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169 Cards in this Set

  • Front
  • Back
"Which of the following does not belong?"

Hernia
Eventration
Evisceration
Evisceration = the intestines are coming out of the body

Herniation and Eventration = theyre still covered by skin
Whats the key difference between herniation and eventration?
Herniation is thru a natural or acquired OPENING

Eventration is thru a debilitated area of the abdominal wall (due to trauma or surgery)
True or false. Herniated content is lined by peritoneum.
True
Which is more external, a hernial sac or a hernial ring?
The sac protrudes thru the ring so it is more external.
True or false. Eventration can progress into evisceration.
True
Are coercible and incoercible hernias reducible or irreducible?
Reducible! They can be pushed back into the abdominal cavity, its just a matter of whether or not you can get them to stay pushed in.
What are the two types of irreducible hernias?
Incarcerated vs Strangulated
If you have ischemic herniated intestines, what kind of hernia is it?
Irreducible, strangulated hernia
Which is more caudal, the inguinal or femoral ring?
Femoral
True or false. If a $1400 purebred puppy comes in with an umbilical hernia, chances are it has other congenital defects too (because of its stellar breeding, of course)
True
What do you call a hernia that can be reduced but then pops right back out again?
Reducible, incoercible hernia.
Whats an incarcerated hernia gonna be present like on PE?
Youre not going to be able to push its contents back into the abdominal cavity. (but the blood supply is still intact as compared to a strangulated irreducible hernia)
True or false. You should treat umbilical hernias ASAP.
True
HAHA someone pronounce the word "herniorrhaphy" and then telle what the 4 principles are.
1. Return all viable content to the abd cavity
2. Close the inguinal ring
3. Obliterate redundant tissue in the hernial sac
4. Use the patients own tissues whenever possible.
Why do you close the inguinal ring when fixing an inguinal hernia?
To prevent recurrence
What can be mistaken for an inguinal hernia?
A round ligament with lots of fat around it.
What goes thru the inguinal canal in males?
External pudendal vessels and the vaginal process
What goes thru the inguinal canal in females?
External pudendal vessels and round ligament
Whats the dofference between an indirect and a direct inguinal hernia?
Indirect goes theu the vaginal process, whereas a direct creates its own sac.
Which is more common in females, direct or indirect inguinal hernias?
Direct!
Why are direct inguinal hernias more common in females?
Because females dont have a vaginal process or other big opening.
Tru or false. Only males have a vaginal process going theu their inguinal canal.
True
If a dog comes in with an obvious right inguinal hernia, how should you examine him?
Palpate BOTH inguinal rings in dorsal recumbency.

Then, stand the dog up and wheelbarrow him to see if tou can reduce the hernia or not.
(wheelbarrow to put gravity on your side)
Where is the inguinal LN located in relation to the inguinal canal?
Inguinal LN is on the ,edial aspect of the inguinal canal?
How might you tell the difference between an enlarged inguinal LN and an inguinal hernia?
An inguinal hernia usually takes up the whole canal and so can be felt more cranial too. The LN is just on the medial aspect.
How does an abscess present?
Warm, red, smooth, fluid-filled mass
True or false. Mammary neoplasia is a rule out for inguinal hernia because the mammary chain basically ends on top of the inguinal canal.
True
How does a hematoma present?
Black, may be fluid-filled or may be flat
Is fat a normal finding in thinguinal canal?
Yesh
Whats the differnce between eventration and herniation.
Eventration is Thru a weak defective abdominal wall (history of trauma or surgery).

