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Surgery > Hernias > Flashcards

Hernias Flashcards

1
Q

congenital hernia locations

A
  • umbilical
  • inguinal
  • scrotal
  • femoral
  • peritoneal-pericardial diaphragmatic
  • hiatal
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2
Q

traumatic/acquired hernia locations

A
  • abdominal
  • incisional
  • diaphragmatic
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3
Q

3 parts of the hernia

A
  1. The ring: defect in the wall
  2. The sac: peritoneum lining the hernia contents
  3. Contents: organ/tissue that has moved into the hernia ring
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4
Q

What is a true vs false hernia?

A

True hernia = w/ peritoneal lining

False hernia = no peritoneal lining

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5
Q

why are incarcerated and strangulated hernias considered non-reducible?

A 
Incarcerated = adhesions have formed which prevents reduction
Strangulated = blood supply to a herniated organ is compromised
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6
Q

what makes up the internal inguinal ring?

A

internal abdominal oblique + inguinal ligament + rectus abdominis

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7
Q

what makes up the external inguinal ring?

A

longitudinal slit in aponeurosis + external abdominal oblique muscle

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8
Q

structures in the inguinal canal

A
  • genital branch of genitofermoral a., v., n.
  • external pudendal vessels
  • spermatic cord (m)/ round lig(f)
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9
Q

what other congenital abnormalities are associated with umbilical hernias?

A
  • cryptorchid
  • peritoneal-pericardial diaphragmatic
  • ventricular septal defect
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10
Q

umbilical hernia sx

A
  1. incision avoiding hernia contents
  2. Amputate hernia sac
  3. Reduce contents
    * do at same time as spay/castrate
  4. Close ex. rectus sheath
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11
Q

what dog breed is predisposed to scrotal hernias?

A

chondrodystrophic dogs esp. Shar peis

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12
Q

emergency sx of traumatic hernias is indicated when…

A
  • animal cannot be adequately stabilised due to hernias
  • herniated organs progressively turgid or incarcerated
  • penetrating wounds explored after emergency resus
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13
Q

what is the most important strength layer when closing the ventral abdominal wall?

A

external rectus fascia

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14
Q

77-85% of traumatic diaphragmatic hernias are due to?

A

blunt force - automobile accidents, kicks, falls

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15
Q

PE findings assoc. w/ a diaphragmatic hernia

A
  • resp. signs and exercise intolerance
  • muffled or asymmetric thoracic auscultation
  • hyporesonance (pleural effusion)
  • hyperresonance (gastric tympany)
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16
Q

how can traumatic diaphragmatic hernias lead to cardiac dysrhythmias?

A

ventilation perfusion mismatch

17
Q

all patients experiencing significant trauma should get what radiograph?

A

a lateral thoracic and abdominal rad.

18
Q

radiographic findings w/ thoracic hernia

A
  • partial loss of the normal line of the diaphragm
  • obscured or displaced cardiac shadow
  • abdominal viscera w/in the thoracic cavity
  • cranial displacement of pylorus or duodenum: traction on gastro-hepatic ligament
19
Q

which diaphragmatic muscles are usually ruptured in a thoracic hernia?

A

costal muscles (85% unilateral)

20
Q

what precautions do you have in mind when ventilating a dog w/ chronic diaphragmatic herniation?

A
  • do not force reinflation – barotrauma, re-expansion pulmonary oedema + reperfusion injury risks
  • thus low pressure ventilation
21
Q

approach to repair a thoracic hernia?

A

ventral midline coeliotomy w extension to median sternotomy

22
Q

closure technique of thoracic hernias

A
  • debride sparingly
  • interrupted sutures aid in reconstruction
  • simple cont. pattern best = min. suture materials and fewer stiff cut ends
  • start dorsally and progress ventrally
  • correct pneumothorax w/ thoracostomy tube
23
Q

indications for AB in post-op tx of a traumatic diaphragmatic hernia

A
  • liver herniation

- perforation of the GIT

24
Q

what is a congenital PPDH?

A

congenital peritoneo- pericardial-diaphragmatic hernia

= communication btwn abdomen and pericardial sac

25
Q

concurrent defects assoc. w/ PPDH

A
  • sternal defects
  • cranial midline abdominal wall hernia
  • umbilical hernia
  • intracardiac defects (VSD)
26
Q

breeds predisposed to PPDH

A

Weimaraners and cocker spaniels

27
Q

thoracic rad findings of congenital PPDH

A
  • enlarged cardiac silhouette
  • dorsal elevation of trachea
  • overlap of heart and diaphragmatic borders
  • discontinuity of diaphragm
  • gas-filled structures in pericardial sac
    +/- sternal defects
28
Q

prognosis of PPDH w/ surgical correction

A

excellent UNLESS re-expansion/reperfusion pulmonary oedema (poor)

29
Q

define type 1 hiatal hernia

A

sliding protrusion through oesophageal hiatus of gastroesophageal junction +/- gastric fundus

30
Q

breeds predisposed to hiatal hernias

A

shar peis, bulldogs, brachys

31
Q

CS of hiatal hernias

A
  • regurgitation
  • oesophagitis, megaO
  • v+, haematemesis, anorexia, weight loss (poor BCS)
32
Q

cause of hiatal hernia

A

an anatomical oesophageal hiatal malformation - loose connection w/ diaphragm

33
Q

sx treatment of hiatal hernias

A

dorsal hiatal herniorrhaphy

34
Q

post op support of hiatal hernias

A
  1. Metoclopramide: sensitizes upper GIT to acetylcholine –> inc. prssure of gastro-oesophageal junction + a prokinetic
  2. Erythromycin: increases lower oesophageal sphincter pressure and stim. migrating motility complexes + peristalsis
  3. PPIs
  4. Anti-emetic: maropitant/ondansetron
  5. No food for 12h post op
35
Q

erythromycin dose as GIT support

A

1mg/kg q8h slow IV over 30min

36
Q

metoclopramide dose

A

1mg/kg IV

2mg/kg/hr CRI

Surgery (22 decks)

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