Hernias and ruptures Flashcards
define hernia
A protrusion of an organ or part of an organ through a defect in the wall of the anatomical area in which it normally lies.
define prolapse
A prolapse is the movement of an organ or tissue out of its normal anatomical location, without passing through a deficit in the body wall, often occurring under the influence of significant force
what are the aims of hernia surgery
Return hernia content to normal location
Secure closure of neck of sac
Obliterate redundant tissue in the sac
Try to use the patient’s own tissues for repair
describe how to diagnose umbilical hernia
palpation
describe how to treat umbilical hernia
- Can resolve spontaneously, or be corrected at neutering
Repair by reducing, incise over hernia, excise sac and repair muscle edges
what do we tend to close hernia repairs with
synthetic, absorbable monofilament
what can you see if hernia is strangulated
vomiting/abdominal pain
when do incisional hernias occur
Surgical closure of body cavity fails
Generally linea alba
Normally within 7 days
Can be chronic
describe how to investigate incisional hernias
palapation
radiography or US
describe how to treat incisional hernia
repair ASAP
Lavage and resect nonviable
Re-open and repair entire wound
Suture EXTERNAL SHEATH OF RECTUS ABDOMINIS (strongest holding layer)
Ensure monofilament suture, long lasting and appropriate size
describe how to treat traumatic abdominal rupture
same as hernia
Identify free edge of abdominal wall and reattach to cranial pelvic brim if prepubic tendon rupture
Prognosis relates to organs involved
what can happen in inguinal hernia
Intestine, bladder or uterus can enter subcutaneous space (in the groin)
what is inguinal hernias associated with
obesity and pregnancy
though to be inherited
why should you not castrate guinea pig with open method
have large inguinal rings
increases chance of scrotal hernia
describe how diaphragmatic ruptures present
generally after trauma
* Pale/cyanotic
* Tachypnoeic/dyspnoeic
* Tachycardic
* Occasional cardiac arrythmias
* Hydrothorax
often incidental finding
how do diaphragmatic ruptures occur
Tear in diaphragm allows abdominal content to move into thorax
what do you see on radiography with diaphragmatic rupture
○ Loss of diaphragmatic line
○ Loss of cardiac silhouette
○ Presence of gas filled structure in thorax
○ Atelectasis
○ Displaced abdominal organs
Describe how to treat diaphragmatic rupture
Stabilise first- O2, IVFT and warm up
Prophylactic antibiotics due to toxin release from organ strangulation
ECG
Only do surgery ASAP- Acute gastric distension- if not do after 24hr
which breeds are more likely to get hiatal hernias
Brachycephalic breeds (English bulldog, French bulldog, pug, etc.), Shar pei
what do you see with hiatal hernias
Clinically very similar to oesophagitis
○ Regurgitation
○ Hypersalivation
○ Visceral discomfort
Normally thin
describe how to diagnose hiatal hernias
radiography- soft tissue opacity in dorso-caudal thorax adjacent to diaphragm
Fluoroscopy
Endoscopy
Describe how to treat hiatal hernias
Antacid
Sucralfate
Prokinetic
Antibiotic (if aspiration)
+ surgery
what is a Peritoneopericardial diaphragmatic hernia (PPDH)
Congenital communication between pericardial sac and abdomen
Faulty development of septum transversum
List the clinical signs seen with PPDH
GI or respiratory signs e.g. v+/d+, anorexia weight loss, wheezing, dyspnoea
which breeds tend to be effected by PPDH
weimaraner
cocker spaniel
describe what you see on radiography with PPDH
enlarged cardiac silhouette
dorsally displaced trachea
gas opacities in pericardial sac
what surgery is used to fix PPDH
Ventral midline coeliotomy
Incise sternum if necessary
Reduce viscera
Suture diaphragm - no need to seperatley close the pericardium
What is the difference between a rupture and a hernia
rupture normally has no ring or sac
what are the principles of defect closure of a hernia
-Direct opposition if possible
-Use holding later
-Dont tighten too much to compromise vasculature
-Use strong monofilament suture (PDS)
-Eliminate dead space
How are defects that are too big to be closed by direct oppositon closed?
-Muscle flap
-Polypropylene mesh
-Omentum
what are the clinical signs of an umbilical hernia
Soft painless swelling at umbilicus
V+ and abdominal pain if strangulation of bowel
What can umbilical hernias contain
Usually fat or omentum
Occasionally intestine
What are the predisposing factors to incisional hernias
Surgeon
Incorrect surgical technique
Incorrect suture/pattern
Entrapped fat between wound edges
Infection
Steroid therapy/cushings patient
Poor post op care
what is the holding layer in linea alba closure
external rectus sheath
what are traumatic abdominal ruptures commonly caused by
blunt trauma
bite
What is the typical signalment for non traumatic inguinal hernias
-Intact female middle aged dogs
-<2yr male dogs
-Small breeds
What types of tears of the diaphragm can result in diaphreagmatic hernia?
radial
circumferential
What do you have to ensure takes place when performing diaphragmatic rupture surgery?
IPPV- open chest surgery
List the clinical signs of a chronic diaphragmatic rupture
exercise intolerance
dyspnoea
vomiting
weight loss
How is hiatal hernia treated surgically
-Ventral midline coeliotomy
-Reduce hernia a oesophageal hiatus and close
-Pexy oesophagus to diaphragm
-Pexy stomach to body wall
describe a reducible hernia
is a hernia in which the contents of the hernial sac can be returned to their normal position
describe a non-reducible hernia
ring has closed behind the herniated tissue and it can not be easily replaced