Herniation is thru a natural or acquired opening.
True or false. A uterus can herniate.
True
What are your options to approach bilateral inguinal hernias?
Two inguinal approaches or q ventral midline approach.
Ir you harm a mammary gland during surgical correction of an inguinal hernia, whats the most likely result?
Mastitis
Where would you have a drain exit the inguinal canal?
Medial stifle
True or false. Castration is not usually necessary when repairing an inguinal hernia.
False. Castration is many times necessary.
How do you enlarge the inguinal ring?
In a cranial direction
Why cant you enlarge an inguinal ring in a caudal direction?
Because its against the pubis--theres no room!
Why do you hsve to be careful not to obliterate the entire inguinal ring?
Because the vessels are at the caudal most aspect and you dont want to impair blood flow.
When would you perform a vest over pants aka mayo mattress suture?
When you are putting a thin abdominal wall back together, you may want to overlap the muscle layers for a more secure hold.
After performing a mattress suture to put a thin abdominal wall back together, what would you do next?
Reinfoce the edges with simple continuous suture distal to the edge.
Teue or false. Dont strangulate testicular vessels when closing an orchiectomy.
True
In general, what happens when an open space is created?
It fills with fluid
Whats the point of a drain?
To drain fluid
What is a good alternative to drains?
Walking sutures
True or false. Walking sutures help bring skin edges together without a lot of tension.
True
True or false. If you have to close up a big dead space (such as after mastectomy) you could do walking sutures throughout the area.
True
True or false. There is no increase in recurrence of scrotal hernia whether or not you perform castration aka orchiectomy.
False. Less recurrence of scrotal hernia if you perform orchiectomy.
Whats the definition of femoral hernia?
Protrusion thru femoral canal
Which is more cranial, inguinal or femoral canal?
Inguinal
True or false. An irreducible scrotal hernia is similar to inguinal hernias or inguinal eventration.
True. I dont get it but whatever
How should you plapate for femoral hernia?
With animal held standing on his back legs
What do you have to be really careful of when correcting a femoral hernia?
The femoral artery!
When are antibiotics indicated for post-op hernial repair?
If a hollow organ was entered (intestine, uterus)
When do you give analgesics in relation to surgery (any surgery)?
Before! And after
What kind of diet should a pet be fed after hernial repair?
Soft, low-residue
When is a diaphragmatic hernia considered a truw emergency?
Whwn the stomach is involved.
Whats the definition of a diaphragmatic hernia?
When the continuity of the diaphragm is disrupted, leading to protrusion of abd viscera thru the diaphragm into the thoracic cavity.
There are three types of congenital diaphragmatic hernias. What are they.
1. Pleuroperitoneal
2. Peritoneo-pericardial
3. Hiatal
True or false. Trauma accounts for only a small minority of diaphragmatic hernias.
False it accounts for 93% of diaphragmatic hernias!
What vessel do you have to be careful of when working with the diaphragm?
The caudal vena cava
There are three types of diaphragmatic tears....radial, _______, and combined.
Circumferential
How do you diagnose a diaphragmatic hernia?
History of trauma and CS. (remember the majority of them are going to be caused by trauma)
What are respiratory CS of traumatic diaphragmatic hernia?
Dyspena
Tachypnea
Orthopnea
Cyanosis
What might you hear on thoracic auscultation of a dog with a traumatic diaphragmatic hernia?
Muffled heart sounds (theres abdominal organs between the heart and the chest wall)

Borborygmus
Why is the stomach in the thoracic cavity considered a true emergency?
Because it could dilate, compromising respiration.
Truor false. Adhesions are a concern in diaphragmatic hernias.
True
Do intestines usually remain within the thoracic cavity or go back and forth between it and the abdominal cavity?
Thy usually go back and forth.
Ho might you repair a circumferential tear?
By suturing it around a rib
Where do the pillars of the diaphragm arise from?
Lumbar vertebrae
True or false. Diaphragmatic hernias are often an incidental finding.
True
What side is a pleuroperitoneal hernia on?
The left
Why might a dog with a diaphragmatic hernia have a tucked-up abdomen?
Thes no abdominal viscera in there so she looks skinny.
What hernia might you use fluoroscopy to diagnose?
Hiatal hernia--youll see the esophagus moving
What are 4 radiographic signs of a diaphragmatic hernia?
GILS

