SA Sx - Hernias (General)

drraythe's version from 2017-10-10 13:54


Question Answer
What is a hernia?Is the protrusion of the abdominal content incldd in a peritoneal sac through a natural or acquired opening
What's the thing he harps on about what makes a hernia a true hernia?There is a SEROSAL LINING
To be a TRUE HERNIA you need what 4 things?(1) Hernial ring (red)
(2) Hernial sac (blue)
(3) Hernial content (green)
(4) Peritoneal lining (yellow)
What are the 4 types of hernias?True
What is EVENTRATION?The protrusion of the abdominal content through a debilitated area of the abdominal wall due to a surgical or traumatic origin w/ an intact skin (he thinks incisional hernias fall into this category bc no peritoneal lining in incisional hernia)
What is this? How would you classify this? This is a "paracostal hernia" which is a type of EVENTRATION. See some intestine or omentum going into this defect. If take L rad might look like D. hernia, but this is OVER ribcage under skin - SQ hernia. Usually easy to reduce
He considers incisional hernias to be what kinda hernia?Eventration (not really hernia)
Why do paracostal hernias occur?Mm gets ripped off from attachment from ribs, which creates the opening
What is EVISCERATION?The rupture of all the structures constituent of the abdominal wall w/ the protrusion of the visceral content, through a wound or surgical incision
(Mentioned in class) If there is a evisceration & the owner is calling you, what do you tell them to do & what do you do?Tell owners wrap around w/ towel, bring it in, anesthetize animal & wash THOROUGHLY
What are the 2 types of reducible hernias?Coercible vs incoercible
REDUCIBLE hernias → what is a COERCIBLE hernia?The hernial content can be manually reduced & is retained inside the abdominal cavity (you can "pop it back in" & it'll stay there)
REDUCIBLE hernias → what is a INCOERCIBLE hernia?The hernial content can be manually reduced but is NOT retained inside the abdominal cavity (you can "pop it back in" but it wont stay there)
IRREDUCIBLE hernias → what are the 2 types?Incarcerated vs strangulated
IRREDUCIBLE hernias → what is an INCARCERATED hernia?Impossible reduction of the hernia into the abdominal cavity, w/ no alteration yet in the blood supply to the hernial content
IRREDUCIBLE hernias → what is a STRANGULATED hernia?Impossible reduction of the hernia into the abdominal cavity, w/ vascular compromise to the protruded viscera.... ISCHEMIC LESIONS
What are the 7 possible locations of hernias?Ventral
Cranial pubic ligament
Where do ventral hernias occur? What are they due to?Usually occur btwn umbilicus & xiphoid. Tend to occur close to most cr aspect of linea alba bc of xiphoid. Due to abnormal closure on midline - linea alba + diaphragm not closed properly
So a ventral hernia often is near the xiphoid & the diaphragm is often not closed properly. How, then, is it that when you do & OVH w/ a dog w/ a ventral hernia, they don't suffocate?Bc abdomen opens into pericardium, not into thorax, so only pneumopericardium
Which hernia is common in newborns?Umbilical
You should meticulously examine PTxs w/ hernia looking for possible associated congenital defects... what are 6 of these associated defects?(1) PSS (portosystemic shunt - think yorkies)
(2) Cardiac defects
(3) Hypospadia (abnormal urethral opening along urogenital line)
(4) Imperforated anus
(5) Cryptorchidism
(6) Peritoneopericardial diaphragmatic hernia (PPDH)


Question Answer
What are the 4 principals of herniorrhaphy? (4 things you need to do)(1) Return all viable contents to the abd cavity
(2) Close the hernial ring to prevent reoccurrences
(3) Obliteration of redundant tissue in the hernial sac
(4) Use the PTxs own tissues whenever possible (there are options like PDS mesh or special treated fascia lata aka deep fascia of the thigh, but their own tissue is best bc wont be rejected)
2 kinds of umbilical hernias?Reducible or irreducible
What might predispose an animal to an umbilical hernia?Ligating umbilicus too close to abd wall
Things to consider when determining when to go to Sx for umbilical hernia?Small hernia or incomplete?
Vaccination plan?
Stage of hernia?
How do you perform a herniorrhaphy on an umbilical hernia?Elliptical incision around base of hernial sac. Or if smaller - incision right on top of protrusion of the hernia. Then blunt dissection - falciform ligament protruding. Dont snip this - can have vessels there or other structures. Bluntly dissect 360°. Then ligate the little pedicle & close the hole it came from.

