Large Ani. Sx- Equine Male Urogenital 2

drraythe's version from 2016-04-29 14:28

inguinal hernia

Question Answer
CQ: (T/F) In domestic animals, most inguinal hernias are direct hernias.F (most are indirect)
CQ: (T/F) Phimosis is the inability to retract the penis into the prepuceF-- that is paraphimosis
CQ: (T/F) In a stallion, an ischial urethrotomy would commonly be performed with the animal under general anesthesia.F
CQ: (T/F) Most acute irreducible inguinal hernias occur when a stallion is breeding a mare.T
In domestic animals inguinal hernias are usually ___ hernia (direct or indirect?) indirect (as in, go into the scrotum). He says it as: The bowel goes through the vaginal ring
what is an indirect hernia? direct hernia?indirect: The bowel goes through the vaginal ring. Direct: The bowel goes through a break in the peritoneum
what are the three types of hernias equine can get?(1) Acute irreducible inguinal hernias (2) Congenital scrotal hernias of the newborn (3) Chronic reducible inguinal hernia
Acute irreducible inguinal hernias usually happen why?Most commonly a post breeding problem in stallions, Seldom occurs secondary to breeding in other species
what are Signs associated with acute irreducible inguinal hernias?Acute abdominal pain (as with other G.I. obstructions), Careful rectal examination reveals intestine passing through the internal inguinal ring (This can be missed shortly after the hernia occurs). The scrotum it is usually distended and sometimes intestine can be palpated in the scrotum
Congenital scrotal hernias of the newborn--> what usually causes this?Considered an inherited trait so these animal should not not be retained in the breeding herd
what are signs of a congenital scrotal hernia of the newborn?Palpable enlargement of the inguinal area. Intestine can usually be forced back through the enlarged inguinal ring
in foals, what are 3 different ways to go about managing congenital scrotal hernias of the newborn?(1) Many are self correcting in time as a result of increased muscle tone (2) The application of a truss to maintain pressure over the inguinal area is indicated (3) If the hernia persists it must be corrected surgically
how common are congenital hernias in calves? piglets?calves: uncommon. Piglets: Many times noticed at the time of castration--> When holding pigs for castration the application of pressure to the abdomen will force intestine through the inguinal ring and aid in the diagnosis. sx correction indicated
Chronic reducible inguinal hernia--> pros and cons of this hernia?PRO: No immediate danger of strangulation, Repair is elective. CON: Stallions and Bulls have marked reduction in fertility because of increased testicular temperature
why do you want to sx repair chronic reducible inguinal hernias?To maintain fertility (temperature degeneration of testes)
in which sp are hernias thought to be heritable? so what should you do with these animals?In horses and swine... Animals with hernias are usually castrated at the time of repair (if is economically feasible to repair the hernia) (stops passing trait down)
in which sp are hernias not thought to her heritable? so what should you do with these animals?In cattle the problem does not seem to be a heritable so surgical correction is an option.
which type of cattle are more prone to hernias, why?(remember, not heritable in cattle) Bulls with this condition are many times those who have been in show condition prior to entering the breeding herd--> This is thought to be because there has been enough fat in the area to dilate the inguinal canal
which side are cattle more likely to have an inguinal hernia on, and why?It is very rare to see a right sided inguinal hernia in a bull! usually left sided! This is because bulls usually lie down with their right rear leg under them and the left slightly extended and as a result,.the left inguinal ring is distended
3 ddx for inguinal hernias?Periorchitis, Mesothelioma, Hydrocele
in which sp might an inguinal be able to be fixed without sx?In the STALLION, Some hernias can be corrected without surgery if diagnosed and treated soon after they occur.
how can you non-surgically correct an inguinal hernia in the stallion?The testicle is grasped with one hand and traction applied to cause the vaginal tunic to become a rigid tube--> The second hand is placed immediately above the testicle and pressure is applied to force the viscera proximally ( Hands of assistants can be alternately placed to force the viscera proximally). Following epidural anesthesia a hand in the rectum can grasp the intestine proximal to the internal inguinal ring and apply pressure to free the intestine
if you are able to non-surgically correct inguinal hernia in the stallion, what must you do after the procedure?Post correction monitoring is important do determine if blood supply to the bowel is maintained
how do you surgically correct an acute hernia?Open the vaginal tunic and check the viability of the intestine--> (1) If the intestine is not viable: Resection and anastomosis must be performed. Increase the size of the inguinal ring (Best to make a ventral midline incision)--> Pull the intestine into the abdominal cavity--> Perform a resection and an anastomosis (2) If the intestine is viable: It is usually necessary to increase the size of the external inguinal ring to place the intestine back in the abdomen. THEN, CLOSURE: In stallions it is normal to perform a unilateral castration, and completely close the external inguinal ring with suture. (Technique for closure of the external inguinal ring is as described under cryptorchid)
what are the clinical signs of chronic hernias in bulls?An hour glass appearance of the scrotum, Intestine can be palpated in the scrotum
what are the clinical signs of chronic hernias in stallions?Sometimes have recurring digestive problems, Occasionally associated with a slight rear leg lameness
how do you surgically correct a chronic hernia in a stallion?(The approach is the same as for an acute hernia) The common vaginal tunic is dissected from the scrotal fascia--> The testicle and vaginal tunic are twisted to force the intestine into the abdomen--> A ligatures are placed and the testicle and vaginal tunic removed--> The external ring and skin are closed
describe the DIRECT approach of how to sx fix a chronic hernia in a BULLThe involved testicle is usually not removed! A surgical approach is made to the testicle--> The common vaginal tunic is incised and the testicle checked for damage and if adhesions are present they are broken down so that the intestine can be placed in the abdomen--> Sutures are placed through the internal abdominal oblique muscle to close the inguinal canal without producing excessive pressure on the spermatic cord--> The vaginal tunic and skin are sutured
describe the ABDOMINAL approach of how to sx fix a chronic hernia in a BULLAn incision is made through the abdominal wall in the paralumbar fossa on the involved side. The surgeon's arm is introduced and tension applied to the herniated bowel to bring it back into the abdomen. A needle is placed on a long piece of suture and the ends of the suture tied (to form a large loop). The needle is passed through the most anterior aspect of the inguinal ring and brought through the loop (to form a larks head knot). The needle is passed through the edges of the inguinal ring to partially close the ring. The suture is cut and the needle placed on one end of the suture. The needle is passed through the tissue again and the two ends of the suture are tied. The incision in the paralumbar fossa is repaired