Gas-filled viscera in the thorax
Interruption of diaphragmatic outline
Loss of cardiac silhouette
Soft tissue density in the thorax
Whats the heart look like on radiograph?
There is loss of the cardiac silhouette
What 3 things might you hear on auscultation of a thorax if a dog has a diaphragmatic hernia?
Muffled heart and resp sounds

Borborygmus

Tympany on the left side if the stomachs in there
Why are heart and lung sounds muffled with diaphragmatic hernia?
There is fluid or viscera in the pleural space
Why are you hearing borborygmus in the thoracic cavity?
Intestines are in thpleural space
Why might you hear tymapny on the left side of the thorax?
If the gas-filled stomach is in the pleural space
Will you normally see abnormal bloodwork in the case of diaphragmatic hernia?
No
When does surgical correction of a diaphragmatic hernia result in greatest mortality (death)?
Under 24 hours or over a year after occurrence
Why would repairs carried out within th first 24 hours after injury lead to a higher mortality rate?
Diaphragmatic hernia due to trauma....need to stabilize the patient before cutting him
What is the success rate of repair of diaphragmatic hernia if you wait 1-2 weeks?
90% altho you prob dont have to wait that long to do it
Why might you want to wait a few weeks before repairing a diaphragmatic hernia?
The torn edges of the diaphragm will start healing over time, allowing for better handling
True or false. Be careful of using morphine in the repair of diaphragmatic hernia because it could cause respiratory depression.
True, theyre prob already having issues breathing since there are intestines all in the thoracic cavity
Why do you want to avoid over-inflation of th lungs?
Pulmonary re-expansion edema
True or false. A dilating stomach will cause complete and rapid collapse of the lungs.
True! Emergency surgery now!
What is the most common approach to a diaphragmatic hernia repair?
Abdominal approach (rarely have to do paracostal)
When might a ventral midline incision have to be extended with a sternotomy?
If there are adhesions
Do you suture over th convex or concave surface, when repairing diaphragmatic hernia via thoracic approach?
Convex surface (of what i have no idea...sad)
True or false. You are repairing a diaphragmatic hernia via abdominal approach so your patient wont require ventilatory support.
False! You open that abdomen youve created open pneumothorax
For repair of the diaphragmatic hernia, whats your first step after youve opened the abdomen?
Gently retract the herniated viscera back into the abdomen
What do you do if the abd viscera are adhered in the thorax?
Extend your incision cranially (median sternotomy) and break up the adhesions with blunt dissection under DIRECT VISUALIZATION (youre not allowed to do blind dissection)
Where do you begin suturing radial tears?
At the dorsal margin
How do you anchor circumferential diaphragmatic tears?
By suturing around the ribs
What kind of suture do you use for diaphragmatic repair?
Non-abs
Whoch animal will have a more radio-opaque thoracic cavity? One with or without a diaphragmatic hernia?
With. Shoukd be black with air, not gray with soft tissue density.
You just fixed a diaphragmatic hernia! What do you have to place before closing?
Thoracostomy tube of course!
Why do yo have to insufflate th lungs slowly after repairing a diaphragmatic hernia?
To avoid reperfusion injuries, leading to pulmpnary edema
If ypu have a traumatic diaphragmatic hernia and primary closure is not possible, what are your two options?
1. Use a graft
2. Advance the diaphragm
What can you use as an autologous graft to close a diaphragmatic injury?

A synthetic graft?
Fascia lata
Muscular pedicle graft from abdominal wall
Omental pedicle flap

