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Hernias Flashcards

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1
Q

5 different types of abdominal hernias classified by anatomical site

A
  1. Umbilical
  2. Ventral midline (incisional)
  3. Lateral abdominal
  4. Diaphragmatic (internal abdominal)
  5. Caudal abdominal (inguinal
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2
Q

3 categories of hernia

A

Reducible

Incarcerated (non-reducible)

Strangulated

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3
Q

3 anatomical portions of a hernia:

A

Ring, sac, and contents

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4
Q

Describe a True vs a False Hernia

A

True hernia = opening through normal aperture containing a complete peritoneal sac = INDIRECT hernias

False - do not contain a complaete peritoneal sac, usually created by trauma or after breakdown of surgical entry = DIRECT hernias

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5
Q

Two different epidemiologies of hernias:

A

congenital or aquired

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6
Q

T/F: A true hernia is an indirect hernia without a complete peritoneal sac.

A

F, it has a complete peritoneal sac

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7
Q

What term is preferred over “direct” hernia in a horse?

A

Inguinal rupture.

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8
Q

Most commontype of inguinal hernia in horses?

Most common type of hernia in general?

A

Indirect (true) inguinal hernia

Umbilical hernia

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9
Q 
Equine breed dispositions for inguinal hernias
1.
2.
3.
4.
A

Draft breeds
American saddlebreds
Standardbreds
Andalusians

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10
Q

Inguinal hernias are (common/rare) in geldings?

A

rare

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11
Q

Congenital Inguinal Hernias:

1 usually (unilateral/bilateral)?

2 (young/old) affected?

3 Typical end result?

A
  1. unilateral
  2. young - colts.
  3. resolve spontaneously around 3-6 months
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12
Q

Treatment for Congenital inguinal Hernia?

A

Confine to box stall, instruct owner to reduce it several times a day.

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13
Q

Ruptured inguinal hernia:

Occurs when?

3 common signs?

A

4-48 hours after birth in foals

Intermittent colic, depression, severe scrotal/preputial swelling

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14
Q

Adult vs Foal Inguinal Hernia

Adults are usually:

  1. (acquired/congenital)?
  2. (reducible/non-reducible)?
  3. CS: (painful/non-painful?
A
  1. acquired
  2. non-reducible
  3. painful = mild-severe colic
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15
Q

Adult vs Foal Inguinal Hernia:

Foals:
1 (acquired/congenital)?
2. (reducible/non-reducible)?
3. (painful/non-painful)?

A
  1. congenital
  2. reducible
  3. Non-painful
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16
Q

DDX for inguinal hernias in stallions

1.
2.
3.
4.
5.
A
  1. testicular thrombosis
  2. Seroma or hematoma of the scrotum
  3. Neoplasia
  4. Spermatic cord torsion
  5. orchitis
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17
Q

Clinical signs of inguinal hernia

  1. Scrotum appearance?
  2. Testicle palpation reveals…
A
  1. swollen

2. often cool d/t vascular compromise

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18
Q

Inguinal Hernia - Type/Contents:

Most commonly what parts of the intestines?

A

distal jejunum and ileum

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19
Q

Inguinal Hernia - Type/Contents:

Equine inguinal hernias are usually (true/false) hernias?

A

True (or indirect)

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20
Q

Inguinal Hernia - Type/Contents:

Contents pass through ______ into ____-

A

vaginal ring into vaginal tunic

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21
Q

Inguinal Hernia - Type/Contents:

Size of external inguinal ring (is/is not) relevant to development of inguinal hernia?

A

IS NOT

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22
Q

When is surgical intervention appropriate for congenital inguinal hernia?
1.
2.
3.

A
  1. Failure to resolve on it’s own

2 . Enlargement

  1. Rent in vaginal sac has allowed escape into SQ tissue
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23
Q

surgical intervention for acquired inguinal hernia/inguinal rupture/non-reducible hernia?

  1. Usually ______ required
  2. % survival rate?
A
  1. emergency surgery required

2. 76%

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24
Q

Surgical intervention in Congenital Inguinal Hernia:

.What approach is recommended?

