Hernias-McClain

Question 1

True/indirect hernia

Answer 1

Intact/complete peritoneal sac

Question 2

False/direct hernia

Answer 2

Ruptured/incomplete peritoneal sac

Question 3

Types of abdominal hernias

Answer 3

1. Direct (false)-non-intact vaginal tunic

2. Indirect (true)-intact vaginal tunic

Question 4

Examples of acquired hernias

Answer 4

1. Inguinal hernia (inc diameter over time)
2. Ventral midline hernia (surgical incision)
3. Lateral abdominal wall hernia (trauma)
4. Degeneration (pre-pubic tendon rupture)

Question 5

Incarcerated hernia

Answer 5

Cant reduce

Question 6

Strangulating hernia

Answer 6

Incarcerated hernia that obstructs vascular supply

Question 7

Parietal hernia

Answer 7

Portion of intestine wall involved with hernia

-Leads to external drainage without internal contamination

Question 8

Hernia anatomy

Answer 8

1. The ring
2. The sac
3. The components

Question 9

Anatomic location

Answer 9

1. Umbilical
2. Ventral midline
3. Caudal abdominal-inguinal hernia
4. Lateral abdominal
5. Pre-pubic tendon rupture
6. Diaphragmatic (internal abdominal hernia)

Question 10

Umbilical Hernia Background

Answer 10

1. Natural closures w/in 1-2 weeks of life
2. True umbilical hernia if present at 5-8 weeks old
3. No clear etiology

Question 11

Umbilical Hernia Treatment

Answer 11

1. < 5 cm-conservative, sx if still present at 4 months

2. > 10 cm SURGERY

Question 12

Hernia clamp

Answer 12

probs bad news bears, don’t use

Question 13

Umbilical Herniorraphy techniques

Answer 13

Closed-sac intact

Open-sac removed

Question 14

Post op care umbilical herniorraphy

Answer 14

1. Meds
   - abx clean (24-48 hours), clean-contaminated (3-5d)
   - anti-inflammatories: 3-5 days
2. Abdominal support bandage-dead space
3. Exercise restrictions: 30-45d stall rest

Question 15

Caudal abdominal hernia types

Answer 15

Indirect (most common; adults > foals)

Direct (less common; foals > adults)

Question 16

Caudal abdominal hernia predispositions

Answer 16

Breed
Standarbreds, Tennessee walkers, saddlebreds
Other hx
Strenuous exercise, trauma, breeding

Question 17

Caudal abdominal hernia foals

Answer 17

1. Congenital
2. Indirect-reducible, resolve 3-6 mos
3. Direct hernias-Irreducible, large segment (3 ft), strangulation (emergency)

Question 18

Caudal abdominal hernia adults

Answer 18

1. Acquired indirect hernias
2. Irreducible
3. Short segment (6 inches)

Question 19

Caudal abdominal hernia foal-tx

Answer 19

1. Dorsal recumbency under GA
2. Approaches
   - inguinal approach +/- castration
   - midline celiotomy; ring closure
   - laparoscopic repair +/- castration
3. Inguinal
   - Locate tunic and contents
   - twist
   - closed castration
   - +/- external ring closure

Question 20

Ventral Midline hernias etiology

Answer 20

1. Inadequate healing of previous incision

2. Excessive strain

Question 21

Ventral midline hernias types

Answer 21

Acute total

Chronic insidious

Question 22

Acute total dehiscence

Answer 22

First 4-7 days post-op
Emergency
Peritoneal leakage
Palpable gaps in abdominal wall
Place support abdominal bandage and take to sx

Question 23

Acute total dehiscence procedure

Answer 23

1. Removed devitalized tissue
2. Sample for C & S -> Abx tx
3. Vertical mattress pattern
4. Preplace sutures
5. Twist vs tie

Question 24

Acute total dehiscence post-op

Answer 24

1. Compression abdominal bandage, change q 24h, for 30d
2. abx
3. stage removal wires and stent

Question 25

Chronic incisional hernia

Answer 25

1. Can be managed conservatively 2. Establish drainage, find pockets eval linea w/ U/S 3. Hernia belt (6-8 months)

Question 26

Chronic incisional hernia indications for sx

Answer 26

1. Chronic incisional hernias 2. Large defects 3. Previous herniorrhaphy failure

Question 27

Chronic incisional hernia Types

Answer 27

1. Proxoplast-plastic, cheaper | 2. Marlex-knitted polypropylene, better

Question 28

Chronic incisional hernia sx requires

Answer 28

1. No infection | 2. Skin for primary closure

Question 29

Chronic incisional hernia sx types

Answer 29

1. Retroperitoneal 2. Subperitoneal 3. Subcutaneous

Question 30

Pre-pubic tendon rupture etiology

Answer 30

Old mares that have had tons of babies

Question 31

Prepubic tendon rupture CS

Answer 31

1. Lordosis 2. Tail head elevation 3. Ischial tuberosity elevation 4. Ventral edema - muscle damage - venous congestions 5. Crania udder displacement

Question 32

Prepubic tendon rupture TX

Answer 32

1. Supportive care (belly band, NSAIDS) | 2. No more breeding

Question 33

Internal Abdominal Hernia types

Answer 33

1. Mesenteric hernias 2. Epiploic foramen entrapment 3. Gastrosplenic ligament entrapment 4. Diaphragmatic hernias - congenital-ventral diaphragm - acquired-dorsal diaphragm

Question 34

Lateral abdominal hernia

Answer 34

It's a thing, no notes

Question 35

Parietal Hernia

Answer 35

Parietal hernia with 1/2 bowel in it is a richter's hernia | -old horse problem