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Hernias Flashcards

1
Q

5 different types of abdominal hernias classified by anatomical site

A
  1. Umbilical
  2. Ventral midline (incisional)
  3. Lateral abdominal
  4. Diaphragmatic (internal abdominal)
  5. Caudal abdominal (inguinal
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2
Q

3 categories of hernia

A

Reducible

Incarcerated (non-reducible)

Strangulated

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3
Q

3 anatomical portions of a hernia:

A

Ring, sac, and contents

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4
Q

Describe a True vs a False Hernia

A

True hernia = opening through normal aperture containing a complete peritoneal sac = INDIRECT hernias

False - do not contain a complaete peritoneal sac, usually created by trauma or after breakdown of surgical entry = DIRECT hernias

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5
Q

Two different epidemiologies of hernias:

A

congenital or aquired

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6
Q

T/F: A true hernia is an indirect hernia without a complete peritoneal sac.

A

F, it has a complete peritoneal sac

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7
Q

What term is preferred over “direct” hernia in a horse?

A

Inguinal rupture.

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8
Q

Most commontype of inguinal hernia in horses?

Most common type of hernia in general?

A

Indirect (true) inguinal hernia

Umbilical hernia

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9
Q 
Equine breed dispositions for inguinal hernias
1.
2.
3.
4.
A

Draft breeds
American saddlebreds
Standardbreds
Andalusians

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10
Q

Inguinal hernias are (common/rare) in geldings?

A

rare

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11
Q

Congenital Inguinal Hernias:

1 usually (unilateral/bilateral)?

2 (young/old) affected?

3 Typical end result?

A
  1. unilateral
  2. young - colts.
  3. resolve spontaneously around 3-6 months
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12
Q

Treatment for Congenital inguinal Hernia?

A

Confine to box stall, instruct owner to reduce it several times a day.

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13
Q

Ruptured inguinal hernia:

Occurs when?

3 common signs?

A

4-48 hours after birth in foals

Intermittent colic, depression, severe scrotal/preputial swelling

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14
Q

Adult vs Foal Inguinal Hernia

Adults are usually:

  1. (acquired/congenital)?
  2. (reducible/non-reducible)?
  3. CS: (painful/non-painful?
A
  1. acquired
  2. non-reducible
  3. painful = mild-severe colic
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15
Q

Adult vs Foal Inguinal Hernia:

Foals:
1 (acquired/congenital)?
2. (reducible/non-reducible)?
3. (painful/non-painful)?

A
  1. congenital
  2. reducible
  3. Non-painful
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16
Q

DDX for inguinal hernias in stallions

1.
2.
3.
4.
5.
A
  1. testicular thrombosis
  2. Seroma or hematoma of the scrotum
  3. Neoplasia
  4. Spermatic cord torsion
  5. orchitis
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17
Q

Clinical signs of inguinal hernia

  1. Scrotum appearance?
  2. Testicle palpation reveals…
A
  1. swollen

2. often cool d/t vascular compromise

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18
Q

Inguinal Hernia - Type/Contents:

Most commonly what parts of the intestines?

A

distal jejunum and ileum

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19
Q

Inguinal Hernia - Type/Contents:

Equine inguinal hernias are usually (true/false) hernias?

A

True (or indirect)

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20
Q

Inguinal Hernia - Type/Contents:

Contents pass through ______ into ____-

A

vaginal ring into vaginal tunic

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21
Q

Inguinal Hernia - Type/Contents:

Size of external inguinal ring (is/is not) relevant to development of inguinal hernia?

A

IS NOT

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22
Q

When is surgical intervention appropriate for congenital inguinal hernia?
1.
2.
3.

A
  1. Failure to resolve on it’s own

2 . Enlargement

  1. Rent in vaginal sac has allowed escape into SQ tissue
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23
Q

surgical intervention for acquired inguinal hernia/inguinal rupture/non-reducible hernia?