Ischial urethrostomy + pararectal cystostomy

Question Answer
what is the indication for a ischial urethrostomy in a male?Removal of urethral or vesicular (bladder) calculi in the male
position/anesthesia for a ischial urethrostomy?Standing with epidural or local
describe the sx technique of an ischial urethrostomy?Pass catheter to identify the urethra--> Midline incision just below the anal sphincter. Sharply dissect between the retractor penis muscles continue through the bulbospongiosus muscle, the corpus spongiosum and urethra. Enlarge the incision to remove the calculi or allow passage of forceps into the pelvic urethra and bladder to remove calculi (Lithiotripsy with shock wave or laser technology can be used to break down the calculi for removal). Bladder and urethra should be flushed to remove all of the fragments. Wound is left to heal as an open wound
when do you do a pararectal cystostomy?An extremely old technique - recently revisited. Worth consideration for large calculi that are too large to remove through an ischial urethrotomy
when is a pararectal cystostomy preferred over a ischial urethrostomy?large calculi that are too large to remove through an ischial urethrotomy. With an abdominal approach (which is always possible) the bladder is quite difficult to get to the body wall incision so that the calculi can be removed without abdominal contamination. The pararectal approach approach ( although a crude technique) is sometimes better
describe the technique for a pararectal cystostomy?Epidural anesthesia--> Remove feces from the rectum-->10 Cm vertical pararectal skin incision between the rectum and the semimembranosus muscle--> Careful blunt and scissor dissection between the semimembranosus muscle and anal sphincter to avoid the pudendal vein and artery and the pudendal nerves--> Surgeon's hand in the rectum forces the calculus back into the retroperitoneal segment of the bladder where a small incision is made in the bladder wall to remove the calculi--> Bladder is thoroughly flushed to remove all fragments--> Incision is left to heal as an open wound
which structures must you be extra careful of when doing a pararectal cystotomy?Internal pudendal Artery, Internal pudendal Vein, Pudendal Nerve