Hernia Surgery

Question 1

Hernia

Answer 1

Protrusion of contents through a defect in the wall of the cavity in which it normally lies

Question 2

What type hernia has no sac?

Answer 2

Traumatic Hernia

False Hernia

Question 3

What Hernia has a sac?

Answer 3

True Hernia

Congenital Hernia

Question 4

Congenital Hernia

Answer 4

Defect already present at birth but herniation may not occur until later

Question 5

What are the types of Acquired Hernias?

Answer 5

Degenerative
Traumatic
Iatrogenic (surgery)

Question 6

What are the locations of Abdominal Hernias?

Answer 6

Paracostal
Dorsal lateral 
Inguinal 
Cranial pubic ligament 
Femoral 
Umbilical 
Ventral 
Scrotal

Question 7

Reducible

Answer 7

Contents readily manipulated into cavity

Question 8

Incarcerated

Answer 8

contents fixed into abnormal location

usually due to adhesions

Question 9

Strangulated

Answer 9

incarceration obstructs vascular supply

usually surgical emergency

Question 10

What are the principles of Herniorrhaphy?

Answer 10

Ensure viability 
Return viable contents
Obliterate redundant tissue in the sac
Secure closure of defect 
Use patients own tissue when possible

Question 11

What is the most common abdominal hernia?

Answer 11

Umbilical Hernia

Question 12

What are the congenital defects associated with Umbilical Hernia?

Answer 12

Cleft palate
Cryptorchidism 
Cranial abdominal hernia 
Incomplete sternal fusion 
Fucosidosis

Question 13

What are the clinical signs of an Umbilical Hernia?

Answer 13

Soft round mass at umbilical scar
Often reducible
viscera is entrapped and becomes hard and painful

Question 14

What is the treatment for Umbilical Hernia?

Answer 14

Conservative treatment for small or large hernias - Repair during elective surgery

Question 15

Direct Inguinal Hernia

Answer 15

Hernia passes through vaginal process

Question 16

Direct Inguinal Hernia

Answer 16

Hernia passes through inguinal musculature

Question 17

What is the most common form of Inguinal Hernias?

Answer 17

Indirect form

Question 18

Which Inguinal Hernia is less likely to become incarcerated?

Answer 18

Direct Inguinal Hernia

Question 19

Congenital Inguinal Hernia

Answer 19

More common in males less than 2 years old due to a delayed inguinal ring narrowing from late testicular descent

Question 20

Acquired Inguinal Hernia

Answer 20

Common in middle aged overweight intact females due to a shorter or longer inguinal canal and associated with estrogen/estrus

Question 21

What are the clinical signs of Inguinal Hernia?

Answer 21

Painless unilateral or bilateral mass in inguinal area

Unilateral more on the left

Question 22

Describe Traditional Inguinal Hernia Repair

Answer 22

1. Incision over lateral aspect of swelling
2. Extend ring if cannot reduce contents
3. Close ring

Question 23

What is the cause of Scrotal Hernia?

Answer 23

Weakness of vaginal orifice

Question 24

What causes Traumatic Abdominal Hernias?

Answer 24

Hit By Car

Question 25

Clinical signs of Traumatic Abdominal Hernia

Answer 25

Bulging mass Asymmetric abdomen Reducible contents Palpable ring

Question 26

What patterns should you use for Acute Abdominal Hernia Repair?

Answer 26

Cruciate Horizontal mattress Vertical Mattress

Question 27

Describe Prepubic Tendon Rupture Repair

Answer 27

Place the patient with Truncal flexion with rear legs forward Drill holes in the pubis Place Synthetic mesh

Question 28

What suture should you use for Prepubic Tendon Rupture Repair?

Answer 28

Monofilament non-absorbable suture

Question 29

What are predisposing factors for Incisional Hernias?

Answer 29

``` Intra-abdominal pressure: Obesity, Effusions, or pregnancy Entrapped fat Inappropriate suture Infection Steroids delay healing Post op care ```

Question 30

When would you place an interrupted suture pattern in the closure of an Incisional Hernia?

Answer 30

pregnant | immunocompromised

Question 31

How do you tell the difference between a seroma and a hernia?

Answer 31

Seroma will not reduce | Hernia will reduce

Question 32

Perineal Hernia

Answer 32

Weakness and separation of the pelvic diaphragm

Question 33

What are the types of perineal hernias?

Answer 33

Lateral Dorsal Caudal Ventral

Question 34

What is the most common perineal hernia?

Answer 34

Caudal

Question 35

What are the predisposing factors for perineal hernia?

Answer 35

Hormonal influence from intact male Relaxin secreted in patients with prostatic disease Neurogenic atrophy from straining

Question 36

Clinical signs of Perineal Hernia

Answer 36

Perineal swelling Tenesmus Constipation Firm non-reducible painful mass

Question 37

How do you diagnose Perineal Hernia?

Answer 37

Rectal Palpation Radiographs US

Question 38

Medical Management for Perineal Hernia

Answer 38

Stool softeners Periodic fecal evaluation High fiber/high moisture diets

Question 39

When does Perineal Hernia become an emergency?

Answer 39

Irreducible painful discolored swelling Bladder retroflexion Urethral obstruction Azotemia

Question 40

What are the surgical options for Perineal Hernia Repair?

Answer 40

``` Traditional Herniorrhaphy Internal obturator muscle transposition Superficial gluteal muscle transposition Semitendinosus muscle transposition Prosthetic implants ```

Question 41

What do you preform if the surgery for Perineal Hernia Repair fails?

Answer 41

Colopexy Cystopexy Ductus deferopexy

Question 42

What is the post op care for Perineal Hernia surgery?

Answer 42

4-6 weeks of stool softeners | Pain Management

Question 43

What are the complications associated with Perineal Hernia Repair?

Answer 43

``` Infection/Abscess Fecal Incontinence Sciatic injury Urinary dysfunction Tenesmus ```

Question 44

What effects the prognosis for Perineal Hernia Repair?

Answer 44

``` Surgeons experience Previous repairs Suture type Poor local tissue strength Amount of tension Castration ```

Question 45

What are the predisposing factors for Feline Perineal Hernia?

Answer 45

Megacolon Perineal masses Colitis