A

inguinal approach

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25
Surgical intervention in Congenital Inguinal Hernia: First step is to expose _______ and remove _____
expose tunic and contents, and remove the cremaster muscle.
26
Surgical intervention in Congenital Inguinal Hernia: After removing the cremaster muscle, what do you do?
Twist the testicle and tunic to force contents back to abdomen.
27
Surgical intervention in Congenital Inguinal Hernia: Suture closing pattern?
Close castration with transfixation ligature using 0 PDS, than close external inguinal ring
28
Surgical Management of inguinal hernia - Open Approach What position should animal be in? Anesthetics y/n?
Dorsal recumbancy under general anesthesia
29
Surgical Management of inguinal hernia - Open Approach Incision location?
over superficial inguinal ring
30
Surgical Management of inguinal hernia - Open Approach Transect ______, then.....
Transect scrotal ligament, than milk intestinal contents back into abdomen
31
Surgical Management after Reduction of Intestinal Contents: Three things you must do?
1. Ligate spermatic cord and emasculate to prevent reherniation 2. Close superficial inguinal ring with absorbable monofilament in simple continous or interrupted pattern 3. +/- closure of SQ or skin!
32
Surgical management of inguinal hernia via laparoscope: 1. Use laproscopic instruments to.... 2. Do what with the testis? 3. Close the ____, using....
1. reduce intestinal contents. 2. ligate and remove them 3. deep inguinal ring using laparoscopic stapling devices or sutures
33
Laparoscopic Herniorraphy as tx for Inguinal Hernia: Advantages: 1. 2. 3.
1. Faster 2. Minimal post-op swelling 3. rapid return to normal activity
34
3 techniques that can preserve viable testis during inguinal hernia treatment 1. 2. 3.
1. Partial suturing of cranial aspect of superficial inguinal ring 2. Laparoscopic inguinal herniorrhaphy 3. Peritoneal flap hernioplasty
35
Describe the peritoneal flap hernioplasty procedure to preserve viable testis during treatment of inguinal hernia
Transect peritoneum ventrolateral to vaginal ring on 3 sides, elevate and transpose over the vaginal ring, attach dorsomedially and laterally to abdominal wall.
36
Treatment of Acquired Inguinal Hernia 1st thing to do?
Give IV fluids to stabilize if animal is in shock.
37
Treatment of Acquired Inguinal Hernia Sites to prep for surgery?
Inguinal region AND ventral abdomen**
38
Treatment of Acquired Inguinal Hernia Incise over...
Superficial inguinal ring
39
Treatment of Acquired Inguinal Hernia After incision, open ____ to expose herniated contents and testis
Vaginal sac.
40
Treatment of Acquired Inguinal Hernia After opening vaginal sac....
dilate vaginal ring and apply traction to intestine through celiotomy
41
Treatment of Acquired Inguinal Hernia After dilating the vaginal ring and apply traction to intestines....
R/A of non-viable intestine and removal of affected testis
42
Methods to prevent reherniation after treating acquired inguinal hernia? 1. additionally: 2. 3.
1 ligating spermatic cord during castration 2. pack inguinal cavity with gauze for 24-48 hours post-op 3. Superficial ring closed using heavy absorbable suture
43
Indirect Inguinal Hernia in Cattle: 1. Age affected? 2. Side affected?
Mature bulls Left side
44
Indirect Inguinal Hernia in Cattle: More common in beef or dairy breeds?
Beef, especially hereford
45
Indirect Inguinal Hernia in Cattle: Usually (acute/chronic) in cattle, and leads to:
chronic, | decreased semen quality
46
Indirect Inguinal Hernia in Cattle: Strangulation (rare/common)?
rare, but it does occur
47
Indirect Inguinal Hernia in Cattle: Best way to Dx?
Rectal palpation
48
Direct Inguinal Hernia in Cattle: 1. (Congenital/acquired)? 2. side predilection? 3. Tx?
1. Acquired - Traumatic 2. None 3. Immediate surgery with medical stabilization
49
Which type of hernia in cattle has an "hourglass" appearance associated with it?
Indirect Inguinal Hernias
50
Repair of congenital inguinal hernia in cattle is not recommended unless...
Unless bilateral castration is performed
51
DDx for Scrotal Swelling in Bulls ``` 1. 2. 3. 4. 5. 6. 7. ```
1. Scrotal / Inguinal hernia 2. Fat 3. Abscessation 4. Hydrocele 5. Orchitis 6. Hematoma 7. Mass
52
Surgical Intervention for Inguinal Hernias in Cattle: 1. what position should they be in?
Lateral recumbancy
53
Surgical Intervention for Inguinal Hernias in Cattle: ___ approach over _____
Direct approach over superficial inguinal ring
54
Umbilical hernias in Horses: Most common epidemiology?
Congenital
55
Strangulated Umbilical Hernia: (common/rare)? (non-reducible/reducible)? (non-painful/painful)? (does/does not) have associated colic?
Rare Non-reducible Painful on palpation Does
56
Parietal (Richter) Hernia What is it? When do you suspect it?
Antimesenteric wall of ileum is incarcerated Suspect when hernia becomes firm, non-reducible and painful.
