Kapitel 85 - Diaphragmatic Hernias

Question 1

The diaphragmatic muscle is divided into three major parts, name the parts 1, 2 and 3.
The diaphragm has three major openings, name these openings A,B and C.

Answer 1

1 Pars sternalis
2 Pars costalis
3 Pars lumbalis

A Caval foramen
B Esophageal hiatus
C Aortic hiatus

Question 2

The surgical approach of a diafragmatic hernia is a midline celiotomy. Name 3 advantages of this approach? What are 2 disadvantages of this approach

Answer 2

Advantage
1. It allows inspection of all the abdominal viscera
2. provides access to all of the diaphragm
3. Can be extended to a sternotomy for thoracic exposure
4. causes less postoperative pain than a thoracotomy

Disadvantage
1. the diaphragm is viewed from its concave surface, making suturing more difficult
2. adhesions of abdominal viscera to intrathoracic structures may not be easily or safely broken down without enlarging the opening in the diaphragm or extending the celiotomy to a median sternotomy.

Question 3

In case of a lateral diaphragmatic hernia which approach can be performed to inspect the convex pleural surface? Be specific.

Answer 3

9th intercostal lateral thoracotomy

Question 4

Can this lateral approach be used for a peritoneopericardial hernia?

Answer 4

No, this approach is contraindicated (doesnt say why in the book)

Question 5

With traumatic diaphragmatic hernia’s, which muscle is most often ruptured?

Answer 5

Pars costalis

Question 6

Traumatic diaphragmatic hernia’s can be orientated left or right. What percentage is bilateral or multiple?

Answer 6

15%

Question 7

Which statements are true/false?

A. On lateral radiographs the normal diaphragmatic silhoutee has a curved profile, with the dome-shaped cupula in contact with or overshadowing the cardiac silhouette.

B. On lateral radiographs the crura are parallel in left lateral recumbency but cross each other in right lateral recumbency.

Answer 7

A true
B False

Question 8

Atrophy and fibrotic contraction of the chronically torn diaphragm may produce a defect that cannot be closed with sutures.
What are alternative closure options?

Answer 8

With the use autologous tissue:
- Muscle (transversus abdominis, rectus abdominis, latissimus dorsi)
- Fascia
- Omentum

With the use of synthetic implants
- Polypropylene mesh
- Teflon-reinforced silicone sheeting
- Gore tex

With the use of collagenous xenografts
- Lyophilized collagen sheet derived from porcine submucosa

Question 9

A 2 year old cat has been operated after stabilization, because of an traumatic diaphragmatic hernia. There were no abnormalities during surgery. During the recovery the cat becomes hypoxic, what can be causing the hypoxia?

Answer 9

1. hypoventilation because of pain
2. pneumothorax
3. hemothorax
4. tight chest bandage
5. anesthetic agents
6. narcotics
7. reexpansion pulmonary edema
8. abdominal compartment syndrome

Question 10

There appears to be an intra-abdominal pressure of 18mm Hg
You decide to perform non-surgical treatment to provide relief, what are the options?

Answer 10

1. Improve abdominal wall compliance (analgesic therapy)
2. Evacuation of any intraperitoneal (fluid, air) or intraluminal contents (urine, gastric air)

Question 11

The non-surgical therapy does not seem to have an effect, after measuring the IAP again after 4 hours the pressure still is 18mm Hg. You decide to perform surgery to provide relief.
What are the surgical options?

Answer 11

1. Placement of a surgical mesh in the abdominal closure
2. Removal of certain abdominal organs (e.g. spleen)
3. Advancement of the diaphragm
4. Relaxing incisions in the external rectus sheath
5. Leaving the linea unopposed