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EXAM 2 > Hernias > Flashcards

Hernias Flashcards

1
Q

What are the 3 portions of a hernia?

A

1) ring
2) sac
3) content

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2
Q

What are signs of herniation?

A

Swelling (if external)

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3
Q

What is a true hernia?

A

Opening through normal aperture, contained a complete peritoneal sac

INDIRECT hernia**

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4
Q

What is a false hernia

A

Do not contain a complete peritoneal sac, usually created by trauma or after breakdown of surgical entry

DIRECT hernia**

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5
Q

What is an inguinal hernia?

A
  • intestinal contents within the inguinal canal
  • equine inguinal hernia usually true (indirect)
  • contents pass through vaginal ring into vaginal tunic
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6
Q

What is a scrotal hernia?

A

Intestinal content within scrotum

-can be used interchangeably with inguinal hernia

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7
Q

What intestine is common herniated in an inguinal hernia?

A

Distal jejunum and ileum most commonly

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8
Q

What is the limiting factor for the development of an inguinal hernia and why?

A

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

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9
Q

What breeds of horses are predisposed to INGUINAL hernias?

A 
Drafts
American Saddlebreds
Standardbred (increased risk for event ration after open castration)
Andalusian
TWH
RARE in geldings
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10
Q

What is the most common INGUINAL hernia in the horse?

A

INDIRECT / true hernia

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11
Q

What is the difference between a Ruptured inguinal hernia and an Inguinal Rupture?

A

*result is the same

Ruptured inguinal hernia = inguinal hernia that then ruptured

Inguinal rupture =

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12
Q

What should all colicky stallions be checked for?

A

Inguinal hernias

  • scrotal swelling
  • testicles often cool (vascular compromise)
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13
Q

What are some differential diagnosis for INGUINAL hernias in a Stallion?

A

1) testicular thrombosis
2) Seroma or hematoma of the scrotum
3) Neoplasia
4) spermatic cord torsion
5) Orchitis

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14
Q

T/F: Congenital Inguinal Hernias are equally unilateral and bilateral in occurrence?

A

FALSE

Congenital inguinal hernias are unilateral >bilateral

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15
Q

T/F: Congenital inguinal hernias occur equally in colts as the do in fillies?

A

FALSE

Congenital inguinal hernias are more common in colts

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16
Q

T/F: Congenital inguinal hernias are easily reduced?

A

TRUE

Congenital inguinal hernias are easily reduced when foal is rolled onto their back
-usually resolves in 3-6months

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17
Q

After reducing a congenital inguinal hernia in a colt, how long does it take to resolve?

A

3-6 months

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18
Q

How would you treat a colt with a congenital inguinal hernia?

A
  • manual reduce hernia
  • confine to box stall
  • show owner how to reduce several times daily

*larger hernias may require additional support/inguinal bandages

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19
Q

What is the presentation of a RUPTURED Inguinal Hernia?

A

Ruptured inguinal hernia = inguinal hernia that then ruptured

  • 4-48 hrs after birth in foals
  • intermittent colic
  • depression
  • severe scrotal/prenuptial swelling
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20
Q

What is the difference between Adult inguinal hernias and Foal inguinal hernias?

A

Adults:

  • ACQUIRED
  • non reducible
  • CS: mild-severe colic

Foals:

  • CONGENITAL
  • reducible
  • non painful, intermittent colic
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21
Q

When would you consider surgical intervention for a Congenital inguinal hernia?

A

1) failure to resolve
2) Enlargement
3) rent in vaginal sac has allowed escape into SQ tissue

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22
Q

When should you consider surgical intervention for an Acquired inguinal hernia/inguinal rupture/ non reducible hernia?

A

Emergency surgery-usually acute/severe colic

76% survival rate

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23
Q

Can a horse still breed with one testicle?

A

YES

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24
Q

Describe the process of surgical intervention of a congenital inguinal hernia?