Teflon or Silastic sheeting
You just finished repair of a traumatic diaphragmatic hernia. What four things is your patient at risk for post-op?
Reperfusion injury
Re-expansion pulmonary edema
Hemorrhage
Pneumothorax
What is the prognosis after surgery to repair a traumatic diaphragmatic hernia?
Guarded until 24 hours after the operation, after which he has a 60-90% survival rate =excellent prognosis.
When do most deaths occur in a patient with traumatic diaphragmatic hernia?
Pre-operative, during induction
When is the only time you could use diaphragmatic advancement?
If the trauma was involving the diaphragm under the last 2-3 ribs...nothing more cranial to that.
What has the greatest impact on mortality rate in an animal with a traumatic diaphragmatic hernia?
Pre and post op care (us)
True or false. A paracostal hernia is usually congenital and can coexist with a diaphragmtaic hernia.
False. Usually due to trauma.
How do you diagnose a paracostal hernia?
Youll notice a skin-covered bulge on the side of their body wall. Careful palpation is required.
True or false. A thoracostomy tube is required prior to closing your paracostal hernia repair.
False. And its ok to leave a little air trapped inside when you close.
True or false. Peritoneo-pericardial hernias (PPH) are usually due to trauma.
False. PPHs are always congenital!
What two abnormalities are PPHs associated with?
Cardiac abnormalities and sternal deformities
Soooo whats going on with PPH. Whats not where it belongs?
Abd organs are inside the pericardium = NOT NORMAL haha
True or false. PPH may be assoxiated with abnormal closure of the ventral midline.
Thats what Rex said.
Despite th fact that theres intestine in the freakin pericardium, patients woth PPH might be ________
Asymptomatic!
Tell me four heart thongs about PPH
1. Murmur
2. Right heart insufficiency
3. Muffled heart sounds
4. Low voltage ECG (guess its hard for the electricity to pass thru all that poop)
What three things are PPH associated with?
1. Vemtral or umbilical hernias
2. Cardiac defects
3. Lack of union of thladt sternebra
What are five radiographic findings of a dog with PPH?
1. Enlarged cardiac silhpuette
2. Discontinued ventral diaphragm
3. Gas-filled structures in the pericardial sac might tip ypu off
4. Sternum defects
5. Tracheal elevation
Why tracheal elevation with PPH?
Guess its being pushed up by all that shit in the pericardial sac
Do we normally enter the pleural cavity in repair of a PPH?
No
Do we normally need to place a thoracostomy tube before we close the abdomen after repair of a PPH?
No
What approach do we take to repair a PPH?
Abdominal
What DONT we close during repair of PPH?
The pericardial sac
After relocating the abdominal viscera from the pericardial sac, what do we do?
Debride edges of the defect and close from dorsal to ventral.
If we do enter the pleural cavity (by accident?) during repair of PPH, who has to be ready to do what?
Anesthetist has to be ready to bag
If we have to increase the defect size of our PPH to allow reduction, what do we enter?
The pleural cavity, so make sure to vemtilate the patient, put a thoracostomy tube in, and keep him ICU for 24-48 hrs
Whats the definition of a perineal hernia?
Rupture of the pelvic diaphragm
Signalment of animal with perineal hernia?
8 year old intact male dog with a right sided perineal hernia
What breeds like to get perineal hernias?
GSD
Collie
Boxer
Doxen
Peke
Mutt
What two atrophies can cause perineal hernias?
Neurogenic and senile atrophy
What six things can predispose to perineal hernias?
Neurogenic atrophy
Senile atrophy
Myopathy
Endocrine disorders
Prostatomegaly
Constipation and tenesmus
Why would prostatomegaly cause perineal hernia?
When the prostate enlarges, it moves back and forth on th pelvic diaphragm, causing it to rupture
Whats the brst way to diagnose a perineal hernia?
Good palpation

CS
PE including a rectal exam
Rdiography was bolded whatever that means
US
Hich animal has straiated external and internal anal sphincters?
Cat
What structure does a cat lack (something that assists with repair of a perineal hernia in dogs)
Sacrotuberous ligament
Whats the difference between a real and false diverticle?
Real: the seromuscularis layers separate

False: bleb outside th rectum with all layers intact
True or false. Overzealous perineal urethrostomy is the number one reason for perineal hernia in cats.
True. If you dissect too roughly, you can damage the pelvic diaphragm
What are 4 poophole signs of perineal hernias?
Constipation
Tenesmus
Anal dilatation
Rectal mucosa prolapse
What are the seven CS of perineal hernias?
Inflammation
Edema
Dysuria

