Hernias I Flashcards
Protrusion of organs through a normal abdominal opening. Examples include umbilical hernia, inguinal hernia, scrotal hernia, fremoral hernia
True hernia
Protursion of organs outside a normal abdominal opening. Seldom contained in a peritoneal sac. Example: abdominal hernia (paracostal, cranial pubic ligament)
False hernia
Protrusion of abdominal content through a debilitated area of the abdomen with intact skin.
Eventration
Protrusion of abdominal content through a debilitated area of the abdomen with non-intact skin.
Evisceration
A _____ hernia is when content can be manually reduced and is retained inside the abdomen.
Coercible
A _____ hernia is when content can be manually reduced but is not retained inside.
Incoercible
An ______ hernia is impossible to reduce into the abdominal cavity but no alteration of blood flow to the hernia contents.
Incarcerated
A ______ hernia is impossible to reduce and had vascular compromise to the protruded viscera.
Strangulated
____ abdominal hernias occur through a defect in the external wall of the abdomen, allowing protrusion of organs. Can involve the wall anywhere EXCEPT in the umbilicis, inguinal ring, femoral canal, or scrotum.
External
______ abdominal hernias occur within a ring of tissue confined within the abdomen or thorax rather than protruding through the outer wall. Examples are diaphragmatic and hiatal hernias.
Internal
The cranial pubic ligament is also called the _______ tendon.
Prepubic
Cranial abdominal hernias have been associated with ______-______ diaphgragmatic hernias.
peritoneal-pericardial
Abdominal hernias are most commonly _______. (acquired or congenital).
acquired
False hernias do not contain a _______ sac.
hernial
The two most common sites for trauamatic abdominal hernias are
the pre-pubic region (cranial pelvic ligament) often associated with pelvic fractures, and the flank.
- Large midline umbilical and skin defect - evisceration
- Covered by amniotic tissue - easily reuptured
- Most neonates die or are euthanized
Omphaloceles
Umbilical hernias are usually _____ and caused by flawed ______.
congenital; embryogenesis
What three structures pass through the umbilical ring in the fetus?
- the umbilical vessels
- Vitelline duct
- Stalk of the allantois
Umbilical hernias are _____ hernias. (true/false)
True
Umbilical ring closes after birth and can close up to ____ months after birth. If the umbilical ring fails to close or is too large or improperly formed, an umbilical hernia results.
6
Standard orthogonal radiographs generally are indicated in small umbilical hernias. True or False.
False - generally NOT indicated
When is it necessary for emergency surgery?
If actively bleeding, or obstructed itnestines or bladder in some form
If stable, or able to be stabilized, ______ the surgery will make suriviving anesthesia more likely, will also allow the wound to “declare” itself and make thorough debridement more possible and dehiscence and infection less likely.
delaying
In bite wounds, do not use _______ mesh, becuase it acts as a nidus for bacteria and won’t be treated by anitbiotics.
nonabsorbable mesh
Umbilical hernias may resolve ______ as late as ___ months of age.
Spontaneously, 6
Intestinal strangulation is ___ with very small or large defects.
rare
Surgery should be performed ASAP with umbilical hernias if the viscera _____
cannot be reduced
Hernias can occur at insertions or attachemnts of these four muscle layers, or through the muscle bellies themselves.
- Internal abdominal oblique
- External abdominal oblique
- Rectus abdominis
- Transversus abdominis muscle
The cranial public ligament (prepubic tendon) is a distinct tendon in _____ only. It attaches the ventral abdominal muscles to the _____ border of the pubis.
dogs; cranial
Cats do not have a distinct prebuic tendon, and abdominal muscles attach directly to the _____
pelvic brim
In correcting abdominal hernias, a _____ midline appraoch is used.
ventral
For treating paracostal hernias, the appraoch depends on the hernia - either a ____ or ____ incision is made.
Midline, or direct (over the hernia)
In hernias invovling the cranial pubic ligmanet, it is recommended to use a _____ suture as it retaines its tensile strenght for longer. THis is becuse muscle fascia takes about ____ weeks to regian ____ of its original strength.And up to a year to regain _____ of its tensile strength.
nonabsorbable; 3 weeks; 20%; 80%
In umbilical hernias, repair the defect with ____ suture.
monofilament
In irreducible or strangulated hernias, make an ____ incision to prevent damage, then incise the hernial sac and repalce contents into the abdomen.
eliptical
Protrusion of organs or tissues through the inguinal canal adjacent to the vaginal process.
