Hernias (what ya need to know) Flashcards
When the _____ goes through a hernia it is a MEDICAL EMERGENCY!!! (Surgery now!!!)
Stomach
Which procedure for a perineal hernia has a very low complication rate and lowest rate of occurrence over traditional?
Internal Obturator flap
What is a negative prognostic factor that affects success post op after hernia surgery?
Chronicity
A true hernia contains a ____ sac; False hernias lack it
hernial
Traumatic hernias are initially _____ hernias
false
Uncomplicated irreducible hernia example?
Hernial rings are too small
Complicated irreducible hernia example?
Strangulation or Obstruction
Incarceration is a ______ hernia that MAY lead to _____
Irreducible; strangulation
This is an end stage condition where incarceration obstructs the vascular supply and is indicative of an SX EMERGENCY
Strangulation
What is an example of a congenital hernia?
peritoneopericardial diaphragmatic hernia
What is an example of a acquired hernia?
Traumatic hernia
Loss of domain most commonly happens in the ____
abdomen
What main hernia can cause loss of domain ?
Chronic diaphragmatic
What does loss of domain mean?
Normal location is too small to accomodate reduced contents!!
Loss of domain can lead to this negative syndrome? describe it
Compartment syndrome- increased pressure in the are leading to organs having damage (think femoral fracture) flaps and mesh may be indicated?
The surgical repair of a hernia is known as ______?
Herniorrhaphy
Name the 4 internal hernias?
- Diaphragmatic
- Hiatal
- Mesenteric
- Intercostal
I Hate Memorising Dammit!
Name the 6 External Hernias?
- Paracostal
- Prepubic
- Ventral
- Inguinal
- Femoral
- Intercostal
Pneumonic: Please Put Very Important Factual Information
What are the 4 main principles to Herniorrhaphy?
- Return contents to normal location
- Secure ring closure
- Tension free closure
- Utilize patient tissues
Remember unbearable silly terms
What suture material do we normally use with hernias?
Usually absorbable 2-0 (PDS) lasts a long time!
An open Herniorrhaphy the hernial sac is ______ and ______. What is not necessary and to be avoided?
incised; removed;
Freshening edges by removing the hernial ring is NOT Necessary even in spay!!(unless necrotic don’t do it)!!!!! ** stressed**
A Closed Herniorrhaphy, the sac and contents is _____ without _____ the hernial sac
inverted; opening(w/out opening hernial sac)
What is the most common abdominal hernia and how does it result
Umbilical hernia; failure of fusion of rectus abdominis muscle at the unbilicus
If a dog is <6 months hold how do we treat umbilical hernias versus a dog that is 7 months-8months to a year?
<6 months old- often resolve on their own
7 month-1 year += yields surgical correction
What must you do with umbilical hernias?
Differentiate from cranial abdominal hernias
Breed predisposition for umbilical hernias?
Airdales, Weimaraner,
If we suspect heritable hernias what do we recommend?
neutering
Umbilical hernias are often ______(most common this is what comes through?)
reducible (most common falciform fat or omentum)
What signs will you often have if viscera is entrapped in umbilical hernia?
hard painful, GI signs if obstructed
What main associated congenital defect do we see in males concurring with umbilical hernias?
Cryptorchidism
What size are we concerned with for umbilical hernias?
if less than 3 mm (not going to herniate)
concerned with 2.5 cm or large >2.5 cm
What if the size of the umbilical hernia is a finger size? Can we wait to repair?
NOOOOO finger size is size of the intestines! DO NOT WAIT SX NOWWWW
Incarcerated umbilical hernias what is our approach?
Enlarge the ring and dissect the sac free then examline contents
What is a major pathogenesis risk factor for inguinal hernias?
Obesity!! due to increased pressure (also estrogen influence, estrus, pregnancy-acquired inguinal hernia)
Describe what an indirect inguinal hernia passes through and an example?