Constipation
Tenesmus
Anal dilatation
Rectal mucosal peolapse
Where is the sciatic nerve in relation to the sacrotuberous ligament in dogs?
One cm lateral to the scrotuberous ligament
Whats the clinical significance of the location of th sciatic nerve in relation to the sacrotuberous ligament?
Never pass your suture AROUND the sacrotuberous lg, you have to go THRU it or you might entrap thr sciatic nerve in your ligature.
Why do you catheterize the UB?
To make sure its not herniated
What should you do to prepare the poop chute for perineal hernia repair?
Purse string that anus

Do NOT give an enema or its going to be oozing into your field all surgery YUCK
What are your two surgical options for approach to repair a perineal hernia?
Perineal (sternal with hindlimbs hanging over the back of the table)
How do you keep the tail out of the way for perineal hernial repair?
Wrap a piece of tape around the base (ish) of the tail and tape the ends to the table (more cranially)
Why dont you put a dog on a triangular piece of wood to position him so his rear end is high in the air? (see pic on page 3 of perineal hernia pkt)
Because that wood can damage his femoral nerve = no bueno
To perform a hernial rwpair via a perineal approach, make a straight vertical incision thru the skin, sq, and perineal fascia.
False. Curved, not straight
What nerves and vessels do you have to be careful of when surgically reducing a perineal hernia?
Pudendals!
True or false. Preplace a suture thru the levator muscle and the external anal sphincter.

And then preplace a suture thru the internal obturator and levator muscle.
Apparently true--eh
I th levator muscle doesnt hold the suture, what could you suture instead?
If its a dog, the sacrotuberous ligament, but remember go THRU it, not around it (because of the sciatic nerve)
True false. You suture the perineal fascia.
True
Weres the sciatic nerve in relation to the femur?
Caudal to the greater trochanter
Since we know thr sciatic nerve is CAUDAL to the greater trochanter, and LATERAL to the sacrotuberous ligament, how will we remember what approach is used to fix a sciatic nerve leaion?
Caudolateral approach
True false. If you entrap the sciatic nerve during perineal hernial repair the dog will have crazy pain.
Yes poor thing
Whats the recurrence rate for a perineal hernia after repair?
Up to almost 50% can recur!
True or false. For sciatic nerve lesion, you can do a herniorrhaphy approach.
False
What is a deferentopexy?
Idk putting the vas deferens thru a loop of abdominal wall then tying it to itself or something....its an alternate method of repair for perineal hernia, along with colopexy and cystopexy.
Which would you remove first--a cryptorchid testicle or a scrotal testicle?
Cryptorchid--always do abdominal procedures first, theyre the cleanest and need to be kept sterile!
Which would you work on first--a peritoneal defect or a perineal defect?
Peritoneal--the perineum is dirty!
Whats more common--a perianal adenoma or adenocarcinoma?
Adenomas
Perianal gland adenomas have the opposite signalment of anal sac adenocarcinomas. Explain.
Adenomas = intact male dogs.

ASAs = females and neutered males
True or false. Perianal gland adenomas are more common in dogs than in cats.
True. Cats dont even have perianal glands or cicumanal glands o they dont get this disease.
Do cats have anal sacs?
Yes, and you should hear the lovely noises they make when they have to be expressed
What medication should you treat perianal fistulas with?
Cyclosporine
Whats the difference between an anal sac adenocarcinoma and a perineal hernia?
The adenocarcinoma is harder, irreducible, infiltrates hip miscles and metastasizes
What blood abnormality can anal sac adenocarcinoma cause (corrigan)
HyperCa....paraneoplastic ayndrome
This dog has chronic anal sac problems. He comes in at least twice a month to have them emptied. Last month his parents went on vacation so he had to sit around with full glands and now they are infected. What are our two options?
Medial treatment (infuse antibiotics in thm and give him CCS) or anal sac excision.
What are the two methods of anal sac excision?
Closed and open
What kind of suture pattern do you use to close an open anal sac excision?
Cross mattress sutures, not simple continuous
Is anal sac disease and perianal fistulas the same thing?
No way