Hernias Flashcards
What are the 3 portions of a hernia?
1) ring
2) sac
3) content
What are signs of herniation?
Swelling (if external)
What is a true hernia?
Opening through normal aperture, contained a complete peritoneal sac
INDIRECT hernia**
What is a false hernia
Do not contain a complete peritoneal sac, usually created by trauma or after breakdown of surgical entry
DIRECT hernia**
What is an inguinal hernia?
- intestinal contents within the inguinal canal
- equine inguinal hernia usually true (indirect)
- contents pass through vaginal ring into vaginal tunic
What is a scrotal hernia?
Intestinal content within scrotum
-can be used interchangeably with inguinal hernia
What intestine is common herniated in an inguinal hernia?
Distal jejunum and ileum most commonly
What is the limiting factor for the development of an inguinal hernia and why?
Internal inguinal ring
*the size of the external inguinal ring is irrelevant to development of inguinal hernia because have to go through the internal inguinal ring first
What breeds of horses are predisposed to INGUINAL hernias?
Drafts American Saddlebreds Standardbred (increased risk for event ration after open castration) Andalusian TWH RARE in geldings
What is the most common INGUINAL hernia in the horse?
INDIRECT / true hernia
What is the difference between a Ruptured inguinal hernia and an Inguinal Rupture?
*result is the same
Ruptured inguinal hernia = inguinal hernia that then ruptured
Inguinal rupture =
What should all colicky stallions be checked for?
Inguinal hernias
- scrotal swelling
- testicles often cool (vascular compromise)
What are some differential diagnosis for INGUINAL hernias in a Stallion?
1) testicular thrombosis
2) Seroma or hematoma of the scrotum
3) Neoplasia
4) spermatic cord torsion
5) Orchitis
T/F: Congenital Inguinal Hernias are equally unilateral and bilateral in occurrence?
FALSE
Congenital inguinal hernias are unilateral >bilateral
T/F: Congenital inguinal hernias occur equally in colts as the do in fillies?
FALSE
Congenital inguinal hernias are more common in colts
T/F: Congenital inguinal hernias are easily reduced?
TRUE
Congenital inguinal hernias are easily reduced when foal is rolled onto their back
-usually resolves in 3-6months
After reducing a congenital inguinal hernia in a colt, how long does it take to resolve?
3-6 months
How would you treat a colt with a congenital inguinal hernia?
- manual reduce hernia
- confine to box stall
- show owner how to reduce several times daily
*larger hernias may require additional support/inguinal bandages
What is the presentation of a RUPTURED Inguinal Hernia?
Ruptured inguinal hernia = inguinal hernia that then ruptured
- 4-48 hrs after birth in foals
- intermittent colic
- depression
- severe scrotal/prenuptial swelling
What is the difference between Adult inguinal hernias and Foal inguinal hernias?
Adults:
- ACQUIRED
- non reducible
- CS: mild-severe colic
Foals:
- CONGENITAL
- reducible
- non painful, intermittent colic
When would you consider surgical intervention for a Congenital inguinal hernia?
1) failure to resolve
2) Enlargement
3) rent in vaginal sac has allowed escape into SQ tissue
When should you consider surgical intervention for an Acquired inguinal hernia/inguinal rupture/ non reducible hernia?
Emergency surgery-usually acute/severe colic
76% survival rate
Can a horse still breed with one testicle?
YES
Describe the process of surgical intervention of a congenital inguinal hernia?
- INGUINAL approach
- expose tunic and contents
- remove cremaster muscle
- twist testicle and tunic (intestine will go back into body)
- closed castration with transfixation ligature
- closure of EXTERNAL (superficial) inguinal ring
Describe the surgical management of an inguinal hernia with LAPAROSCOPY
- Foal (GA)
- reduce context with laparoscopic instruments
- testis on the affected side retracted into abdominal cavity (so ligament and remove)
- close DEEP (internal) inguinal ring
- laparoscopic stapling Devine or suture
What are the advantages of Laparoscopic herniorrhaphy?
