Umbilical hernia Flashcards
what passes through the umbilical opening
- Umbilical opening: Passage for urachus, umbilical arteries, and umbilical vein
umbilical hernia contents
- perietal peritoneum outpouching through hole in muscle, contains:
- Peritoneal fluid
- Greater omentum
- Small intestine (horses)
- Abomasum
origin of umbilical hernial ring
Defect in Linea Alba
Occurrence & Etiology
- species
congenital: pigs > horses > cattle
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a. In foals, often regress
b. In pigs & calves, often enlarge
umbilical hernia variable characteristics
- Size? > smaller is better
- Inflammatory (heat, pain, redness, discharge) or non-inflammatory? > simple, uncomplicated usually not inflammed
- Contents? (Ultrasound often beneficial)
- Reducible or non-reducible?
non-reducible hernia - why it is like this? complications?
Etiology
* Incarceration
* Adhesions
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Complications
* Obstruction
* Inflammation
* Strangulation
when can we use non-surgical treatments for an umbilical hernia?
- what are examples of these treatments?
reducible and uncomplicated hernias only
- abdominal pressure bandage
- hernia clamp > necrosis and sloughing, then fibrosis across defect
- inject hernial ring with inflammatory agent > foals, small hernias, may close ring
surgical treatment for umbilical hernias, indications
- No spontaneous recovery
- Size increasing
- Non-reducible
contraindications for surgical treatment of umbilical hernias? why?
Animal < 4 wk old, unless non- reducible
* More susceptible to stress of anesthesia
* Give time for spontaneous improvement
* If umbilical infection present, ± treat local infection before surgery
restraint and anesthesia for surgical umbilical hernia repair, options:
- preanesthetic protocol: fast ruminants, but not simple stomach (including calves)
- dorsal recumbecy
- Sedation (xylazine) & local anesthesia: Possible restraint problem compared to general anesthesia (kicking & potential contamination of surgical site)
- General anesthesia:
> injectable (e.g. xylazine (± diazepam) & ketamine)
or
> Inhalation anesthesia preferred (most common method for foals)
umbilical hernia surgical repair incision and dissection methods
- fusiform skin incision
- “Sharp/Blunt” Dissection
umbilical hernia surgical repair techniques - open vs closed, when we use them and why
- Internal Hernial Sac: Excision or Replacement, open vs closed techniques
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Closed technique: - reducible hernias only
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Open technique: - reducible and non-reducible hernias
- usually faster method… good
- +/- better incision healing… good
- enters abdonimal cavity… good or bad
hernia repair surgical technique - closure
Closure of Hernial Ring (Abdominal Wall)
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* Small defect → Mild ↑ tension on suture line
* Primary choice = Simple interrupted sutures.
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Larger defect → ↑↑ Tension
* Usually horizontal or vertical mattress
alternative method for umbilical hernia surgery closure - prosthetic mesh
- types of mesh
- propylene
- nylon
- stainless steel
surgical hernia repair closure of SQ tissue and skin
- Suture pattern(s) & materials appropriate for amount of tension on suture line and other factors + other factors…
> pattern options for SQ and skin
Subcutaneous tissue
* Simple continuous ?
* Simple continuous in multiple segments ?
* Simple interrupted ?
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Skin
* Simple continuous ?
* Simple continuous in multiple segments ?
* Simple interrupted ?
* Tension suture patterns ?
* Staples ?