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6th MELEAH SAS 1 > Hernias (what ya need to know) > Flashcards

Hernias (what ya need to know) Flashcards

1
Q

When the _____ goes through a hernia it is a MEDICAL EMERGENCY!!! (Surgery now!!!)

A

Stomach

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2
Q

Which procedure for a perineal hernia has a very low complication rate and lowest rate of occurrence over traditional?

A

Internal Obturator flap

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3
Q

What is a negative prognostic factor that affects success post op after hernia surgery?

A

Chronicity

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4
Q

A true hernia contains a ____ sac; False hernias lack it

A

hernial

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5
Q

Traumatic hernias are initially _____ hernias

A

false

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6
Q

Uncomplicated irreducible hernia example?

A

Hernial rings are too small

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7
Q

Complicated irreducible hernia example?

A

Strangulation or Obstruction

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8
Q

Incarceration is a ______ hernia that MAY lead to _____

A

Irreducible; strangulation

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9
Q

This is an end stage condition where incarceration obstructs the vascular supply and is indicative of an SX EMERGENCY

A

Strangulation

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10
Q

What is an example of a congenital hernia?

A

peritoneopericardial diaphragmatic hernia

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11
Q

What is an example of a acquired hernia?

A

Traumatic hernia

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12
Q

Loss of domain most commonly happens in the ____

A

abdomen

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13
Q

What main hernia can cause loss of domain ?

A

Chronic diaphragmatic

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14
Q

What does loss of domain mean?

A

Normal location is too small to accomodate reduced contents!!

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15
Q

Loss of domain can lead to this negative syndrome? describe it

A

Compartment syndrome- increased pressure in the are leading to organs having damage (think femoral fracture) flaps and mesh may be indicated?

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16
Q

The surgical repair of a hernia is known as ______?

A

Herniorrhaphy

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17
Q

Name the 4 internal hernias?

A
  1. Diaphragmatic
  2. Hiatal
  3. Mesenteric
  4. Intercostal

I Hate Memorising Dammit!

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18
Q

Name the 6 External Hernias?

A
  1. Paracostal
  2. Prepubic
  3. Ventral
  4. Inguinal
  5. Femoral
  6. Intercostal

Pneumonic: Please Put Very Important Factual Information

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19
Q

What are the 4 main principles to Herniorrhaphy?

A
  1. Return contents to normal location
  2. Secure ring closure
  3. Tension free closure
  4. Utilize patient tissues

Remember unbearable silly terms

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20
Q

What suture material do we normally use with hernias?

A

Usually absorbable 2-0 (PDS) lasts a long time!

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21
Q

An open Herniorrhaphy the hernial sac is ______ and ______. What is not necessary and to be avoided?

A

incised; removed;

Freshening edges by removing the hernial ring is NOT Necessary even in spay!!(unless necrotic don’t do it)!!!!! ** stressed**

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22
Q

A Closed Herniorrhaphy, the sac and contents is _____ without _____ the hernial sac

A

inverted; opening(w/out opening hernial sac)

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23
Q

What is the most common abdominal hernia and how does it result

A

Umbilical hernia; failure of fusion of rectus abdominis muscle at the unbilicus

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24
Q

If a dog is <6 months hold how do we treat umbilical hernias versus a dog that is 7 months-8months to a year?

A

<6 months old- often resolve on their own

7 month-1 year += yields surgical correction

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25
Q

What must you do with umbilical hernias?

A

Differentiate from cranial abdominal hernias

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26
Q

Breed predisposition for umbilical hernias?

A

Airdales, Weimaraner,

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27
Q

If we suspect heritable hernias what do we recommend?

A

neutering

28
Q

Umbilical hernias are often ______(most common this is what comes through?)

A

reducible (most common falciform fat or omentum)

29
Q

What signs will you often have if viscera is entrapped in umbilical hernia?

A

hard painful, GI signs if obstructed

30
Q

What main associated congenital defect do we see in males concurring with umbilical hernias?

A

Cryptorchidism

31
Q

What size are we concerned with for umbilical hernias?

A

if less than 3 mm (not going to herniate)

concerned with 2.5 cm or large >2.5 cm

32
Q

What if the size of the umbilical hernia is a finger size? Can we wait to repair?

A

NOOOOO finger size is size of the intestines! DO NOT WAIT SX NOWWWW

33
Q

Incarcerated umbilical hernias what is our approach?

A

Enlarge the ring and dissect the sac free then examline contents

34
Q

What is a major pathogenesis risk factor for inguinal hernias?

A

Obesity!! due to increased pressure (also estrogen influence, estrus, pregnancy-acquired inguinal hernia)

35
Q

Describe what an indirect inguinal hernia passes through and an example?

A

Indirect passes through the vaginal process (not through inguinal mm) (more common)

Ex: scrotal hernia in intact male dogs

36
Q

Describe what an direct inguinal hernia passes through and an example?

A

Passes through inguinal MM (less common)

37
Q

Describe who we often see with congenital inguinal hernias??

A

Young intact male dogs <2 years old from delayed inguinal ring narrowing from late testicular desent

38
Q

Describe who we often see with acquired inguinal hernias??

