Hernias-McClain Flashcards
True/indirect hernia
Intact/complete peritoneal sac
False/direct hernia
Ruptured/incomplete peritoneal sac
Types of abdominal hernias
- Direct (false)-non-intact vaginal tunic
2. Indirect (true)-intact vaginal tunic
Examples of acquired hernias
- Inguinal hernia (inc diameter over time)
- Ventral midline hernia (surgical incision)
- Lateral abdominal wall hernia (trauma)
- Degeneration (pre-pubic tendon rupture)
Incarcerated hernia
Cant reduce
Strangulating hernia
Incarcerated hernia that obstructs vascular supply
Parietal hernia
Portion of intestine wall involved with hernia
-Leads to external drainage without internal contamination
Hernia anatomy
- The ring
- The sac
- The components
Anatomic location
- Umbilical
- Ventral midline
- Caudal abdominal-inguinal hernia
- Lateral abdominal
- Pre-pubic tendon rupture
- Diaphragmatic (internal abdominal hernia)
Umbilical Hernia Background
- Natural closures w/in 1-2 weeks of life
- True umbilical hernia if present at 5-8 weeks old
- No clear etiology
Umbilical Hernia Treatment
- < 5 cm-conservative, sx if still present at 4 months
2. > 10 cm SURGERY
Hernia clamp
probs bad news bears, don’t use
Umbilical Herniorraphy techniques
Closed-sac intact
Open-sac removed
Post op care umbilical herniorraphy
- Meds
- abx clean (24-48 hours), clean-contaminated (3-5d)
- anti-inflammatories: 3-5 days - Abdominal support bandage-dead space
- Exercise restrictions: 30-45d stall rest
Caudal abdominal hernia types
Indirect (most common; adults > foals)
Direct (less common; foals > adults)
Caudal abdominal hernia predispositions
Breed
Standarbreds, Tennessee walkers, saddlebreds
Other hx
Strenuous exercise, trauma, breeding
Caudal abdominal hernia foals
- Congenital
- Indirect-reducible, resolve 3-6 mos
- Direct hernias-Irreducible, large segment (3 ft), strangulation (emergency)
Caudal abdominal hernia adults
- Acquired indirect hernias
- Irreducible
- Short segment (6 inches)
Caudal abdominal hernia foal-tx
- Dorsal recumbency under GA
- Approaches
- inguinal approach +/- castration
- midline celiotomy; ring closure
- laparoscopic repair +/- castration - Inguinal
- Locate tunic and contents
- twist
- closed castration
- +/- external ring closure
Ventral Midline hernias etiology
- Inadequate healing of previous incision
2. Excessive strain
Ventral midline hernias types
Acute total
Chronic insidious
Acute total dehiscence
First 4-7 days post-op Emergency Peritoneal leakage Palpable gaps in abdominal wall Place support abdominal bandage and take to sx
Acute total dehiscence procedure
- Removed devitalized tissue
- Sample for C & S -> Abx tx
- Vertical mattress pattern
- Preplace sutures
- Twist vs tie
Acute total dehiscence post-op
- Compression abdominal bandage, change q 24h, for 30d
- abx
- stage removal wires and stent
Chronic incisional hernia
- Can be managed conservatively
- Establish drainage, find pockets eval linea w/ U/S
- Hernia belt (6-8 months)
Chronic incisional hernia indications for sx
- Chronic incisional hernias
- Large defects
- Previous herniorrhaphy failure
Chronic incisional hernia Types
- Proxoplast-plastic, cheaper
2. Marlex-knitted polypropylene, better
Chronic incisional hernia sx requires
- No infection
2. Skin for primary closure
Chronic incisional hernia sx types
- Retroperitoneal
- Subperitoneal
- Subcutaneous
Pre-pubic tendon rupture etiology
Old mares that have had tons of babies
Prepubic tendon rupture CS
- Lordosis
- Tail head elevation
- Ischial tuberosity elevation
- Ventral edema
- muscle damage
- venous congestions - Crania udder displacement
Prepubic tendon rupture TX
- Supportive care (belly band, NSAIDS)
2. No more breeding
Internal Abdominal Hernia types
- Mesenteric hernias
- Epiploic foramen entrapment
- Gastrosplenic ligament entrapment
- Diaphragmatic hernias
- congenital-ventral diaphragm
- acquired-dorsal diaphragm
Lateral abdominal hernia
It’s a thing, no notes
Parietal Hernia
Parietal hernia with 1/2 bowel in it is a richter’s hernia
-old horse problem