What is this?
New material been developed. Place these lines then pull from small loops, bring edges together & maintains edges in apposition. New way of suturing abd wall. Like a zipper.
Where does inguinal hernia occur? (pic)
What are the 2 classifications of inguinal hernias?Direct (B) & indirect (A)
What is going on in an INDIRECT inguinal hernia?This is when the hernia goes into the vaginal process & goes towards scrotum. Indirect → scrotal → MALES get this type usu. (A on pic)
What is going on in a direct inguinal hernia?Male or female, through inguinal canal, creates own hernial sac (B in pic)
So an inguinal hernia is just going to look like a big lump from the outside - what should you do when assessing it & how can you make this easier?You should find out which side the hernia is coming from. You can do this by elevating the hind legs (makes your life easier) & then palpate both inguinal rings
7 DDx for inguinal hernias?Abscess
Mammary neoplasia
Neoplasia from another origin
Inguinal lymph node
How might you be able to tell a mammary neoplasia from an inguinal hernia?Hernial content is soft compared to a mammary tumor
How might you be able to differentiate a hematoma from an inguinal hernia?W/ a hematoma will have inflammation - sign of godet (the pitting edema) doughy
What are 6 possible things which can be the content of an inguinal hernia?Omentum
How might you be able to differentiate an inguinal hernia from an inguinal lymph node?LN is more close to linea alba & prepubic tendon
Inguinal hernias more cranial
How do you go about repairing an inguinal hernia?Open skin, oblique incision, follow inguinal canal, dissect skin & SQ, Peel off hernial sac. Open up. Reduce contents. Remove hernia sac, close remnants of sac, close inguinal ring.
If you need to enlarge the inguinal ring to reduce the inguinal hernia, how do you do it? (And why this way?)Enlarge inguinal ring in a cranial direction cant do caudal - you will hit the pelvis/pubis & the PUDENTAL VESSELS ARE CAUDAL TOO, lateral uncomfortable, medial is linea alba hit. So go cr!
What happens if a strangulated hernia is left too long?Necrosis → nasty abscess
What is the suture pattern for closing the inguinal canal/ring when repairing a hernia? Why is this pattern desirable?Vest over pant technique. Provides reinforcement & also prevents reoccurrence w/ sliding of tissue. Also some tension relief
Explain the vest-over-pant suture techniqueAn interrupted horizontal mattress pattern. Tissues to be sutured are overlapped instead of meeting end to end. Interrupted sutures pass through both layers at both edges. Then, the place where the edge is can be reinforced w/ a simple continuous
A scrotal hernia is actually what kinda hernia?An indirect inguinal hernia in a male
Possible CSs of a scrotal hernia?Pain, Inflammation, Usually unilateral, Hydrocele
If there is dead space w/ a scrotal hernia, you will want to close it. If you cannot, what can you do?Penrose drain or walking stitches - used for mastectomies when lots of dead space - make multiple bites before placing stitch
What inc chances for reoccurrence of scrotal hernia?If not castrated
How do you Sx Tx a scrotal hernia w/ no orchiectomy?Open parietal vaginal tunic & push hernia back in. Then reduce size of inguinal opening - work less medially bc preputial mm & nn & vessels & do on CRANIAL aspect.
How do you Sx Tx a scrotal hernia WITH orchiectomy?In this case, you close parietal tunic & the inguinal canal. Ligate spermatic cord.
What will inc the chances of a scrotal hernia reoccurring?Not castrated
Where is the hernia herniating through in a femoral hernia?femoral canal
What are the 2 types of femoral hernias (how are they diff?)(1) Reducible: palpation femoral ring
(2) Irreducible: similar to IH or inguinal eventration
How should you palpate a femoral hernia?Palpation standing on hind legs
Why is the femoral hernia risky/ such a prob?Bc it's around really high volume vessels
What are some post-op instructions for after your hernia repair?Analgesics/NSAID’s, restrict exercise, feeding: soft/low residue diet
Should you give ABx post-op for a herniorrhaphy?Dont use unless Dzd tissue