Soft tissue surgery (hernias)

Question 1

what is a hernia?

Answer 1

full thickness defect in an anatomical structure allowing protrusion of viscera

Question 2

what are the 2 components of a hernia?

Answer 2

ring (border of defect)
sac (mesothelial layer coating hernia)

Question 3

what are the types of hernias?

Answer 3

internal/external
true/false
spontaneous/acquired
reducible/incarcerated/strangulating

Question 4

what is a true hernia?

Answer 4

hernia through an existing anatomical opening

Question 5

what is a false hernia?

Answer 5

hernia through a rupture/trauma (opening that should be there)

Question 6

what is an incarcerated hernia?

Answer 6

one that isn’t reducible through the ring

Question 7

what are some pathophysiological consequences of hernias?

Answer 7

loss of domain
incarceration
strangulation

Question 8

what does loss of domain mean when describing a hernia?

Answer 8

the cavity adapts to lower its volume to having less contents in it so it makes repair harder and increased pressure when put back in (compartment syndrome)

Question 9

what is the main problem of incarceration?

Answer 9

lumen of the herniated structure can become obstructed

Question 10

what is strangulation of a hernia?

Answer 10

loss of blood supply to the herniated structure leading to necrosis and possibly rupture (release of the contents can worsen the condition)

Question 11

what can cause a delayed strangulating hernia?

Answer 11

traumatic hernia ring healing and fibrosis causing constriction to the contents

Question 12

what should be done to hernia contents of strangulating hernias?

Answer 12

resect them if they aren’t viable to prevent the release of toxins

Question 13

what causes umbilical hernias?

Answer 13

an incomplete fusion of the ventral abdominal wall

Question 14

what are the two types of inguinal hernias?

Answer 14

direct and indirect

Question 15

what is a direct inguinal hernia?

Answer 15

herniation through the inguinal ring adjacent to the vaginal process into subcutaneous tissue

Question 16

what is an indirect hernia?

Answer 16

herniation through the inguinal ring into the cavity of the vaginal process

Question 17

what are some possible causes of weakened/enlarged inguinal rings?

Answer 17

oestrogen
malnutrition
obesity (increased intrabdominal pressure)

Question 18

what type of hernia is a scrotal hernias?

Answer 18

indirect inguinal hernia (of male dogs)

Question 19

are scrotal hernias usually reducible?

Answer 19

tend to be incarcerated or strangulated

Question 20

why are traumatic hernias more prone to adhesions/incarceration?

Answer 20

lack a hernia sac due to peritoneal being torn during trauma (ring constricts during healing leading to strangulation)

Question 21

what causes an incisional hernia?

Answer 21

dehiscence of a surgical abdominal wound

Question 22

what may cause dehiscence of a surgical wound leading to herniation?

Answer 22

excessive force on inaction (obesity, effusions, straining…)
poor holding strength (delayed healing, poor suturing…)

Question 23

what is a diaphragmatic hernia due to?

Answer 23

failure of fusion of transverse septum resulting in midline communication between abdomen and pericardium
blunt force trauma

Question 24

what are possible clinical signs of an umbilical hernia?

Answer 24

can be asymptomatic
respiratory - dyspnoea, tachypnoea, cough…
GI signs - anorexia, polyphagia, vomiting…
right sided heart failure (tamponade)

Question 25

how do traumatic diaphragmatic hernias occur?

Answer 25

blunt force trauma with the glottis open - increased pleuroperitoneal pressure gradient causing tearing of muscle of diaphragm

Question 26

what is perineal hernias due to?

Answer 26

weakness/separation of pelvic diaphragm

Question 27

what is the aetiology of perineal hernias?

Answer 27

inherited (certain breeds predisposed) androgens (more common in older intact males) relaxin secreted by prostate tenesmus neurogenic myopathy

Question 28

what are the clinical signs of perineal hernias/

Answer 28

erythema or oedema constipation faecal tenesmus/pain on defaecation flatulence faecal incontinence altered ail carriage dysuria

Question 29

what are the indications for hernia repair?

