Smallies 11 Flashcards
What is the treatment for a diaphragmatic hernia?
Oxygen
IVFT and warm up
Surgery
Prophylactic antibiotics due to toxin release from organ strangulation
Discuss the mortality with diaphragmatic hernia surgery
Higher mortality if surgery performed less than 24 hr following injury (also greater than 1-year-old). Give 24 hours to stabilise unless there is acute gastric distention
Why is IPPV essential when doing a diaphragmatic hernia repair?
As soon as you have opened the abdomen you are doing open chest surgery due to the direct communication
What are signsof a perineal hernia?
Bulging perineal area
`Faecal tenesmus/dysuria
What is the common signalment of a perineal hernia?
Normally entire older male but occasionally seen in bitch/cat
What are causes of a perineal hernia?
Progressive weakening of pelvic diaphragm Hormonal influence Tenesmus Congenital/acquired weakness Colitis/prostatomegaly
How can testosterone cause a perineal hernia?
Testosterone causes muscle atrophy which reduces muscular function
What muscles are found in the pelvic area?
Levator ani, coccygeus and external anal sphincter muscles
What can herniate through a perineal hernia?
Pelvic fat, peritoneal fat, prostate and bladder can herniate
What will you feel on rectal examination of a patient with perineal hernia?
Reducible perineal swelling
Absence of pelvic diaphragm on the lateral side of the pelvic rim
What are consequences of bladder retroflexion through a perineal hernia?
Stranguria, Hyperkalaemia, Azotaemia, Avascular necrosis
What is the treatment for a retroflexed bladder through a perineal hernia?
Cystocentesis through perineum if bladder retroflexed and cannot pass urethral catheter
IVFT (check K+ levels if urinary obstruction)
Herniorrhaphy
Preplace sutures in the muscle before you close (using PDS suture material)
Why should you neuter when doing a herniorrhaphy during treatment of a perineal hernia?
Aetiology is related to excess testosterone so neuter during herniorrhaphy
What are complications of perineal hernia surgery?
Faecal incontinence Urinary problems Infection Rectal prolapse Sciatic nerve entrapment Recurrence
Why can you get faecal incontinence after perineal hernia surgery?
Suture placement – anchor sutures through prepubic tendon, if you go around the tendon you could accidentally entrap the sciatic nerve
How can you try to reduce the risk of rectal prolapse after perineal hernia surgery?
Can use local blocks pst surgery to prevent straining post surgery
What breeds are at risk of a hiatal hernia?
Brachycephalic breeds (English bulldog, French bulldog, pug, etc.), Shar pei Congenital defect
What is the clinical presentation of a hiatal hernia?
Clinical presentation very similar to oesophagitis
Regurgitation
Hypersalivation
Visceral discomfort
Cough – excess saliva at the back of the throat
What is included in the diagnostic workup of a hiatal hernia?
Radiography
Fluoroscopy
Endoscopy
What will you see on radiography with a hiatal hernia?
A soft tissue opacity in dorso-caudal thorax adjacent to diaphragm
What is the treatment for a hiatal hernia?
Treat oesophagitis
Surgery
What can you use to treat oesophagitis?
Antacid, Sucralfate, Prokinetic, Antibiotic (if aspiration)
Describe the surgery for the treatment of a hiatal hernia?
Ventral midline coeliotomy
Reduce hernia at oesophageal hiatus and close
Pexy oesophagus to diaphragm
Pexy stomach to body wall if the stomach has also moved into the chest (similar to procedure done for a gastric torsion)
What is a Peritoneopericardial Diaphragmatic Hernia?
Rare congenital communication between pericardial sac and abdomen, due to faulty development of septum transversum
What breeds are predisposed to a Peritoneopericardial Diaphragmatic Hernia?
Weimaraner, Cocker spaniel
What will you see on radiography with a Peritoneopericardial Diaphragmatic Hernia?
Enlarged cardiac silhouette
Dorsally displaced trachea
Gas opacities in pericardial sac – will have small intestine within the pericardium
Describe the surgery for a Peritoneopericardial Diaphragmatic Hernia?
Ventral midline coeliotomy
Incise sternum if necessary
Reduce viscera
Suture diaphragm - no need to separately close pericardium