57
Etiologies of Umbilical Hernias 1. 2. 3.
1. Trauma to umbilical cord during birth 2. Excessive straining 3. Umbilical cord infection
58
Umbilical Hernia Etiology 1. Usually (acute/chronic), (small/large) defects. 2. Potential site of _____ 3. What percent of umbilical hernias require emergency surgery?
1. chronic, small 2. bowel incarceration 3. 8-10%
59
Diagnosis of Umbilical Hernia: 1. 2.
1. Digital Palpation | 2. U/S
60
Diagnosis of Umbilical Hernia via palpation Good prognosis if... Bad prognosis if....
Firm/thickened hernia ring Thin/indistinct hernia ring
61
Possible contents of an umbilical hernia: 1. 2. 3.
1. Subperitoneal fat 2. Omentum 3. Viscera - ileum or small intestine
62
T/F: Umbilical hernias are almost always reducible
T
63
Differential Diagnosis for Umbilical Hernia: 1. 2.
1. Umbilical abscessation | 2. Local infection of umbilical structures with concomitant swelling
64
Describe the kind of umbilical hernias in horses should you treat conservatively? Why is it ok to treat these conservatively?
hernias < 5cm in diameter and are reducible they usually close spontaneously as the foal matures
65
Umbilical Hernia - Surgical Treatment: When to perform? 1. 2. 3.
1. Not spontaneously resolving by 4 mos of age 2. Hernia > 10 cm diameter 3. Increased risk of strangulation
66
Surgical treatment of umbilical hernia in foals: 1. DO NOT USE _____ 2. ______ is reccomended
1. Hernia clamp | 2. Direct surgical repair
67
Surgical treatment of umbilical hernia in foals: What position should they be in?
Dorsal Recumbency
68
Surgical treatment of umbilical hernia in foals: Incision?
Make elliptical incision around hernia, removing skin and loose SQ. Sharp dissection to expose rectus abdominal m.
69
Surgical treatment of umbilical hernia in foals: What are you doing if it's a closed procedure?
Inverting hernial sac and repairing hernia.
70
Open surgery method for treatment of umbilical hernia in foals: 1. Incise.... 2. caution with...
1. hernial sac along edge of ring | 2. umbilical remnants
71
Open surgery method for treatment of umbilical hernia in foals: How do you close the body wall?
simple continous pattern with absorbable suture
72
Strangulated Umbilical herniorrhapy 1. ____ approach (cranial/caudal) to ring.
celiotomy | cranial
73
Stragulated Umbilical herniorrhapy What are you doing to the lesion? May require...
En block resection R&A
74
Umbilical hernia in foals: Aftercare 1. 2.
1. Abdominal support bandage for 48 hours to reduce edema and decrease dead space 2. Confine to box stall 30-45 days
75
5 categories of Umbilical Hernias in Calves ``` 1. 2. 3. 4. 5. ```
1. Uncomplicated hernias 2. Hernias with SQ infection/abscessation 3. Hernias with infection of umbilical remnant 4. Umbilical abscesses/chronic omphalitis 5. Urachal cysts/ruptures
76
Most common birth defect in cattle?
Uncomplicated umbilical hernias
77
Uncomplicated Umbilical Hernia - Calves Most common in (beef/dairy) breeds? What breed specifically?
Dairy Holstein-Friesian
78
Uncomplicated Umbilical Hernia - Calves Hernial sac most commonly contains ____
abomasum
79
Uncomplicated Umbilical Hernia - Calves Excellent prognosis for.... Decreased prognosis if....
simple hernia repair infected umbilical remnants
80
Umbilical Abscess in Calves CxS similar to hernia because...
Umbilical area is enlarged.
81
Umbilical Abscess in Calves How would you confirm that it's a hernia and not an abscess?
Visual inspection, palpation, presence of hernial ring with reducibility of contents, U/S
82
When to conservatively treat uncomplicated hernias in Calves: 1. 2. 3.
1 < 5 cm 2. Reducible 3. No hx or evidence of infection
83
Options for conservative treatment of uncomplicated hernias in calves 1. 2. 3.
1. hernial clamps 2. elastrator bands 3. abdominal support bandages
84
Umbilical infection in calves: 1. (common/rare)? 2. ID via....
1. common | 2. Via Palpation. Hernia will be reducibile dorsally. Infection will be a non-reducibile ventral mass adhered to skin.
85
Treatment of choice for umbilical infections in calves
Surgical removal of infection with herniorrhaphy
86
Pre-op management of Umbilical infections: 1. 2. 3.
1. Culture/sensitivity 2. Drain any large abscess 3. Antibiotics (penicillin)
87
Post-Op complications of herniorrhaphy: 1. More common in (foals/calves)? 2. (foals/calves) more commonly have concurrent infections
Calves Calves
88
Incision complications from Herniorrhaphy 1. 2. 3.
1. Abscess 2. Seroma/hematoma 3. Dehiscence
89
Umbilical infection in calves: Treatment method?
Open herniorrhaphy
90
Umbilical infection in calves: Most commonly infected remnant?
Urachus
91
Herniorrhaphy as Tx for Umbilical infection in calves Three main Steps:
1. Ligate umbilical aa and v 2. remove apex of urinary bladder 3. complete herniorrhaphy routinely

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