Hernia VSR (2+1)-608 - PowerPoint Presentation

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Hernia VSR (2+1)-608Small animal soft tissue surgery

Dr

Archana

Kumari

Department

of

V

eterinary

S

urgery and

R

adiology

BIHAR VETERINARY COLLEGE

PATNA

Hernia Hernia is defined as the protusion of the contents of a body cavity through a normal or abnormal opening in the wall of that cavity either to lie beneath the intact skin or to occupy another adjacent body cavity. A hernia is different from prolapse . In prolapse the protruded tissue is exposed outside whereas in a hernia it is covered by the skin.

Etiology Congenital as well as acquired hernia is common in domestic animals. A congenital hernia may occur due to anatomical variations , polygenic inheritance or infectious diseases. The primary predisposing cause of acquired hernia is mostly trauma. Other factors may be exciting causes that is Increased intra-abdominal pressure .In most cases abdominal contents herniate through the abdominal wall, diaphragm or perineum.

Constituents of HerniaA hernia consist of of the Hernial ring, sac and contents. The ring may be formed due to rupture in the abdominal wall(Ventral hernia) , limiting wall(Diaphragmatic hernia),or due to persistent prenatal opening(Umblical hernia). A normal opening or passage (inguinal hernia/canal)may also form a ring.The hernial sac is made of tissue that enclose the hernial contents .

The contents of hernia include the organ (a loop of bowel ) or tissue(omentum) or both.

Constituents of Hernia

HERNIA IMAGESInguinal hernia in horseHernia examination by manual palpation.

CLASSIFICATION OF HERNIA A hernia can be classified according to its-:Location Functional alteration Contents and cause LocationExternal Hernia:- Which consist of the hernial ring, hernial sac, and contents of the sac . egVentral hernia or lateral hernia , inguinal or scrotal hernia , umblical hernia. and perineal hernia.Internal Hernia:- Which lacks t hernial sac , eg; diaphragmatic hernia , and “gut-tie”.

CONT....Functional alteration;Reducible Hernia :where contents of the hernial sac can be returned to the original position through the hernial opening .Irreducible Hernia: When the contents of the hernial sac can not be returned to the original position through the hernial opening .it could be positioned through the hernial opening . It ould be of three types:-Hernia with Adhesion Incarcerated HerniaStrangulated Hernia

CONT..Hernia with adhesion: When adhesion between the sac and its content prevent reduction . Incarcerated Hernia: When the hernial contents become too voluminous to be replaced through a narrow hernial ring. Strangulated Hernia: When the blood vessels supplying the hernial contents are affected to cause complications like necrosis and extensive adhesion.

CONT..Content of the sac :The contents of the sac define the terminology used for hernia eg:Enterocele(Intestine)Epiplocele(omentum)Enteroepiplocele (intestine plus omentum)Reticulocele (Reticulum)

Hysterocele

( Uterus)

Vesicocele

(Urinary bladder)

Different types of herniaRadiograph Perineal Hernia in dogUmblical hernia in calf

.Name of HerniaCharacteristicsIncidence

U

mblical

hernia

According to anatomical location

An opening in the abdominal wall, which normally closes before birth, doesn't close completely. Even if the area is closed at birth,

umbilcal

hernias can appear later in life because this spot remains a weaker place in the abdominal wall.

Calves, pups, foals and pigs

I

nguinal hernia

Occurs in the groin area in which tissue that belongs in the rear of the abdominal cavity presses out through a weak area surrounding the femoral artery and nerve.

Usually the hernial sac contains nothing but fat and can be reduced back into the abdomen with finger

pressure.

Bitches, bulls, horses and pigs

.Perineal hernia Herniation of abdominal contents through the pelvic diaphragm and causing swelling on one side of the anus. The hernial sac may contain fat, intestines, or the bladder. Un castrated, old male dogs

Diaphragmatic

hernia

Protrusion of abdominal organs to the thoracic cavity by tearing of diaphragm.