  1. Usually ______ required
  2. % survival rate?
A
  1. emergency surgery required

2. 76%

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24
Q

Surgical intervention in Congenital Inguinal Hernia:

.What approach is recommended?

A

inguinal approach

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25
Q

Surgical intervention in Congenital Inguinal Hernia:

First step is to expose _______ and remove _____

A

expose tunic and contents, and remove the cremaster muscle.

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26
Q

Surgical intervention in Congenital Inguinal Hernia:

After removing the cremaster muscle, what do you do?

A

Twist the testicle and tunic to force contents back to abdomen.

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27
Q

Surgical intervention in Congenital Inguinal Hernia:

Suture closing pattern?

A

Close castration with transfixation ligature using 0 PDS, than close external inguinal ring

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28
Q

Surgical Management of inguinal hernia - Open Approach

What position should animal be in? Anesthetics y/n?

A

Dorsal recumbancy under general anesthesia

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29
Q

Surgical Management of inguinal hernia - Open Approach

Incision location?

A

over superficial inguinal ring

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30
Q

Surgical Management of inguinal hernia - Open Approach

Transect ______, then…..

A

Transect scrotal ligament, than milk intestinal contents back into abdomen

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31
Q

Surgical Management after Reduction of Intestinal Contents:

Three things you must do?

A
  1. Ligate spermatic cord and emasculate to prevent reherniation
  2. Close superficial inguinal ring with absorbable monofilament in simple continous or interrupted pattern
  3. +/- closure of SQ or skin!
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32
Q

Surgical management of inguinal hernia via laparoscope:

  1. Use laproscopic instruments to….
  2. Do what with the testis?
  3. Close the ____, using….
A
  1. reduce intestinal contents.
  2. ligate and remove them
  3. deep inguinal ring using laparoscopic stapling devices or sutures
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33
Q

Laparoscopic Herniorraphy as tx for Inguinal Hernia:

Advantages:
1.
2.
3.

A
  1. Faster
  2. Minimal post-op swelling
  3. rapid return to normal activity
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34
Q

3 techniques that can preserve viable testis during inguinal hernia treatment

1.
2.
3.

A
  1. Partial suturing of cranial aspect of superficial inguinal ring
  2. Laparoscopic inguinal herniorrhaphy
  3. Peritoneal flap hernioplasty
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35
Q

Describe the peritoneal flap hernioplasty procedure to preserve viable testis during treatment of inguinal hernia

A

Transect peritoneum ventrolateral to vaginal ring on 3 sides,
elevate and transpose over the vaginal ring,
attach dorsomedially and laterally to abdominal wall.

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36
Q

Treatment of Acquired Inguinal Hernia

1st thing to do?

A

Give IV fluids to stabilize if animal is in shock.

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37
Q

Treatment of Acquired Inguinal Hernia

Sites to prep for surgery?

A

Inguinal region AND ventral abdomen**

38
Q

Treatment of Acquired Inguinal Hernia

Incise over…

A

Superficial inguinal ring

39
Q

Treatment of Acquired Inguinal Hernia

After incision, open ____ to expose herniated contents and testis

A

Vaginal sac.

40
Q

Treatment of Acquired Inguinal Hernia

After opening vaginal sac….

A

dilate vaginal ring and apply traction to intestine through celiotomy

41
Q

Treatment of Acquired Inguinal Hernia

After dilating the vaginal ring and apply traction to intestines….

A

R/A of non-viable intestine and removal of affected testis

42
Q

Methods to prevent reherniation after treating acquired inguinal hernia?

1.
additionally:
2.
3.

A

1 ligating spermatic cord during castration

  1. pack inguinal cavity with gauze for 24-48 hours post-op
  2. Superficial ring closed using heavy absorbable suture
43
Q

Indirect Inguinal Hernia in Cattle:

  1. Age affected?
  2. Side affected?
A

Mature bulls

Left side

44
Q

Indirect Inguinal Hernia in Cattle:

More common in beef or dairy breeds?