Indirect passes through the vaginal process (not through inguinal mm) (more common)
Ex: scrotal hernia in intact male dogs
Describe what an direct inguinal hernia passes through and an example?
Passes through inguinal MM (less common)
Describe who we often see with congenital inguinal hernias??
Young intact male dogs <2 years old from delayed inguinal ring narrowing from late testicular desent
Describe who we often see with acquired inguinal hernias??
Middle aged intact overweight females (common)shorter and larger inguinal canal
Unilateral inguinal hernias more often take place on the ____ side
left
What is a major complication and why in inguinal hernias?
Major complication due to dead space was seroma and hematomas!
Describe the approach to inguinal hernias in the male versus the female? How do we close
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
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.
Umbilical; weakness of vaginal ring orifice; unilateral; cryptorchid; painful; castration
Dog bites often result blunt trauma which cause this type of hernia?
Traumatic Abdominal hernia
With Traumatic Abdominal hernia, what is your number one thing you do first
Stabilise them and wait!!! Give them some time so inflamm and swelling goes down.
Radiograph bulging mass what do you think it is? Why do we see the bulge?
matic Abdominal hernia
loose abdominal strip
How do we repair a ACUTE traumatic Abdominal hernia versus a CHRONIC one?
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)
What is the most important thing to remember when doing surgery on prepubic tendon ruptures? What often causes theM
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
When do acute versus chronic incisional hernias usually occur and what characterises the acute (time and something else)
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
What is the main cause on incisional hernias?
inappropriate surgical technique
How can we often diagnose incisional hernias?
SS fluids or Ultrasound/rads
-U/S you can follow the wall and look for disruption
WHat is your apporach to incisional hernias and what type of suture)
use the original incision line; long lasting sutures PDS but NON ABSORBABLE
With Perineal hernias, the cause is often weakness and separation of the _____ ______ components and allows _____ and rectal deviation
Pelvic diaphragm; dilation
Where is the most common defects perineal hernia?
Caudal (involving the levator ani and external anal sphincter, and internal obturator
Perineal hernias are often seen with this signalment an are either uni or bilateral????
Intact male 90 % (uni or bilateral) with concurring prostatic disease (why they strain to defecate)
What are the common signs of perineal hernias? What commonly happens with 20-30%?
Tenesmes(and constipation) from swollen prostate on colon
Perineal swelling
20-30% commonly have bladder retroflexion (dysuria)
What indicated a non reducible mass in perineal hernias?
A firm painful mass indicating strangulation (can’r reduce)
What is treatment of choice for perineal hernias and what is the goal? What do we do in recovery?
Surgery is the TOC***** goal is to promote regular defecation (may need to implement stool softener and high fiber diet while recovering)
In perineal hernias….what indicates an emergency case!!!! What can it lead to?
Bladder retroflexion because it can lead to urethral obstruction (see azotemia)
WHat do we tell owners preoperatively with perineal tumors and whY?
Fast the night before, no enema within 24 hours because working in a liquid fecal env then!! increase risk of infection
What type of classification is perineal hernia surgery (clean, clean contam, contam, or dirty) so what do we do when we do surgery
Dirty!!! presence of fecal material! give empirical prophylactic ab
What consideration do you need to think about with sutures near the sacrotuberous ligament?
Suture THROUGH not around bc could entrap sciatic
What is the most common procedure we perform with perineal sx?
Internal obturator muscle TRANSPOSITIONAL FLAP bc much less incidence of recurrence (better tissue strength, if you did traditional its poor tissue strength)
If Perineal surgery fails what do we consider?
Pexy procedure Cystopexy or colopexy
Post operative what do you want to check for in terms of sutures for perineal hernias? What happens if they are in there?
Perform a rectal and feel closed wall, with NO SUTURE in the rectum, if sutures through the rectal wall will cause tenesmes
When do we see perineal hernias in cats? Uni or Bilateral often?
Rare but indicated in cats with megacolon (straining) most are bilateral
