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40 Cards in this Set
- Front
- Back
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What is a hernia
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Protrusion of tissue through a defect in the body wall
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What are the steps in hernial repair
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Incise over ring or sac
Return or resect contents Close hernial ring - use patient's own tissues if possible (primary closure or muscle flap - mesh if too large) |
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What are some diagnostic procedures when hernia is on your differentials list
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Hx - vomiting, straining to urinate/defecate, anuric, dyspneic
Rads - contrast Ultrasound CBC - neutrophilia Chem - elevated liver enzymes, BUN/Creat/K+ |
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What is an incisional hernia
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Most commonly due to surgeon error
Could be due to delayed healing states - cushings, diabetes, hypoproteinemia |
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If we know the patient has a defect that may delay healing what is something we can do
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Use suture that will last for longer peiod of time (PDS or permanent suture material)
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What are some surgeon errors that can result in hernia
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Sutures too far apart, incorrect layers involved in suture, suture not strong enough, suture too close to edge (tear through)
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What are some properties of umbilical hernia
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Congenital, common, rarely a problem, can be fixed at time of neuter/OVH
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When is umbilical hernia a problem
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When really large or incarceration of contents
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What are some aspects of hernial surgery
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Prepare large area, freshen edges of hernia, remove falciform fat, follow a routine closure
may have to enlarge incision to have area large enough to replace contents |
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What are the three F to remember or inguinal hernia
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Fat, Female, Forty
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When must you always inspect the inguinal ring
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any young, vomiting, male dog
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What are some possible differentials for abdominal mass
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Ln, mammary tumor, abscess, always include hernia
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What is an indirects hernia
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Herniation in vaginal tunic
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What is a direct hernia
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Herniation out of ring, swelling next to scrotum
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What are some indications of traumatic herniation
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Bruising, erythema, swelling
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Where should the incision be made when correcting an inguinal hernia
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On the midline
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Once inguinal hernia is visualized what are the steps
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Remove/replace contents, remove protruding sack, close neck of hernial sack, partially close ring
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What is important to remember about the inguinal ring
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It is a natural orifice, we have to leave room for the passage of vessels and nerves when closing (insert instrument up to box lock)
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Do diaphragmatic hernias cause immediate problems
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No, they may not present until something is strangulated or another problem is caused
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What does PPDH stand for
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Peritoneopericardial Diaphragmatic Hernia
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What are two presentation of traumatic diaphragmatic hernia
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Circumferential - ripped from side of wall
Radial - radial pattern from wall toward center |
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What indicates surgery ASAP with an acute hernia
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Once stabilized if the stomach is trapped in the stomach acute hernia is taken to surgery
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What often accompanies acute diaphragmatic hernia
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Pneumothorax - must stabilize for a day or two
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In which direction should diaphragmatic hernias be closed
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Dorsal to ventral
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What can result from pelvic trauma
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Prepubic tendon rupture
General swelling in prepubic region, may be difficult to diagnose due to painand swelling Can have trauma with delayed hernia (shows up days later) |
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Where are perineal hernias normally seen
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Intact older dogs
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What are some clinical signs of perineal hernia
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Tenesmus, perineal swelling, vomiting, stranguria/anuria, collapse/shock
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What are some properties of perineal hernia
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Males at increased risk, decrease # adrogenic receptors - atrophy of levator ani/coccygeus mm
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When is a perineal hernia considered an emergency, what steps are taken
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Urinary obstruction
Catheterize, cystography, US, ECG (hyperkalemic, arrhythmias), drain until stabilized |
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What are some potential complications when repairing a perineal hernia
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Pudendal n damage - incontinence, infection, recurrence, rectal prolapse, sciatic damage
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What are some methods of repairing perineal hernias
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Standar perineal herniorrhaphy (50% recurrence - do not use)
Purse string suture Internal Obturator m Transposition (high success rate - suture internal obturator m to the sphincter, levator ani, and sacrotuberous ligament) |
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What are the boundaries of the inner inguinal ring
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IAO, inguinal ligament, rectus abdominus
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What are the outer inguinal ring boundaries
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Slit in aponeurosis of EAO
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What is a complication of indirect inguinal hernia
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Blood supply to the testicle is compromised - testicular ischemia and necrosis
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What is loss of domain, what is done in this situation to close the linea
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If organs from abdomen are herniated into chest for several years the abdominal/peritoneal cavity would decrease in size = "loss of domain"
Difficult to close incision without too much pressure on sutures, or causing an increase in abdominal pressure = GI becomes ischemic Often place a synthetic mesh over linea to leave room in the abdomen for the organs |
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What is reperfusion injury
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When an organ is suddenly reperfused after being poorly perfused for a period of time a molecular cascade occurs the end production being oxygen radicals that damage phospholipids in cell walls = leaky vessels, pulmonary edema (esp cats = reexpansion edema)
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What does reducible mean
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content can be pushed back to where they are supposed to be
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What does incarcerated mean
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Contents no longer reducible, trapped within hernia
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What does strangulated mean
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Contents no longer viable, cut off blood supply
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On which side are most perineal hernia located
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60% of cases are on the right, can be bilateral
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