezia
Constipation

Dysuria (bladder retroflexion)

49
Q

What are possible contents of a perineal hernia?

A 
Retroperitoneal fat 
Serous fluid 
Rectus 
Prostate 
Urinary bladder 
Small intestine
50
Q

Diagnosis of a perineal hernia?

A

Rectal palpation -> finger pass through into rectal dilation

Radiographs —> prostate size, bladder disposition, contrast study

US-> hernial contents

51
Q

When would you consider medical management for perineal hernia?

A

Only in patients where health status prevents general anesthesia

Stool softeners —> lactulose, psyllium
Fecal evaluation
High fiber/high moisture diet

52
Q

What is treatment of choice for perineal hernias?

A

Surgery
Internal obturator muscle transposition (most commonly and most successful procedure)

Others: 
Traditional herniorraphy 
Superficial gluteal muscle transposition 
Semitendinosisus muscle transposition 
Various prosthetic implants
53
Q

What do you do for surgical preparation in a perineal hernia case?

A 
Prep 
-CBC, chem, U/A 
Fast the night before 
No enema within 24hrs of surgery (liquid fecal contamination) 
Perioperative antibiotics 
Remove fecal material from rectum 
Express anal glands 
Hang legs over padded elevated table 
Secure tail 
Gauze in rectum 
Purse string suture
54
Q

How will you do a traditional herniorraphy in in a perinal hernia case?

A

Approach over hernia lateral to anus

From tail base to ischial tuberosity

Open sac and replace contents

Reconstruct pelvic diaphragm
—> use levator ani and coccygeus (often atrophied)
—> sarcotuberous ligament (suture through)
—> preplace all sutures

Avoid rectal wall, sciatic nerve, and gluteal and pudendal (artery, vein and nerve)

55
Q

How do you perform an internal obturator muscle transposition ?

A

Reduce tension
Adds blood supply

Incise cd/lat border
No farther than cd obturator foramen
Periosteal elevator dorsally and medially

Suture to coccygeus, EAS, and ST ligament

56
Q

What pexy procedures can help minimize perinal hernial content?

A

Cool pexy
Cystopexy
Ductus deferopexy

57
Q

Post op care for perinal hernia repair?

A

Perform rectal exam while under anesthesia —» assess repair, assess opposite side if unilateral repair

Pain management
Continue medial management for 4-6weeks

58
Q

Common complications with perineal hernia repair?

A 
Infection/abscess
Fecal incontinence (injury to pudendal or caudal rectal nerve)

Sciatic nerve injury

Urinary dysfuntion —>. Muscle/nerve damage from bladder herniation

Tenesmus —> structures through rectal wall

59
Q

What is the prognosis of perinal hernia?

A

Recurrence fro 0-70%

  • > surgeon experiance
  • > previous repair
  • > suture type
  • > poor local tissue strength
  • > amount of tension
  • > castration
60
Q

Predisposition to perineal hernia in cats?

A

Megacolon
Perineal mass
Colitis

—> 95% are bilateral
Only 22% have perineal swelling

RARE in cat

RUSVM Small Animal Surgery 1 (39 decks)

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