Hernias and ruptures

Question 1

define hernia

Answer 1

A protrusion of an organ or part of an organ through a defect in the wall of the anatomical area in which it normally lies.

Question 2

define prolapse

Answer 2

A prolapse is the movement of an organ or tissue out of its normal anatomical location, without passing through a deficit in the body wall, often occurring under the influence of significant force

Question 3

what are the aims of hernia surgery

Answer 3

Return hernia content to normal location
Secure closure of neck of sac
Obliterate redundant tissue in the sac
Try to use the patient’s own tissues for repair

Question 4

describe how to diagnose umbilical hernia

Answer 4

palpation

Question 5

describe how to treat umbilical hernia

Answer 5

• Can resolve spontaneously, or be corrected at neutering
  Repair by reducing, incise over hernia, excise sac and repair muscle edges

Question 6

what do we tend to close hernia repairs with

Answer 6

synthetic, absorbable monofilament

Question 7

what can you see if hernia is strangulated

Answer 7

vomiting/abdominal pain

Question 8

when do incisional hernias occur

Answer 8

Surgical closure of body cavity fails
Generally linea alba
Normally within 7 days
Can be chronic

Question 9

describe how to investigate incisional hernias

Answer 9

palapation
radiography or US

Question 10

describe how to treat incisional hernia

Answer 10

repair ASAP
Lavage and resect nonviable
Re-open and repair entire wound
Suture EXTERNAL SHEATH OF RECTUS ABDOMINIS (strongest holding layer)
Ensure monofilament suture, long lasting and appropriate size

Question 11

describe how to treat traumatic abdominal rupture

Answer 11

same as hernia
Identify free edge of abdominal wall and reattach to cranial pelvic brim if prepubic tendon rupture
Prognosis relates to organs involved

Question 12

what can happen in inguinal hernia

Answer 12

Intestine, bladder or uterus can enter subcutaneous space (in the groin)

Question 13

what is inguinal hernias associated with

Answer 13

obesity and pregnancy
though to be inherited

Question 14

why should you not castrate guinea pig with open method

Answer 14

have large inguinal rings
increases chance of scrotal hernia

Question 15

describe how diaphragmatic ruptures present

Answer 15

generally after trauma
* Pale/cyanotic
* Tachypnoeic/dyspnoeic
* Tachycardic
* Occasional cardiac arrythmias
* Hydrothorax

often incidental finding

Question 16

how do diaphragmatic ruptures occur

Answer 16

Tear in diaphragm allows abdominal content to move into thorax

Question 17

what do you see on radiography with diaphragmatic rupture

Answer 17

○ Loss of diaphragmatic line
○ Loss of cardiac silhouette
○ Presence of gas filled structure in thorax
○ Atelectasis
○ Displaced abdominal organs

Question 18

Describe how to treat diaphragmatic rupture

Answer 18

Stabilise first- O2, IVFT and warm up
Prophylactic antibiotics due to toxin release from organ strangulation
ECG
Only do surgery ASAP- Acute gastric distension- if not do after 24hr

Question 19

which breeds are more likely to get hiatal hernias

Answer 19

Brachycephalic breeds (English bulldog, French bulldog, pug, etc.), Shar pei

Question 20

what do you see with hiatal hernias

Answer 20

Clinically very similar to oesophagitis
○ Regurgitation
○ Hypersalivation
○ Visceral discomfort
Normally thin

Question 21

describe how to diagnose hiatal hernias

Answer 21

radiography- soft tissue opacity in dorso-caudal thorax adjacent to diaphragm
Fluoroscopy
Endoscopy

Question 22

Describe how to treat hiatal hernias

Answer 22

Antacid
Sucralfate
Prokinetic
Antibiotic (if aspiration)

+ surgery

Question 23

what is a Peritoneopericardial diaphragmatic hernia (PPDH)

Answer 23

Congenital communication between pericardial sac and abdomen
Faulty development of septum transversum

Question 24

List the clinical signs seen with PPDH

Answer 24

GI or respiratory signs e.g. v+/d+, anorexia weight loss, wheezing, dyspnoea

Question 25

which breeds tend to be effected by PPDH

Answer 25

weimaraner cocker spaniel

Question 26

describe what you see on radiography with PPDH

Answer 26

enlarged cardiac silhouette dorsally displaced trachea gas opacities in pericardial sac

Question 27

what surgery is used to fix PPDH

Answer 27

Ventral midline coeliotomy Incise sternum if necessary Reduce viscera Suture diaphragm - no need to seperatley close the pericardium

Question 28

What is the difference between a rupture and a hernia

Answer 28

rupture normally has no ring or sac

Question 29

what are the principles of defect closure of a hernia

Answer 29

-Direct opposition if possible -Use holding later -Dont tighten too much to compromise vasculature -Use strong monofilament suture (PDS) -Eliminate dead space

Question 30

How are defects that are too big to be closed by direct oppositon closed?

Answer 30

-Muscle flap -Polypropylene mesh -Omentum

Question 31

what are the clinical signs of an umbilical hernia

Answer 31

Soft painless swelling at umbilicus V+ and abdominal pain if strangulation of bowel

Question 32

What can umbilical hernias contain

Answer 32

Usually fat or omentum Occasionally intestine

Question 33

What are the predisposing factors to incisional hernias

Answer 33

Surgeon Incorrect surgical technique Incorrect suture/pattern Entrapped fat between wound edges Infection Steroid therapy/cushings patient Poor post op care

Question 34

what is the holding layer in linea alba closure

Answer 34

external rectus sheath

Question 35

what are traumatic abdominal ruptures commonly caused by

Answer 35

blunt trauma bite

Question 36

What is the typical signalment for non traumatic inguinal hernias

Answer 36

-Intact female middle aged dogs -<2yr male dogs -Small breeds

Question 37

What types of tears of the diaphragm can result in diaphreagmatic hernia?

Answer 37

radial circumferential

Question 38

What do you have to ensure takes place when performing diaphragmatic rupture surgery?

Answer 38

IPPV- open chest surgery

Question 39

List the clinical signs of a chronic diaphragmatic rupture

Answer 39

exercise intolerance dyspnoea vomiting weight loss

Question 40

How is hiatal hernia treated surgically

Answer 40

-Ventral midline coeliotomy -Reduce hernia a oesophageal hiatus and close -Pexy oesophagus to diaphragm -Pexy stomach to body wall

Question 41

describe a reducible hernia

Answer 41

is a hernia in which the contents of the hernial sac can be returned to their normal position

Question 42

describe a non-reducible hernia

Answer 42

ring has closed behind the herniated tissue and it can not be easily replaced