1) faster procedure (once proficient )
2) minimal post op swelling
3) rapid return to normal activity
Describe the surgical procedure of an Acquired Inguinal Herniorrhaphy
- Patient STABILIZATION
- prep INGUINAL region and VENTRAL abdomen**
- Incise over superficial inguinal ring
- open vaginal sac to expose herniated contents and testis
- dilate vaginal ring and apply traction to intestine through celiotomy
- R/A of non viable intestine
- removal of affected testis
How can you prevent reherniation in a horse?
1) lighting the spermatic cord during castration
2) additionally:
- Pack inguinal cavity with gauze for 24-48hrs post op
- close superficial inguinal ring
Is there a side predilection site for Indirect (true) inguinal hernias in cattle?
Yes
They are more likely to have an inguinal hernia on the LEFT
Why do mature bulls tend to have indirect inguinal hernias on the LEFT side?
The rumen is on the left, the pressure can cause inguinal hernia on the left
You see a mature bull with an “hourglass” configuration in the scrotum, What do you suspect?
True (indirect) inguinal hernia
Which breed of cattle are predisposed to Indirect (True ) inguinal hernias?
More common in beef breeds
HEREFORDS
How would you confirm the suspicion of Indirect inguinal hernia in cattle?
Rectal palpation
T/F: Scrotal hernias in cattle are common
FALSE
Scrotal hernias in cattle are rare
T/F Direct inguinal hernias in cattle are true inguinal hernias
FALSE
Direct inguinal hernias are false inguinal hernias
-traumatic
Do Direct (false) inguinal hernias in cattle have a side predilection?
NO, because it is a traumatic event can happen any side
No “hourglass” appearance
-Bowel incarceration
-may require immediate surgery with medical stabilization
Is it recommended to repair a congenital inguinal hernia in CATTLE? Why?
No, because there is proven hereditary component in cattle.
-Repair not recommended unless bilateral castration performed
we do not want continuous of the hernia formation in that breed line
What is the different between Cattle surgical intervention fo inguinal herniation and horse?
Horses = Dorsal recumbency
CATTLE = GA, LATERAL recumbency
-direct approach over superficial inguinal ring
The remainder is the same as horses
What is the most common type of hernia in the HORSE?
- *Umbilical Hernia**
- most are congenital (possible hereditary component)
- majority of foals with palpable defect at birth close within 4 days
What is the occurrence of Strangulating umbilical hernias in the horse?
RARE
Are strangulated umbilical hernias reducible?
Non reducible????? She said they are usually reducible???
- painful on palpation
- colic
Do Parietal (richter) hernia require surgery?
YES
- Antimesenteric wall of ileum incarcerated
- suspect when hernia becomes firm, non-reducible and painful
- U/S to evaluate hernia
- enterocutaneous fistula
- sometimes colic
You palpate a firm, non-reducible, painful strangulating umbilical hernia in a colicky horse. What do you suspect?
Parietal (Richter) Hernia
What is incarcerated in a Parietal (richter) Hernia? Are these common
Antimesenteric wall of the ileum
RARE
How would you diagnose an umbilical hernia?
1) palpation:
- digital palpation of hernia
- firm thickened hernia ring: GOOD prognosis for repair
- Thin/indistinct hernia ring: potential increased complication
2) ultrasound
In a foal with an umbilical hernia, what would you expect the contents to have?
-Subperitoneal fat
-Omentum
-Viscera
—->most commonly ileum or small intestine
—->possible Richter (parietal)hernia
Almost always reducible!!
Are umbilical hernias in foals reducible?
Almost always reducible
What is the most common Viscera involved in an umbilical hernia in a FOAL?
- most commonly: ILEUM or small intestine
- Possible Richter (parietal) but RARE
Most of the time, How would you treat an umbilical Hernia In a foal?
CONSERVATIVE treatment
- resolves spontaneous
- gone by 1 week
- *As long as they are:**
1) less than 5cm diameter
2) reducible
You have an umbilical hernia in a foal. It is 4 diameters and reducible. How would you treat it?
Conservatively
- close spontaneously as foal matures
- palpate daily to monitor size or development of incarceration of hernia content
When should you consider surgery for an umbilical Hernia in a foal?