A

Beef, especially hereford

45
Q

Indirect Inguinal Hernia in Cattle:

Usually (acute/chronic) in cattle, and leads to:

A

chronic,

decreased semen quality

46
Q

Indirect Inguinal Hernia in Cattle:

Strangulation (rare/common)?

A

rare, but it does occur

47
Q

Indirect Inguinal Hernia in Cattle:

Best way to Dx?

A

Rectal palpation

48
Q

Direct Inguinal Hernia in Cattle:

  1. (Congenital/acquired)?
  2. side predilection?
  3. Tx?
A
  1. Acquired - Traumatic
  2. None
  3. Immediate surgery with medical stabilization
49
Q

Which type of hernia in cattle has an “hourglass” appearance associated with it?

A

Indirect Inguinal Hernias

50
Q

Repair of congenital inguinal hernia in cattle is not recommended unless…

A

Unless bilateral castration is performed

51
Q

DDx for Scrotal Swelling in Bulls

1.
2.
3.
4.
5.
6.
7.
A
  1. Scrotal / Inguinal hernia
  2. Fat
  3. Abscessation
  4. Hydrocele
  5. Orchitis
  6. Hematoma
  7. Mass
52
Q

Surgical Intervention for Inguinal Hernias in Cattle:

  1. what position should they be in?
A

Lateral recumbancy

53
Q

Surgical Intervention for Inguinal Hernias in Cattle:

___ approach over _____

A

Direct approach over superficial inguinal ring

54
Q

Umbilical hernias in Horses:

Most common epidemiology?

A

Congenital

55
Q

Strangulated Umbilical Hernia:

(common/rare)?

(non-reducible/reducible)?

(non-painful/painful)?

(does/does not) have associated colic?

A

Rare

Non-reducible

Painful on palpation

Does

56
Q

Parietal (Richter) Hernia

What is it? When do you suspect it?

A

Antimesenteric wall of ileum is incarcerated

Suspect when hernia becomes firm, non-reducible and painful.

57
Q

Etiologies of Umbilical Hernias

1.
2.
3.

A
  1. Trauma to umbilical cord during birth
  2. Excessive straining
  3. Umbilical cord infection
58
Q

Umbilical Hernia Etiology

  1. Usually (acute/chronic), (small/large) defects.
  2. Potential site of _____
  3. What percent of umbilical hernias require emergency surgery?
A
  1. chronic, small
  2. bowel incarceration
  3. 8-10%
59
Q

Diagnosis of Umbilical Hernia:

2.

A
  1. Digital Palpation

2. U/S

60
Q

Diagnosis of Umbilical Hernia via palpation

Good prognosis if…

Bad prognosis if….

A

Firm/thickened hernia ring

Thin/indistinct hernia ring

61
Q

Possible contents of an umbilical hernia:

1.
2.
3.

A
  1. Subperitoneal fat
  2. Omentum
  3. Viscera - ileum or small intestine
62
Q

T/F: Umbilical hernias are almost always reducible

63
Q

Differential Diagnosis for Umbilical Hernia:

1.
2.

A
  1. Umbilical abscessation

2. Local infection of umbilical structures with concomitant swelling

64
Q

Describe the kind of umbilical hernias in horses should you treat conservatively?

Why is it ok to treat these conservatively?

A

hernias < 5cm in diameter and are reducible

they usually close spontaneously as the foal matures

65
Q

Umbilical Hernia - Surgical Treatment:

When to perform?
1.
2.
3.

A
  1. Not spontaneously resolving by 4 mos of age
  2. Hernia > 10 cm diameter
  3. Increased risk of strangulation
66
Q

Surgical treatment of umbilical hernia in foals:

  1. DO NOT USE _____
  2. ______ is reccomended
A
  1. Hernia clamp

2. Direct surgical repair

67
Q

Surgical treatment of umbilical hernia in foals:

What position should they be in?

