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Small animal (fourth year) > Soft tissue surgery (hernias) > Flashcards

Soft tissue surgery (hernias) Flashcards

1
Q

what is a hernia?

A

full thickness defect in an anatomical structure allowing protrusion of viscera

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2
Q

what are the 2 components of a hernia?

A

ring (border of defect)
sac (mesothelial layer coating hernia)

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3
Q

what are the types of hernias?

A

internal/external
true/false
spontaneous/acquired
reducible/incarcerated/strangulating

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4
Q

what is a true hernia?

A

hernia through an existing anatomical opening

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5
Q

what is a false hernia?

A

hernia through a rupture/trauma (opening that should be there)

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6
Q

what is an incarcerated hernia?

A

one that isn’t reducible through the ring

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7
Q

what are some pathophysiological consequences of hernias?

A

loss of domain
incarceration
strangulation

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8
Q

what does loss of domain mean when describing a hernia?

A

the cavity adapts to lower its volume to having less contents in it so it makes repair harder and increased pressure when put back in (compartment syndrome)

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9
Q

what is the main problem of incarceration?

A

lumen of the herniated structure can become obstructed

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10
Q

what is strangulation of a hernia?

A

loss of blood supply to the herniated structure leading to necrosis and possibly rupture (release of the contents can worsen the condition)

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11
Q

what can cause a delayed strangulating hernia?

A

traumatic hernia ring healing and fibrosis causing constriction to the contents

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12
Q

what should be done to hernia contents of strangulating hernias?

A

resect them if they aren’t viable to prevent the release of toxins

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13
Q

what causes umbilical hernias?

A

an incomplete fusion of the ventral abdominal wall

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14
Q

what are the two types of inguinal hernias?

A

direct and indirect

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15
Q

what is a direct inguinal hernia?

A

herniation through the inguinal ring adjacent to the vaginal process into subcutaneous tissue

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16
Q

what is an indirect hernia?

A

herniation through the inguinal ring into the cavity of the vaginal process

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17
Q

what are some possible causes of weakened/enlarged inguinal rings?

A

oestrogen
malnutrition
obesity (increased intrabdominal pressure)

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18
Q

what type of hernia is a scrotal hernias?

A

indirect inguinal hernia (of male dogs)

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19
Q

are scrotal hernias usually reducible?

A

tend to be incarcerated or strangulated

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20
Q

why are traumatic hernias more prone to adhesions/incarceration?

A

lack a hernia sac due to peritoneal being torn during trauma (ring constricts during healing leading to strangulation)

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21
Q

what causes an incisional hernia?

A

dehiscence of a surgical abdominal wound

22
Q

what may cause dehiscence of a surgical wound leading to herniation?

A

excessive force on inaction (obesity, effusions, straining…)
poor holding strength (delayed healing, poor suturing…)

23
Q

what is a diaphragmatic hernia due to?

A

failure of fusion of transverse septum resulting in midline communication between abdomen and pericardium
blunt force trauma

24
Q

what are possible clinical signs of an umbilical hernia?

A

can be asymptomatic
respiratory - dyspnoea, tachypnoea, cough…
GI signs - anorexia, polyphagia, vomiting…
right sided heart failure (tamponade)

25
Q

how do traumatic diaphragmatic hernias occur?

A

blunt force trauma with the glottis open - increased pleuroperitoneal pressure gradient causing tearing of muscle of diaphragm

26
Q

what is perineal hernias due to?

A

weakness/separation of pelvic diaphragm

27
Q

what is the aetiology of perineal hernias?

A

inherited (certain breeds predisposed)
androgens (more common in older intact males)
relaxin secreted by prostate
tenesmus
neurogenic myopathy

28
Q

what are the clinical signs of perineal hernias/

A

erythema or oedema
constipation
faecal tenesmus/pain on defaecation
flatulence
faecal incontinence
altered ail carriage
dysuria

29
Q

what are the indications for hernia repair?

A

symptomatic (pain, inflammation…)
significant protrusion affecting quality of life
significant risk of incarceration/strangulation

30
Q

what are the goals of hernia repair?

A

ensure entrapped content is viable
released and return viable content
obliterate redundant sac
tension free closure

31
Q

what hernias is a ventral midline coeliotomy indicated for?

A

bilateral hernias
internal abdominal hernias
traumatic hernias
strangulating hernia

32
Q

can can complications associated with hernias be prevented?

A

prepare/stabilise patient
correct predisposing factors
correct surgical technique
good post operative care
rapid treatment/recognition of complications

33
Q

what needs to be checked for in cases of umbilical hernias?

A

other congenital defects (frequently coexist with other defects)

34
Q

how are umbilical hernias treated?

A

small hernia (<3mm) in very young (<6 month old) animals often close spontaneously
neuter animals (inherited)
surgery if risk of incarceration/strangulation

35
Q

how are inguinal hernias treated?

A

ASAP after diagnosis - midline if complicated and over hernia if uncomplicated

36
Q

what should be caught in the suture of an inguinal hernia repair?

A

inguinal ligament, rectus fascia and internal oblique fascia

37
Q

what are some common complications of inguinal hernia repair?

A

infection
haematoma/seroma (because of high movement area)
pain/reluctance to walk
nerve/vessel compression

38
Q

what is the prognosis for inguinal hernia surgery?

A

tend to be good with limited reoccurrence

39
Q

how are traumatic hernias treated?

A

stabilise patient (other injuries are probable)
support hernia with bandage and delay surgery for a few days

40
Q

why is surgery of traumatic hernias delayed a few days?

A

improve blood supply
reduced haemorrhage
resolve oedema
(don’t leave too long as you risk of fibrosis/incarceration)

41
Q

what are the indications for carrying out immediate surgery on a traumatic hernia?

A

if patient can’t be stabilised
if patient deterioration is due to hernia
if hernia is associated with penetrating wound

42
Q

what is the best way to surgically repair an acute traumatic hernia?

A

ventral midline coeliotomy (able to inspect abdominal contents for other injury)

43
Q

how are acute incisional hernias treated?

A

support wound with bandage
(determine cause)
open - reopen original suture if uncomplicated
deride fat/tissue then close again

44
Q

how are chronic incisional hernias treated?

A

conservative - asymptomatic and no incarceration
surgical repair if needed

45
Q

if evisceration occurs due to an incisional hernia, what is the treatment?

A

protect viscera (dressing and collar)
stabilise and repair (may need a drain to be placed)

46
Q

what is the best way to diagnose a peritoneal-pericardium diaphragmatic hernia?

A

thoracic radiography (enlarged/rounded cardiac output and abnormal soft tissue in thorax)

47
Q

how are peritoneal-pericardium diaphragmatic hernias treated?

A

best to do surgery - ventral midline coeliotomy, reduce viscera, close defect and drain air from pericardial sac

48
Q

how do traumatic diaphragmatic hernias often present?

A

tucked up abdomen
reduced heart sounds
borborygmi in thorax
displaced apex beat

49
Q

how long should you wait to repair a traumatic diaphragmatic hernia?

A

until the patent is stable enough for anaesthesia

50
Q

what post operative care do traumatic diaphragmatic hernias need?

A

ICU (complex surgery and often need referral)

51
Q

what is a very good way to diagnose perineal hernias?

A

rectal examination (gap in the muscle) - check for other lesions whilst doing this

52
Q

how are perineal hernias fixed by surgery?

A

internal obturator transposition

Small animal (fourth year) (26 decks)

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