A
  • 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
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25
Q

Describe the surgical management of an inguinal hernia with LAPAROSCOPY

A
  • 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
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26
Q

What are the advantages of Laparoscopic herniorrhaphy?

A

1) faster procedure (once proficient )
2) minimal post op swelling
3) rapid return to normal activity

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27
Q

Describe the surgical procedure of an Acquired Inguinal Herniorrhaphy

A
  • 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
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28
Q

How can you prevent reherniation in a horse?

A

1) lighting the spermatic cord during castration

2) additionally:
- Pack inguinal cavity with gauze for 24-48hrs post op
- close superficial inguinal ring

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29
Q

Is there a side predilection site for Indirect (true) inguinal hernias in cattle?

A

Yes

They are more likely to have an inguinal hernia on the LEFT

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30
Q

Why do mature bulls tend to have indirect inguinal hernias on the LEFT side?

A

The rumen is on the left, the pressure can cause inguinal hernia on the left

31
Q

You see a mature bull with an “hourglass” configuration in the scrotum, What do you suspect?

A

True (indirect) inguinal hernia

32
Q

Which breed of cattle are predisposed to Indirect (True ) inguinal hernias?

A

More common in beef breeds

HEREFORDS

33
Q

How would you confirm the suspicion of Indirect inguinal hernia in cattle?

A

Rectal palpation

34
Q

T/F: Scrotal hernias in cattle are common

A

FALSE

Scrotal hernias in cattle are rare

35
Q

T/F Direct inguinal hernias in cattle are true inguinal hernias

A

FALSE

Direct inguinal hernias are false inguinal hernias
-traumatic

36
Q

Do Direct (false) inguinal hernias in cattle have a side predilection?

A

NO, because it is a traumatic event can happen any side
No “hourglass” appearance
-Bowel incarceration
-may require immediate surgery with medical stabilization

37
Q

Is it recommended to repair a congenital inguinal hernia in CATTLE? Why?

A

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

38
Q

What is the different between Cattle surgical intervention fo inguinal herniation and horse?

A

Horses = Dorsal recumbency

CATTLE = GA, LATERAL recumbency
-direct approach over superficial inguinal ring

The remainder is the same as horses

39
Q

What is the most common type of hernia in the HORSE?

A
  • *Umbilical Hernia**
  • most are congenital (possible hereditary component)
  • majority of foals with palpable defect at birth close within 4 days
40
Q

What is the occurrence of Strangulating umbilical hernias in the horse?

A

RARE

41
Q

Are strangulated umbilical hernias reducible?

A

Non reducible????? She said they are usually reducible???

  • painful on palpation
  • colic
42
Q

Do Parietal (richter) hernia require surgery?

A

YES

  • Antimesenteric wall of ileum incarcerated
  • suspect when hernia becomes firm, non-reducible and painful
  • U/S to evaluate hernia
  • enterocutaneous fistula
  • sometimes colic
43
Q

You palpate a firm, non-reducible, painful strangulating umbilical hernia in a colicky horse. What do you suspect?

A

Parietal (Richter) Hernia

44
Q

What is incarcerated in a Parietal (richter) Hernia? Are these common

A

Antimesenteric wall of the ileum

RARE

45
Q

How would you diagnose an umbilical hernia?

A

1) palpation:
- digital palpation of hernia
- firm thickened hernia ring: GOOD prognosis for repair
- Thin/indistinct hernia ring: potential increased complication

2) ultrasound

46
Q

In a foal with an umbilical hernia, what would you expect the contents to have?

A

-Subperitoneal fat
-Omentum
-Viscera
—->most commonly ileum or small intestine
—->possible Richter (parietal)hernia

Almost always reducible!!

47
Q

Are umbilical hernias in foals reducible?

A

Almost always reducible

48
Q

What is the most common Viscera involved in an umbilical hernia in a FOAL?

A
  • most commonly: ILEUM or small intestine

- Possible Richter (parietal) but RARE

49
Q

Most of the time, How would you treat an umbilical Hernia In a foal?

