Hernias Flashcards
What is a hernia?
protrusion of contents through a defect in the wall of the cavity in which it normally lies
What is the difference between a true hernia and a false hernia?
a true hernia has a peritoneal covering or sac
Define reducible in respect to a hernia
contents are readily manipulated back into the cavity
Define incarcerated in respect to a hernia
contents are fixed into abnormal locations
- cannot be reduced
What is the problem when a hernia is strangulated?
incarceration obstructs vascular supply
- usually a surgical emergency
What are the principles of herniorrhaphy?
- ensure tissue viability
- return viable contents
- obliterate redundant tissue in the sac
- secure closure of defect without tension
- use the patient’s own tissue when possible
What is the most common type of abdominal hernia?
umbilical hernias
Describe the clinical signs/presentation of an umbilical hernia
- soft, round mass at the umbilical scar
- often reducible
- if the viscera is trapped, may be hard and painful
How is an umbilical hernia usually managed?
- conservative management
- may close spontaneously in patients < 6 months
- repair during elective period/neuter
- if incarcerated, enlarge ring and dissect sac free
Describe the indirect form of inguinal hernias
- passes through the vaginal process
- called a scrotal hernia in males
Describe the direct form of inguinal hernias
- passes through inguinal musculature
- less common
Describe the congenital form of inguinal hernias
- more common in males
- delayed inguinal ring narrowing from late testicular descent
Describe the acquired form of inguinal hernias
- more common in intact females
- shorter and larger inguinal canal
- estrogen/estrus predisposes
What are the clinical signs/presentation of an inguinal hernia?
- painless mass in inguinal area
- can be unilateral or bilateral
How is an inguinal hernia diagnosed?
- ability to reduce
- if unable to reduce, use imaging
Describe the traditional repair of an inguinal hernia
- incision over the lateral aspect of the swelling
- reduce contents, extend ring if necessary
- close the ring
Which vessels should be avoided in traditional repair of inguinal hernias?
- pudendal artery
- genitofemoral nerve
Describe the features of the ventral midline approach to correcting inguinal hernias
- commonly done in females
- can inspect both sides
- avoids mammary tissue
- perform one layer closure over ring
What is a scrotal hernia?
an indirect inguinal hernia in a male
What are the clinical features of a scrotal hernia?
- painful swelling
- usually unilateral
How is a scrotal hernia usually managed?
- incision over ring, reduce contents, and close ring
- castrate to decrease risk of recurrence
What are the clinical signs of acute traumatic abdominal hernia?
- bulging mass
- asymmetric abdomen
- reducible contents
- palpable ring
How is an acute abdominal hernia repaired?
- ventral midline approach
- explore abdomen and repair any organ injury
- use tension relieving pattern
What approach is usually used for a chronic abdominal hernia repair?
approach over the hernia
How is a patient usually positioned when they have a prepubic tendon rupture?
truncal flexion
rear legs forward
What is an incisional hernia?
acquired hernia from disruption of surgically closed cavity (iatrogenic)
When does an incisional hernia usually occur?
< 7 days post operation
What are the predisposing factors for an incisional hernia?
- intra-abdominal pressure (obesity, effusion, pregnancy)
- fat trapped in closure
- inappropriate suture
- infection
- steroids
- poor post-op care
How is an incisional hernia diagnosed?
- exaggerated swelling
- serosanguinous discharge
- reducible
- radiographs, ultrasound
What are the differentials for incisional hernias?
- hematoma/seroma
- abscess
How does a perineal hernia occur/develop?
- weakness and separation of the pelvic diaphragm components
- allows dilation and rectal deviation
- stretching of rectal tissue
What is the anatomical location of a lateral perineal hernia?
between coccygeus muscle and sarcotuberous ligament
What is the anatomical location of a dorsal perineal hernia?
between the coccygeus muscle and levator ani muscle
What is the anatomical location of a caudal perineal hernia?
between the levator ani, external anal sphincter, and internal obturator muscle
What is the anatomical location of a ventral perineal hernia?
between the bulbocavernosus, ischiocavernosis, and ischiourethralis muscles
Which type of perineal hernia is most common?
caudal perineal hernia
What are the predisposing factors for perineal hernias?
- hormonal influence
- prostatic disease
- relaxin
- neurogenic atrophy
- chronic straining
What are the clinical signs/presentation of a perineal hernia?
- can be asymptomatic
- tenesmus, constipation, perineal swelling
- a firm, non-reducible mass indicates strangulation
- possible bladder retroflexion
How are perineal hernias diagnosed?
- rectal palpation
- radiographs
- ultrasound
When is medical management used for a perineal hernia?
only with patients whose health status prevents general anesthesia
What is the medical management for perineal hernias?
- promote regular defecation
- stool softeners
- periodic fecal evacuation
- high fiber/high moisture diets
When is a perineal hernia considered an emergency?
- irreducible painful discolored swelling
- bladder retroflexion
What are the surgical options for correcting a perineal hernia?
- traditional herniorrhaphy
- internal obturator muscle transposition
- superficial gluteal muscle transposition
- semitendinosis muscle transposition
What are complications associated with perineal hernia surgery?
- infection/abscess
- fecal incontinence
- sciatic injury
- urinary dysfunction
- tenesmus
What predisposes cats to perineal hernias?
- megacolon
- perineal masses
- colitis