Answer 29

symptomatic (pain, inflammation...) significant protrusion affecting quality of life significant risk of incarceration/strangulation

Question 30

what are the goals of hernia repair?

Answer 30

ensure entrapped content is viable released and return viable content obliterate redundant sac tension free closure

Question 31

what hernias is a ventral midline coeliotomy indicated for?

Answer 31

bilateral hernias internal abdominal hernias traumatic hernias strangulating hernia

Question 32

can can complications associated with hernias be prevented?

Answer 32

prepare/stabilise patient correct predisposing factors correct surgical technique good post operative care rapid treatment/recognition of complications

Question 33

what needs to be checked for in cases of umbilical hernias?

Answer 33

other congenital defects (frequently coexist with other defects)

Question 34

how are umbilical hernias treated?

Answer 34

small hernia (<3mm) in very young (<6 month old) animals often close spontaneously neuter animals (inherited) surgery if risk of incarceration/strangulation

Question 35

how are inguinal hernias treated?

Answer 35

ASAP after diagnosis - midline if complicated and over hernia if uncomplicated

Question 36

what should be caught in the suture of an inguinal hernia repair?

Answer 36

inguinal ligament, rectus fascia and internal oblique fascia

Question 37

what are some common complications of inguinal hernia repair?

Answer 37

infection haematoma/seroma (because of high movement area) pain/reluctance to walk nerve/vessel compression

Question 38

what is the prognosis for inguinal hernia surgery?

Answer 38

tend to be good with limited reoccurrence

Question 39

how are traumatic hernias treated?

Answer 39

stabilise patient (other injuries are probable) support hernia with bandage and delay surgery for a few days

Question 40

why is surgery of traumatic hernias delayed a few days?

Answer 40

improve blood supply reduced haemorrhage resolve oedema (don't leave too long as you risk of fibrosis/incarceration)

Question 41

what are the indications for carrying out immediate surgery on a traumatic hernia?

Answer 41

if patient can't be stabilised if patient deterioration is due to hernia if hernia is associated with penetrating wound

Question 42

what is the best way to surgically repair an acute traumatic hernia?

Answer 42

ventral midline coeliotomy (able to inspect abdominal contents for other injury)

Question 43

how are acute incisional hernias treated?

Answer 43

support wound with bandage (determine cause) open - reopen original suture if uncomplicated deride fat/tissue then close again

Question 44

how are chronic incisional hernias treated?

Answer 44

conservative - asymptomatic and no incarceration surgical repair if needed

Question 45

if evisceration occurs due to an incisional hernia, what is the treatment?

Answer 45

protect viscera (dressing and collar) stabilise and repair (may need a drain to be placed)

Question 46

what is the best way to diagnose a peritoneal-pericardium diaphragmatic hernia?

Answer 46

thoracic radiography (enlarged/rounded cardiac output and abnormal soft tissue in thorax)

Question 47

how are peritoneal-pericardium diaphragmatic hernias treated?

Answer 47

best to do surgery - ventral midline coeliotomy, reduce viscera, close defect and drain air from pericardial sac

Question 48

how do traumatic diaphragmatic hernias often present?

Answer 48

tucked up abdomen reduced heart sounds borborygmi in thorax displaced apex beat

Question 49

how long should you wait to repair a traumatic diaphragmatic hernia?

Answer 49

until the patent is stable enough for anaesthesia

Question 50

what post operative care do traumatic diaphragmatic hernias need?

Answer 50

ICU (complex surgery and often need referral)

Question 51

what is a very good way to diagnose perineal hernias?

Answer 51

rectal examination (gap in the muscle) - check for other lesions whilst doing this

Question 52

how are perineal hernias fixed by surgery?

Answer 52

internal obturator transposition