1) Not spontaneously resolving by 4 months of age
2) **Hernia diameter >10cm (4in) diameter
Usually an elective procedure
When treating an umbilical hernia in a HORSE surgically what must be done?
Do not use a HERNIA CLAMP!!!!!!!!
-food animal can handle these things not horses
*Must perform Direct surgical REPAIR!!!!
-GA/dorsal recumbency
-elliptical incision around hernia
-remove skin and loose SQ
-Sharp dissection to expose rectors abdominal m.
!!!! 1cm peripheral to hernial ring!!! So that you don’t bleed through content
- can do closed or open (preferred)
What is a closed umbilical herniorraphy in a horse involve?
Hernial sac INVERTED and hernia repaired
What is a OPEN umbilical herniorraphy in a horse involve?
- Incise Hernan sac along edge of ring
- Caution with umbilical remnants
- examine contents
- close body wall
What is preferred? Closed or Open umbilical herniorraphy in a Foal? WHy?
Open is preferred !!!!
- can inspect tissue to see everything is ok
- better closure of body wall
What is important for aftercare following an umbilical herniorraphy in a foal?
1) abdominal support bandage 48hrs
- reduce edema
- decrease dead space
2) Foal confined to box stall 30-45days
What are the 5 categories of umbilical hernias in Calves?
1) uncomplicated hernias
2) Hernias with SQ infection/abscessation
3) Hernial with infection of umbilical remnant
4) umbilical abscesses/ chronic Imphal it is
5) urachal cysts/ruptures
What is different between horse and cattle umbilical hernias, based on hereditary?
We KNOW it’s hereditary in cattle!!!!!!!
What is the most common birth defect in cattle?
Uncomplicated Umbilical Hernia!!!
What breeds of cattle are commonly (hereditary) affected by uncomplicated umbilical hernias?
Holsteins - friesian
Dairy Cattle > beef cattle
Is there spontaneous reduction of uncomplicated umbilical hernias in Calves?
No, they are present at birth and they tend to enlarge
What is most commonly contained in an uncomplicated umbilical hernia in calves?
Hernial sac most commonly contains abomasum
What is the prognosis for simple hernia repair (uncomplicated umbilical hernia) in calves?
EXCELLENT prognosis for simple hernia repair
-decreased prognosis if infected umbilical remnants
You have a calve with an umbilical abscess. These sometimes have concurrent hernias. How would you confirm hernia presence?
1) visuals inspection
2) palpation
3) presence of hernial ring with reducibility of contents
4) ultrasound
How would you repair an uncomplicated hernia in a calf?
Conservative treatment ONLY if:
1) **<5cm
2) reducible
3) no he or evidence of infection
Tx: Hernial clamps, elastrator bands, abdominal support bandages
If you have an umbilical hernia greater than 5cm long what must you do?
SURGERY!!!!
-OPEN herniorrhaphy
T/F: umbilical infection in calves are common
True
Umbilical infections in calves are common
What is involved in pre-op management of umbilical infections?
1) culture/sensitivity pre-op if possible
2) Drainage of large abscesses
3) antibiotic administration
- Penicillin (unless culture results dictate otherwise)
- remember antibiotic regulations
Who has more post-op complications from Herniorrhaphy, Calves or foals?
Calves > Foals
-calves more commonly have concurrent infections
Incisional complications:
- abscess
- seroma/hematoma
- Dehiscence
How would you treat a calve with a hernia and umbilical infection?
Open Herniorrhaphy with en bloc removal of umbilical remnants:
- ligate umbilical aa and v.(cranially to the site of Omphalophlebitis )
- Remove apex of urinary bladder
- complete herniorrhaphy routinely
What is omphalophlebitis?
Inflammation and infection of the umbilical VIEN!!!!
If omphalophlebitis in a calf is localized how is it treated?
Ligate the umbilical vien and remove en bloc
If omphalophlebitis in a calf extends cranially to involve the liver, how is it treated?
- requires marsupialization
- separate incision on ventral abdomen
- wall of umbilical vien secured to body wall (2-3 layer closure)
- irrigate marsupialized tract daily until closure by 2 intention
