SA Hernias

Question 1

Give an example of a congenital and acquired hernia

Answer 1

Congenital: umbilical
Acquired: diaphragmatic

Question 2

What is the definition of a reducible, incarcerated and strangulated hernia?

Answer 2

Reducible: can go back into body cavity
Incarcerated: contents of hernia are trapped in hernia
Strangulated: contents are trapped, blood supply is cut off

Question 3

Give some clinical signs of herniation involving the GI tract

Answer 3

Vomiting
Abdominal pain
Toxaemia
Shock

Question 4

Give some clinical signs of herniation involving the bladder/urethra

Answer 4

Dysuria (painful urination)
Abdominal pain
Vomiting
Toxaemia
Shock

Question 5

Which suture material could you use to suture fascia when repairing a hernia and why?

Answer 5

Choose a permanent or slowly absorbed monofilament material eg nylon, PDS, as fascia is slow to heal

Question 6

What is PPDH?

Answer 6

Pericardio-peritoneal diaphragmatic hernia

Question 7

Why are male animals more predisposed to congenital caudal abdominal hernias?

Answer 7

Due to delayed inguinal ring closure associated with testicular descent

Question 8

Why are female animals more predisposed to acquired caudal abdominal hernias?

Answer 8

Effects of oestrogen?

Inguinal canal is wider and has a greater diameter in females

Question 9

How would you diagnose an inguinal hernia from other differential diagnoses eg abscess/lipoma?

Answer 9

Radiography (altered location of abdominal organs, loss of detail of caudal abdominal strip/flank musculature)
Contrast radiography
Ultrasound

Question 10

What passes through the inguinal canal in the male and female?

Answer 10

Female: external pudendal artery and vein. Genitofemoral nerve. (Also caudal superficial epigastric artery and vein)
Male: same, plus spermatic cord

Question 11

How would you perform an uncomplicated hernial repair?

Answer 11

Incise over lateral aspect of swelling
Blunt dissect to expose hernial sac
Reduce hernial contents
Ligate neck of sac close to inguinal ring and amputate
Reduce inguinal ring by suturing

Question 12

Give some post-operative complications following hernial repair surgery

Answer 12

Usual postoperative wound complications plus:
Pain
Haematoma
Seroma
Recurrence

Question 13

How do scrotal hernias occur?

Answer 13

Rare

Defect in vaginal ring allows abdominal contents to protrude into vaginal process beside spermatic cord

Question 14

Give some clinical signs of scrotal hernias

Answer 14

Pain
Swelling
Organ dysfunction

Question 15

Which nerves innervate the levator ani (part of pelvic diaphragm)?

Answer 15

Direct branches of sacral plexus (S3-S5), some innervation from pudendal nerve also

Question 16

What is a perineal hernia?

Answer 16

Failure of muscular pelvic diaphragm to support rectal wall which stretches and deviates
Pelvic and/or abdominal contents protrude between rectum and pelvic diaphragm

Question 17

In which sex are perineal hernias more common and why?

Answer 17

Male entire older dogs, rare in cats and bitches

Due to muscle atrophy (levator ani and coccygeus), hormones, myopathies, prostatic diseases?

Question 18

Give some clinical signs of perineal hernias

Answer 18

Reducible perineal swelling (ventrolateral to anus; disappears when animal defecates)
Constipation/obstipation (severe/complete constipation)
Defecatory/urinary tenesmus
Dysuria (excess straining can push bladder into hernia -> urethral obstruction)

Question 19

What may you find in a perineal hernia?

Answer 19

Prostate
Bladder
Omentum
Small intestines

Question 20

How would you diagnose a perineal hernia?

Answer 20

Rectal examination
Routine haematology/biochemistry and electrolytes (esp if dysuric)
Radiography
Ultrasound

Question 21

Give some post-op complications following perineal hernia surgery

Answer 21

Rectal prolapse
Wound infection
Continued defecatory tenesmus
Faecal incontinence 
Atonic bladder following urethral obstruction/bladder retroflexion 
Recurrence

Question 22

Where would you incise when doing a surgical repair on a diaphragmatic hernia/rupture?

Answer 22

Midline cranial coeliotomy (from umbilicus to xiphoid process -caudal sternum)

Question 23

Why may an incisional hernia occur weeks to years after surgery?

Answer 23

Obesity 
Hypoproteinemia
Chronic steroid treatment
Deep fascial infection
Abdominal distension

Question 24

Why may an incisional hernia occur within 7 days of surgery?

Answer 24

Increased abdominal pressure (eg vigorous activity)
Infection
Chronic steroid treatment
Technical error during wound closure (inappropriate suture choice/placement, entrapment of fat between wound edges)
Poor postoperative care

Question 25

Give some clinical signs of an incisional hernia

Answer 25

Swelling
Oedema/inflammation
Serosanguinous wound discharge
Evisceration

Question 26

What should you do if evisceration occurs following wound breakdown and incisional hernia?

Answer 26

Cover exposed organs with sterile bandage
Elizabethan collar, monitor
Pre-op analgesia, antibiotics, fluid therapy prior to induction
Lavage exposed tissues with large volumes of sterile saline
Open original wound, resect damaged tissues, lavage, close abdomen, drainage?

Question 27

Define a hernia

Answer 27

The protrusion of an organ/part of an organ through a defect in the wall of the anatomical cavity in which it lies

Question 28

What are the 3 parts of a hernia?

Answer 28

Ring: defect in body wall
Sac: tissue covering the herniated contents
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