A

Dorsal Recumbency

68
Q

Surgical treatment of umbilical hernia in foals:

Incision?

A

Make elliptical incision around hernia, removing skin and loose SQ. Sharp dissection to expose rectus abdominal m.

69
Q

Surgical treatment of umbilical hernia in foals:

What are you doing if it’s a closed procedure?

A

Inverting hernial sac and repairing hernia.

70
Q

Open surgery method for treatment of umbilical hernia in foals:

  1. Incise….
  2. caution with…
A
  1. hernial sac along edge of ring

2. umbilical remnants

71
Q

Open surgery method for treatment of umbilical hernia in foals:

How do you close the body wall?

A

simple continous pattern with absorbable suture

72
Q

Strangulated Umbilical herniorrhapy

  1. ____ approach (cranial/caudal) to ring.
A

celiotomy

cranial

73
Q

Stragulated Umbilical herniorrhapy

What are you doing to the lesion?

May require…

A

En block resection

R&A

74
Q

Umbilical hernia in foals: Aftercare

1.

2.

A
  1. Abdominal support bandage for 48 hours to reduce edema and decrease dead space
  2. Confine to box stall 30-45 days
75
Q

5 categories of Umbilical Hernias in Calves

1.
2.
3.
4.
5.
A
  1. Uncomplicated hernias
  2. Hernias with SQ infection/abscessation
  3. Hernias with infection of umbilical remnant
  4. Umbilical abscesses/chronic omphalitis
  5. Urachal cysts/ruptures
76
Q

Most common birth defect in cattle?

A

Uncomplicated umbilical hernias

77
Q

Uncomplicated Umbilical Hernia - Calves

Most common in (beef/dairy) breeds?

What breed specifically?

A

Dairy

Holstein-Friesian

78
Q

Uncomplicated Umbilical Hernia - Calves

Hernial sac most commonly contains ____

79
Q

Uncomplicated Umbilical Hernia - Calves

Excellent prognosis for….

Decreased prognosis if….

A

simple hernia repair

infected umbilical remnants

80
Q

Umbilical Abscess in Calves

CxS similar to hernia because…

A

Umbilical area is enlarged.

81
Q

Umbilical Abscess in Calves

How would you confirm that it’s a hernia and not an abscess?

A

Visual inspection, palpation, presence of hernial ring with reducibility of contents, U/S

82
Q

When to conservatively treat uncomplicated hernias in Calves:

1.
2.
3.

A

1 < 5 cm

  1. Reducible
  2. No hx or evidence of infection
83
Q

Options for conservative treatment of uncomplicated hernias in calves

1.
2.
3.

A
  1. hernial clamps
  2. elastrator bands
  3. abdominal support bandages
84
Q

Umbilical infection in calves:

  1. (common/rare)?
  2. ID via….
A
  1. common

2. Via Palpation. Hernia will be reducibile dorsally. Infection will be a non-reducibile ventral mass adhered to skin.

85
Q

Treatment of choice for umbilical infections in calves

A

Surgical removal of infection with herniorrhaphy

86
Q

Pre-op management of Umbilical infections:

1.
2.
3.

A
  1. Culture/sensitivity
  2. Drain any large abscess
  3. Antibiotics (penicillin)
87
Q

Post-Op complications of herniorrhaphy:

  1. More common in (foals/calves)?
  2. (foals/calves) more commonly have concurrent infections
A

Calves

Calves

88
Q

Incision complications from Herniorrhaphy

1.
2.
3.

A
  1. Abscess
  2. Seroma/hematoma
  3. Dehiscence
89
Q

Umbilical infection in calves:

Treatment method?

A

Open herniorrhaphy

90
Q

Umbilical infection in calves:

Most commonly infected remnant?

91
Q

Herniorrhaphy as Tx for Umbilical infection in calves

Three main Steps:

A
  1. Ligate umbilical aa and v
  2. remove apex of urinary bladder
  3. complete herniorrhaphy routinely

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