Inguinal hernia
Defect in the inguinal ring allowing abdominal contents to protrude into the vaginal process adjacent to the spermatic cord.
Scrotal hernia
Hernia that occurs via a defect in the femoral canal
femoral hernia
Inguinal hernias are most commonly reported in in tact, middle aged ____.
females
Inguinal hernias can occur both unilateral, and bilateral. If unilatera, it is more common on the ____ side.
Left
Scrotal hernias are very rare. They are usually _____ (unilateral or bilateral), and strangulation of abdominal contents is _____ (common or uncommon).
Unilateral, common
Scrotal hernais are most commonly reported in _____ breeds, like ___.
Chondrodystrophic breeds, Shar-peis
It is important to not mistake _______ in obese cats for an inguinal hernia.
Caudal abdominal fat pad
The inguinal canal is a sagittal slit in the caudoventral abdominal wall. What structures run tthrough the inguinal canal?
Genitofemoral N, A, V
External pudendal vessels
Spermatic cord in the male/Round ligament int he female
The inguinal canal is bounded by the ___
Internal and external inguinal rings
Internal inguinal ring includes:
Caudal edge of the ______
_____ medially
And ______ laterally and caudally.
Caudal edge of the internal abdominal oblique (cranially)
Rectus abdominis muscle medially
Inguinal ligament laterally and caudally
The ____ inguinal ring is a slit in the external abdominal oblique aponeurosis.
external
Protrusion through the normal evagination of the vaginal process.
Indirect inguinal hernia
A ____inguinal hernia is a separate outpocketing from the vaginal process.
Direct hernia
In female dogs, a ____ incision is preferred when correcting an inguinal hernia.
Midline
In a scrotal hernia, make incision parallel to flank fold ____ or directly over the inguinal ring.
Lateral
In a femoral hernia, make the skin incision ___ to the inguinal ligament, and use ______ to close defect if intact.
parallel; inguinal ligament
Protrusion of the abdominal esophgaus, gastroesophageal junction or gastric fundus through the esophageal hiatus in to the mediastinum cranium to the diaphragm.
Hiatal hernias
Hiatal hernias are usually caused by congenital abnormalities of the hiatus, especially invovling a lax or stretched ______ ligament, allowing the gastroesophageal junctino to move through the hiatus into the caudal mediastinum.
Phrenicoesophageal
Traumatic injuries to cause hital hernias include:
Diaphragmatic nerve and muscle damage; upper airway obstruction; tetanus
Upper airway obstructions may lead to _____ intrathoracic pressure during inspiration, leading to esophageal reflux and herniation.
reduced
Signalment for hiatal hernia
Young dogs, Shar Peis and English Bulldogs; some are asymptomatic
Most common clinical sign with hiatal hernias is:
regurgitation
The esophageal hiatus contains the esophagus, vagal nerve trunks, and esophageal vessels and is surrounded by the ______ ligament.
Phrenicoesophageal ligament
In hiatal hernias, contents herniate throughthe ______ hiatus.
Esophgaeal
What are the three openings of the diaphragm?
- esophageal hiatus
- Caval hiatus
- Aortic hiatus
An _____ hiatal hernia is also called ______, and is when the gastroesophageal junction is located within the thorax, and may be intermittent.
Axial, sliding
A _____ hiatal hernia is also called “rolling” and it is when the gastroesophageal junction is locate din the normal position, but hte gastric fundus or other abdominal viscera are displaced through the hiatus.
Paraesophageal
When is surgery the recommended treatment for hiatal hernias?
Best in young symptomatic animals that do not respond to medical treatment - treat for reflux esophagitis and aspriation pneumonia first
Hiatal herniorrhaphy:
- Reduce the hernia and reduce the size of the hiatus with ____ sutures.
- Suture esophagus to _____ aka (______)
- Tube or incisional ____ at the fundus
- plicating
- diaphgram (esophagopexy)
- gastropexy
