Hernias Flashcards
hernia
defect in the wall of a body cavity that allows protrusion of an organ
named by location of the defect
external hernias
defects in the external body wall
internal hernias
defects in the internal diaphragm
causes of hernias
- congenital
- acquired/degenerative
- traumatic
- incisional (postoperative)
reasons to treat a hernia
- pain
- damage to viscera
- risk of incarceration, strangulation, necrosis of herniated viscera
- adhesion formation
what are the 3 Rs of hernia treatment
reduction
repair
recurrence
reduction
reposition the herniated contents into normal anatomic location and inspect for damage
repair
closing the defect
requires knowledge of normal anatomy
recurrence
prevent recurrence by using good surgical technique
want a strong repair with appropriate materials and lack of tension
biologic repair
using native tissues without foreign material (except suture)
maximizes blood supply and minimizes risk of infection
synthetic repair
using polypropylene mesh sutured into the defect to prevent recurrence
used when native tissues are not adequate/viable for reconstruction
increases risk of SSI
what type of closure is used for hernia repair
slowly absorbable or nonabsorbable monofilament
PDS or nylon/prolene
causes of umbilical hernias
congenital and/or heritable
usually seen in young patients
how to diagnose an umbilical hernia
soft ventral abdominal mass at umbilical scar
repair for an umbilical hernia
+/- requires surgical repair depending on size
reduce contents and appose abdominal wall margins
cause of incisional hernias
dehiscence of previous surgical wound
can occur anywhere there has been surgical invasion
what layer fails to cause an incisional hernia
ventral sheath of the linea alba
internal vs external incisional hernia
internal: skin incision remains intact
external: skin incision also dehisces causing extravasation of viscera
cause of traumatic hernia
blunt trauma to caudal abdominal wall or paracostal area
diagnosis of traumatic hernias
radiographs - ID discontinuity of abdominal or thoracic wall
causes of inguinal hernias
congenital
traumatic
degenerative
viscera herniates through the internal and external inguinal rings
repair of inguinal hernia
celiotomy +/- over the hernial sac
enter ventral midline and pull contents back through the suture down canal
must leave enough room for normal structures to pass through
use 1-2 non absorbable sutures in the muscle
what are the openings into the diaphragm
- caval foramen
- esophageal hiatus
- aortic hiatus
- central tendon
cause of diaphragmatic hernias
blunt trauma w/ the glottis open –> generates pressure gradient between the chest and abdomen
most ruptures occur in costal muscles
types of tears in the costal muscles
radial tears: most common, tears occur along the fibers of the costal muscles
circumferential tears: avulsion of the muscle from the body wall
diagnosis of diaphragmatic hernia
thoracic radiographs or ultrasound
clinical signs may be present or absent
what radiographic sign indicates emergent surgery
gas filled viscera
will cause necrosis of the viscera
repair of the diaphragmatic hernia
ventral midline celiotomy
- retract abdominal viscera back into abdomen
- inspect herniated viscera
- primary closure of defect
what suture type should be used to repair diaphragmatic hernia
2-0 to 3-0 slowly absorbable or non absorbable suture
do NOT trim edges of the hernia - want greater holding ability of scar tissue
- may require mesh closure if primary is not possible
what is a primary postoperative concern after a diaphragmatic hernia repair
thoracic drainage
- patient MUST be on a ventilator during surgery due to open connection of thorax and abdomen
- need to remove all air from thorax before closing
cause of pericardio-peritoneal diaphragmatic hernia
failure of embryological fusion of ventral diaphragm
- causes communication between the peritoneal and pericardial sac WITHOUT entering the thorax
most common in CATS
diagnosis of PPDH
thoracic radiographs or US
clinical signs are nonspecific
repair of PPDH
surgical repair is controversial - many PPDHs are incidental and asymptomatic
cause of perineal hernias
congenital
acquired/degenerative
causes pelvic +/- some abdominal organs to pass into the sac
occurs most commonly in uncastrated male dogs
diagnosis of perineal hernia
PE - rectal palpation
abdominal radiographs
US
CS: straining to defecate
repair of perineal hernias
requires surgical repair
- elevation of the internal obturator to create a flap
- may need a mesh repair
medical management is unsuccessful