A

CONSERVATIVE treatment

  • resolves spontaneous
  • gone by 1 week
  • *As long as they are:**
    1) less than 5cm diameter
    2) reducible
50
Q

You have an umbilical hernia in a foal. It is 4 diameters and reducible. How would you treat it?

A

Conservatively

  • close spontaneously as foal matures
  • palpate daily to monitor size or development of incarceration of hernia content
51
Q

When should you consider surgery for an umbilical Hernia in a foal?

A

1) Not spontaneously resolving by 4 months of age
2) **Hernia diameter >10cm (4in) diameter

Usually an elective procedure

52
Q

When treating an umbilical hernia in a HORSE surgically what must be done?

A

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)

53
Q

What is a closed umbilical herniorraphy in a horse involve?

A

Hernial sac INVERTED and hernia repaired

54
Q

What is a OPEN umbilical herniorraphy in a horse involve?

A
  • Incise Hernan sac along edge of ring
  • Caution with umbilical remnants
  • examine contents
  • close body wall
55
Q

What is preferred? Closed or Open umbilical herniorraphy in a Foal? WHy?

A

Open is preferred !!!!

  • can inspect tissue to see everything is ok
  • better closure of body wall
56
Q

What is important for aftercare following an umbilical herniorraphy in a foal?

A

1) abdominal support bandage 48hrs
- reduce edema
- decrease dead space

2) Foal confined to box stall 30-45days

57
Q

What are the 5 categories of umbilical hernias in Calves?

A

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

58
Q

What is different between horse and cattle umbilical hernias, based on hereditary?

A

We KNOW it’s hereditary in cattle!!!!!!!

59
Q

What is the most common birth defect in cattle?

A

Uncomplicated Umbilical Hernia!!!

60
Q

What breeds of cattle are commonly (hereditary) affected by uncomplicated umbilical hernias?

A

Holsteins - friesian

Dairy Cattle > beef cattle

61
Q

Is there spontaneous reduction of uncomplicated umbilical hernias in Calves?

A

No, they are present at birth and they tend to enlarge

62
Q

What is most commonly contained in an uncomplicated umbilical hernia in calves?

A

Hernial sac most commonly contains abomasum

63
Q

What is the prognosis for simple hernia repair (uncomplicated umbilical hernia) in calves?

A

EXCELLENT prognosis for simple hernia repair

-decreased prognosis if infected umbilical remnants

64
Q

You have a calve with an umbilical abscess. These sometimes have concurrent hernias. How would you confirm hernia presence?

A

1) visuals inspection
2) palpation
3) presence of hernial ring with reducibility of contents
4) ultrasound

65
Q

How would you repair an uncomplicated hernia in a calf?

A

Conservative treatment ONLY if:

1) **<5cm
2) reducible
3) no he or evidence of infection

Tx: Hernial clamps, elastrator bands, abdominal support bandages

66
Q

If you have an umbilical hernia greater than 5cm long what must you do?

A

SURGERY!!!!

-OPEN herniorrhaphy

67
Q

T/F: umbilical infection in calves are common

A

True

Umbilical infections in calves are common

68
Q

What is involved in pre-op management of umbilical infections?

A

1) culture/sensitivity pre-op if possible
2) Drainage of large abscesses
3) antibiotic administration
- Penicillin (unless culture results dictate otherwise)
- remember antibiotic regulations

69
Q

Who has more post-op complications from Herniorrhaphy, Calves or foals?

A

Calves > Foals
-calves more commonly have concurrent infections

Incisional complications:

  • abscess
  • seroma/hematoma
  • Dehiscence
70
Q

How would you treat a calve with a hernia and umbilical infection?

A

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
71
Q

What is omphalophlebitis?

A

Inflammation and infection of the umbilical VIEN!!!!

72
Q

If omphalophlebitis in a calf is localized how is it treated?

A

Ligate the umbilical vien and remove en bloc

73
Q

If omphalophlebitis in a calf extends cranially to involve the liver, how is it treated?

A
  • 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

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