Hernias

Question 1

hernia

Answer 1

defect in the wall of a body cavity that allows protrusion of an organ

named by location of the defect

Question 2

external hernias

Answer 2

defects in the external body wall

Question 3

internal hernias

Answer 3

defects in the internal diaphragm

Question 4

causes of hernias

Answer 4

1. congenital
2. acquired/degenerative
3. traumatic
4. incisional (postoperative)

Question 5

reasons to treat a hernia

Answer 5

1. pain
2. damage to viscera
3. risk of incarceration, strangulation, necrosis of herniated viscera
4. adhesion formation

Question 6

what are the 3 Rs of hernia treatment

Answer 6

reduction
repair
recurrence

Question 7

reduction

Answer 7

reposition the herniated contents into normal anatomic location and inspect for damage

Question 8

repair

Answer 8

closing the defect

requires knowledge of normal anatomy

Question 9

recurrence

Answer 9

prevent recurrence by using good surgical technique

want a strong repair with appropriate materials and lack of tension

Question 10

biologic repair

Answer 10

using native tissues without foreign material (except suture)

maximizes blood supply and minimizes risk of infection

Question 11

synthetic repair

Answer 11

using polypropylene mesh sutured into the defect to prevent recurrence

used when native tissues are not adequate/viable for reconstruction

increases risk of SSI

Question 12

what type of closure is used for hernia repair

Answer 12

slowly absorbable or nonabsorbable monofilament

PDS or nylon/prolene

Question 13

causes of umbilical hernias

Answer 13

congenital and/or heritable

usually seen in young patients

Question 14

how to diagnose an umbilical hernia

Answer 14

soft ventral abdominal mass at umbilical scar

Question 15

repair for an umbilical hernia

Answer 15

+/- requires surgical repair depending on size

reduce contents and appose abdominal wall margins

Question 16

cause of incisional hernias

Answer 16

dehiscence of previous surgical wound

can occur anywhere there has been surgical invasion

Question 17

what layer fails to cause an incisional hernia

Answer 17

ventral sheath of the linea alba

Question 18

internal vs external incisional hernia

Answer 18

internal: skin incision remains intact

external: skin incision also dehisces causing extravasation of viscera

Question 19

cause of traumatic hernia

Answer 19

blunt trauma to caudal abdominal wall or paracostal area

Question 20

diagnosis of traumatic hernias

Answer 20

radiographs - ID discontinuity of abdominal or thoracic wall

Question 21

causes of inguinal hernias

Answer 21

congenital
traumatic
degenerative

viscera herniates through the internal and external inguinal rings

Question 22

repair of inguinal hernia

Answer 22

celiotomy +/- over the hernial sac

enter ventral midline and pull contents back through the suture down canal

must leave enough room for normal structures to pass through

use 1-2 non absorbable sutures in the muscle

Question 23

what are the openings into the diaphragm

Answer 23

• caval foramen
• esophageal hiatus
• aortic hiatus
• central tendon

Question 24

cause of diaphragmatic hernias

Answer 24

blunt trauma w/ the glottis open –> generates pressure gradient between the chest and abdomen

most ruptures occur in costal muscles

Question 25

types of tears in the costal muscles

Answer 25

radial tears: most common, tears occur along the fibers of the costal muscles

circumferential tears: avulsion of the muscle from the body wall

Question 26

diagnosis of diaphragmatic hernia

Answer 26

thoracic radiographs or ultrasound

clinical signs may be present or absent

Question 27

what radiographic sign indicates emergent surgery

Answer 27

gas filled viscera

will cause necrosis of the viscera

Question 28

repair of the diaphragmatic hernia

Answer 28

ventral midline celiotomy
- retract abdominal viscera back into abdomen
- inspect herniated viscera
- primary closure of defect

Question 29

what suture type should be used to repair diaphragmatic hernia

Answer 29

2-0 to 3-0 slowly absorbable or non absorbable suture

do NOT trim edges of the hernia - want greater holding ability of scar tissue
- may require mesh closure if primary is not possible

Question 30

what is a primary postoperative concern after a diaphragmatic hernia repair

Answer 30

thoracic drainage
- patient MUST be on a ventilator during surgery due to open connection of thorax and abdomen
- need to remove all air from thorax before closing

Question 31

cause of pericardio-peritoneal diaphragmatic hernia

Answer 31

failure of embryological fusion of ventral diaphragm
- causes communication between the peritoneal and pericardial sac WITHOUT entering the thorax

most common in CATS

Question 32

diagnosis of PPDH

Answer 32

thoracic radiographs or US

clinical signs are nonspecific

Question 33

repair of PPDH

Answer 33

surgical repair is controversial - many PPDHs are incidental and asymptomatic

Question 34

cause of perineal hernias

Answer 34

congenital
acquired/degenerative

causes pelvic +/- some abdominal organs to pass into the sac

occurs most commonly in uncastrated male dogs

Question 35

diagnosis of perineal hernia

Answer 35

PE - rectal palpation
abdominal radiographs
US

CS: straining to defecate

Question 36

repair of perineal hernias

Answer 36

requires surgical repair
- elevation of the internal obturator to create a flap
- may need a mesh repair

medical management is unsuccessful