Buffaloes, horses and dogs

Scrotal hernia

Loop of intestine or the bladder may pass down into

the scrotum.

Horse

Ventral hernia

Migration of viscera through a tear in the abdominal wall.

Cattle and horse

Femoral hernia

Protrusion of abdominal viscera through the femoral canal.

Not veterinary practice

Hiatus hernia

Normal passageway through which the esophagus meets the stomach serves as a functional "defect", allowing part of the stomach to herniate into the chest.

Not veterinary practice

Umblical Hernia

Inguinal Hernia in Dog

Symptoms of the Hernia Physical sympotoms include presence of the hernial swelling which may varies in size and shape. It has characteristics consistency depending on the contents .For Example Consistency is elastic in Enterocele Doughy in Epiplocele The swelling may increase in size while coughing. Functional Symptoms are ordinarly absent in reducible hernia.

Colic is seen in incarcerated hernia.

Severe pain and rise in temperature and colic are pronounced strangulated hernia.

DIAGNOSIS By palpating the hernial ring reducible hernias.In the case of umblical hernia , the hernial ring can be easily felt if the animal is placed in dorsal recumbency and palpated. By the nature of its contents . Ascultation will reveal gurgling and bubonic sound in an enterocele . On palpation the contents feel doughy in epiplocele while enterocele will have an elastic consistency.

GENERAL PRINCIPLES OF TREATMENT OF HERNIA Repair of hernias is generally advisable in a timely fashion, in order to minimize complications such as organ dysfunction, gangrene, and multiple organ dysfunction syndromes. Reduction and retention by bandage:- The hernial contents are reduced by local manipulation and retention is done by applying bandage or other articles around the abdomen to prevent is return.

An “

elastoplast

” bandage is better to avoid interference with breathing . The bandage is retained for two to three weeks.

The bandage is to be kept for two to three weeks until closure occurs. This method is effective in early stages of umbilical hernia.

CONT.Application of blister or injection of irritant solutions close to the hernial ring after reducing the hernia causes inflammatiory swelling which is sometimes sufficient to prevent recurrence of small hernia and to faciliate closure of the hernial orifice . the solution commonly employed for the purpose are Sodium Chloride 5% to 15% Zinc Chloride 5% to 10%. A ligature or a hernia clamp or a set through and through mattress sutures may be applied at the base of the hernial sac after reducing the hernia to faciliate sloughing of the sac and simultaneous closure of the hernial ring.

:Radical operation for Hernia: Herniorrhaphy: Suturing of the hernial ring is called is called Herniorraphy.Hernioplasty: If the Hernial ring is very large suturing its edges is not possible . In such cases Hernioplasty is performed by covering the gap with facia lata or Stainless steel wire-mesh and suturing it to the borders.

Terminology related to Hernia Ventropexy:-Fixing portion of any abdominal organ to the abdominal wall is called Ventropexy. Kelotomy:- Enlarging of a hernial ring is callec “Kelotomy” “Gut Tie” In Bullocks:-

Occurence In bullocks only

The adhesion of the cut end of the spermatic cord to the abdominal wall

after castration

predisposes to herniation.

The hernia occurs only on the

Right Side

the occurence on the

left side

being prevented by the presence of

rumen

.

Perineal Hernia

is seen in old

Uncastrated

male dogs.

Surgical remedyMost abdominal hernias can be surgically repaired. Uncomplicated hernias are principally repaired by pushing back, or "reducing", the herniated tissue, and then mending the weakness in muscle tissue (an operation called herniorrhaphy). If complications have occurred, the viability of the herniated organ should be checked and resects it if necessary. Modem muscle reinforcement techniques involve synthetic materials (mesh prosthesis like nylon, Teflon and stainless steel) that avoid over-stretching of already weakened tissue. The mesh is placed over the defect, and suturing it in borders to keep the mesh in place. The skin edges are also sutured after excising any excess skin

.