A

Middle aged intact overweight females (common)shorter and larger inguinal canal

39
Q

Unilateral inguinal hernias more often take place on the ____ side

A

left

40
Q

What is a major complication and why in inguinal hernias?

A

Major complication due to dead space was seroma and hematomas!

41
Q

Describe the approach to inguinal hernias in the male versus the female? How do we close

A

Male: direct inguinal approach over the hernia usually just unilateral in males

Females: ventral midline approach so you can inspect the other side

Perform one layer closure over the ring

42
Q

Scrotal hernias are a type of indirect _____ hernia seen in young dogs <2 years and are due to. ______ of the ____ _____ _____. They are usually (state bilateral or uni?)There is an increased risk in _____ males. You often see _____ swelling. You should recommend _____ to the owner.

A

Umbilical; weakness of vaginal ring orifice; unilateral; cryptorchid; painful; castration

43
Q

Dog bites often result blunt trauma which cause this type of hernia?

A

Traumatic Abdominal hernia

44
Q

With Traumatic Abdominal hernia, what is your number one thing you do first

A

Stabilise them and wait!!! Give them some time so inflamm and swelling goes down.

45
Q

Radiograph bulging mass what do you think it is? Why do we see the bulge?

A

matic Abdominal hernia

loose abdominal strip

46
Q

How do we repair a ACUTE traumatic Abdominal hernia versus a CHRONIC one?

A

Acute AH Repair: ventral midline to explore the abdomen

Chronic AH Repair: Approach over the hernia because there is less likely to be other injuries unlike the acute (but you can implement both approaches)

47
Q

What is the most important thing to remember when doing surgery on prepubic tendon ruptures? What often causes theM

A

PATIENT POSITIONING

  • dorsal recumency with hindlegs in frog leg position with the pelvis raised on a towel or sand bags
  • Cause: HBC caused pubic fracture and the ligament evulses off and abdominal content is in the SUb Q space
48
Q

When do acute versus chronic incisional hernias usually occur and what characterises the acute (time and something else)

A

Acute Incisional Hernia: < 7 days post op or more commonly within 3-5 days and SEROSANGUINOUS discharge is pretty telling of a hernia present!!

Chronic: weeks, months, to years

49
Q

What is the main cause on incisional hernias?

A

inappropriate surgical technique

50
Q

How can we often diagnose incisional hernias?

A

SS fluids or Ultrasound/rads

-U/S you can follow the wall and look for disruption

51
Q

WHat is your apporach to incisional hernias and what type of suture)

A

use the original incision line; long lasting sutures PDS but NON ABSORBABLE

52
Q

With Perineal hernias, the cause is often weakness and separation of the _____ ______ components and allows _____ and rectal deviation

A

Pelvic diaphragm; dilation

53
Q

Where is the most common defects perineal hernia?

A

Caudal (involving the levator ani and external anal sphincter, and internal obturator

54
Q

Perineal hernias are often seen with this signalment an are either uni or bilateral????

A

Intact male 90 % (uni or bilateral) with concurring prostatic disease (why they strain to defecate)

55
Q

What are the common signs of perineal hernias? What commonly happens with 20-30%?

A

Tenesmes(and constipation) from swollen prostate on colon

Perineal swelling

20-30% commonly have bladder retroflexion (dysuria)

56
Q

What indicated a non reducible mass in perineal hernias?

A

A firm painful mass indicating strangulation (can’r reduce)

57
Q

What is treatment of choice for perineal hernias and what is the goal? What do we do in recovery?

A

Surgery is the TOC***** goal is to promote regular defecation (may need to implement stool softener and high fiber diet while recovering)

58
Q

In perineal hernias….what indicates an emergency case!!!! What can it lead to?

A

Bladder retroflexion because it can lead to urethral obstruction (see azotemia)

59
Q

WHat do we tell owners preoperatively with perineal tumors and whY?

A

Fast the night before, no enema within 24 hours because working in a liquid fecal env then!! increase risk of infection

60
Q

What type of classification is perineal hernia surgery (clean, clean contam, contam, or dirty) so what do we do when we do surgery

A

Dirty!!! presence of fecal material! give empirical prophylactic ab

61
Q

What consideration do you need to think about with sutures near the sacrotuberous ligament?

A

Suture THROUGH not around bc could entrap sciatic

62
Q

What is the most common procedure we perform with perineal sx?

A

Internal obturator muscle TRANSPOSITIONAL FLAP bc much less incidence of recurrence (better tissue strength, if you did traditional its poor tissue strength)

63
Q

If Perineal surgery fails what do we consider?

A

Pexy procedure Cystopexy or colopexy

64
Q

Post operative what do you want to check for in terms of sutures for perineal hernias? What happens if they are in there?

A

Perform a rectal and feel closed wall, with NO SUTURE in the rectum, if sutures through the rectal wall will cause tenesmes

65
Q

When do we see perineal hernias in cats? Uni or Bilateral often?

A

Rare but indicated in cats with megacolon (straining) most are bilateral

6th MELEAH SAS 1 (8 decks)

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