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Small Animal Surgery > Hernias > Flashcards

Hernias Flashcards

1
Q

What is a hernia?

A

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

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2
Q

What is the difference between a true hernia and a false hernia?

A

a true hernia has a peritoneal covering or sac

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3
Q

Define reducible in respect to a hernia

A

contents are readily manipulated back into the cavity

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4
Q

Define incarcerated in respect to a hernia

A

contents are fixed into abnormal locations

- cannot be reduced

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5
Q

What is the problem when a hernia is strangulated?

A

incarceration obstructs vascular supply

- usually a surgical emergency

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6
Q

What are the principles of herniorrhaphy?

A
  • 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
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7
Q

What is the most common type of abdominal hernia?

A

umbilical hernias

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8
Q

Describe the clinical signs/presentation of an umbilical hernia

A
  • soft, round mass at the umbilical scar
  • often reducible
  • if the viscera is trapped, may be hard and painful
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9
Q

How is an umbilical hernia usually managed?

A
  • conservative management
  • may close spontaneously in patients < 6 months
  • repair during elective period/neuter
  • if incarcerated, enlarge ring and dissect sac free
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10
Q

Describe the indirect form of inguinal hernias

A
  • passes through the vaginal process

- called a scrotal hernia in males

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11
Q

Describe the direct form of inguinal hernias

A
  • passes through inguinal musculature

- less common

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12
Q

Describe the congenital form of inguinal hernias

A
  • more common in males

- delayed inguinal ring narrowing from late testicular descent

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13
Q

Describe the acquired form of inguinal hernias

A
  • more common in intact females
  • shorter and larger inguinal canal
  • estrogen/estrus predisposes
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14
Q

What are the clinical signs/presentation of an inguinal hernia?

A
  • painless mass in inguinal area

- can be unilateral or bilateral

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15
Q

How is an inguinal hernia diagnosed?

A
  • ability to reduce

- if unable to reduce, use imaging

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16
Q

Describe the traditional repair of an inguinal hernia

A
  • incision over the lateral aspect of the swelling
  • reduce contents, extend ring if necessary
  • close the ring
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17
Q

Which vessels should be avoided in traditional repair of inguinal hernias?

A
  • pudendal artery

- genitofemoral nerve

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18
Q

Describe the features of the ventral midline approach to correcting inguinal hernias

A
  • commonly done in females
  • can inspect both sides
  • avoids mammary tissue
  • perform one layer closure over ring
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19
Q

What is a scrotal hernia?

A

an indirect inguinal hernia in a male

20
Q

What are the clinical features of a scrotal hernia?

A
  • painful swelling

- usually unilateral

21
Q

How is a scrotal hernia usually managed?

A
  • incision over ring, reduce contents, and close ring

- castrate to decrease risk of recurrence

22
Q

What are the clinical signs of acute traumatic abdominal hernia?

A
  • bulging mass
  • asymmetric abdomen
  • reducible contents
  • palpable ring
23
Q

How is an acute abdominal hernia repaired?

A
  • ventral midline approach
  • explore abdomen and repair any organ injury
  • use tension relieving pattern
24
Q

What approach is usually used for a chronic abdominal hernia repair?

A

approach over the hernia

25
Q

How is a patient usually positioned when they have a prepubic tendon rupture?

A

truncal flexion

rear legs forward

26
Q

What is an incisional hernia?

A

acquired hernia from disruption of surgically closed cavity (iatrogenic)

27
Q

When does an incisional hernia usually occur?

A

< 7 days post operation

28
Q

What are the predisposing factors for an incisional hernia?

A
  • intra-abdominal pressure (obesity, effusion, pregnancy)
  • fat trapped in closure
  • inappropriate suture
  • infection
  • steroids
  • poor post-op care
29
Q

How is an incisional hernia diagnosed?

A
  • exaggerated swelling
  • serosanguinous discharge
  • reducible
  • radiographs, ultrasound
30
Q

What are the differentials for incisional hernias?

A
  • hematoma/seroma

- abscess

31
Q

How does a perineal hernia occur/develop?

A
  • weakness and separation of the pelvic diaphragm components
  • allows dilation and rectal deviation
  • stretching of rectal tissue
32
Q

What is the anatomical location of a lateral perineal hernia?

A

between coccygeus muscle and sarcotuberous ligament

33
Q

What is the anatomical location of a dorsal perineal hernia?

A

between the coccygeus muscle and levator ani muscle

34
Q

What is the anatomical location of a caudal perineal hernia?

A

between the levator ani, external anal sphincter, and internal obturator muscle

35
Q

What is the anatomical location of a ventral perineal hernia?

A

between the bulbocavernosus, ischiocavernosis, and ischiourethralis muscles

36
Q

Which type of perineal hernia is most common?

A

caudal perineal hernia

37
Q

What are the predisposing factors for perineal hernias?

A
  • hormonal influence
  • prostatic disease
  • relaxin
  • neurogenic atrophy
  • chronic straining
38
Q

What are the clinical signs/presentation of a perineal hernia?

A
  • can be asymptomatic
  • tenesmus, constipation, perineal swelling
  • a firm, non-reducible mass indicates strangulation
  • possible bladder retroflexion
39
Q

How are perineal hernias diagnosed?

A
  • rectal palpation
  • radiographs
  • ultrasound
40
Q

When is medical management used for a perineal hernia?

A

only with patients whose health status prevents general anesthesia

41
Q

What is the medical management for perineal hernias?

A
  • promote regular defecation
  • stool softeners
  • periodic fecal evacuation
  • high fiber/high moisture diets
42
Q

When is a perineal hernia considered an emergency?

A
  • irreducible painful discolored swelling

- bladder retroflexion

43
Q

What are the surgical options for correcting a perineal hernia?

A
  • traditional herniorrhaphy
  • internal obturator muscle transposition
  • superficial gluteal muscle transposition
  • semitendinosis muscle transposition
44
Q

What are complications associated with perineal hernia surgery?

A
  • infection/abscess
  • fecal incontinence
  • sciatic injury
  • urinary dysfunction
  • tenesmus
45
Q

What predisposes cats to perineal hernias?

A
  • megacolon
  • perineal masses
  • colitis

Small Animal Surgery (26 decks)

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