Hiatal Hernia - Revision history

BaraStudent at 11:02, 30 January 2017

2017-01-30T11:02:28Z

TestStudent at 19:07, 1 September 2015

2015-09-01T19:07:42Z

TestStudent at 19:07, 1 September 2015

2015-09-01T19:07:09Z

Bara at 12:06, 9 August 2012

2012-08-09T12:06:11Z

Bara at 16:51, 18 October 2011

2011-10-18T16:51:02Z

HelenD at 08:34, 5 September 2011

2011-09-05T08:34:52Z

Bara at 12:38, 3 May 2011

2011-05-03T12:38:42Z

Bara at 17:27, 3 March 2011

2011-03-03T17:27:36Z

Bara: /* References */

2010-12-21T10:54:10Z

References

Bara: Text replace - "Category:Peritoneal Cavity Pathology - Dog" to "Category:Peritoneal Cavity Diseases - Dog"

2010-12-16T15:33:42Z

Text replace - "Category:Peritoneal Cavity Pathology - Dog" to "Category:Peritoneal Cavity Diseases - Dog"

← Older revision		Revision as of 11:02, 30 January 2017
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	[[Category:Peritoneal_Cavity_-_Developmental_Pathology]]		[[Category:Peritoneal_Cavity_-_Developmental_Pathology]]
	[[Category:Muscles - Developmental Pathology]]		[[Category:Muscles - Developmental Pathology]]
		+
		+	[https://www.vetstream.com/canis/Content/Disease/dis00644.asp]

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 {{Learning
-|Vetstream = [https://www.vetstream.com/canis/Content/Disease/dis00644.asp, Hiatal hernia]<br>[https://www.vetstream.com/canis/Content/Illustration/ill00366.asp, Hiatal hernia - barium contrast]<br>[https://www.vetstream.com/canis/Content/Illustration/ill00365.asp, Hiatal hernia radiograph]
+|Vetstream = [https://www.vetstream.com/canis/Content/Disease/dis00644.asp, Hiatal hernia]<br>[https://www.vetstream.com/canis/Content/Illustration/ill00366.asp, Hiatal hernia - barium contrast]<br>[https://www.vetstream.com/canis/Content/Illustration/ill00365.asp, Hiatal hernia - radiograph]
 |flashcards = [[Small Animal Soft Tissue Surgery Q&A 14]]
 |literature search = [http://www.cabdirect.org/search.html?rowId=1&options1=AND&q1=Hiatal+&occuring1=title&rowId=2&options2=AND&q2=Hernia&occuring2=title&rowId=3&options3=AND&q3=&occuring3=freetext&x=55&y=10&publishedstart=yyyy&publishedend=yyyy&calendarInput=yyyy-mm-dd&la=any&it=any&show=all Hiatal Hernia publications]

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 {{Learning
 |flashcards = [[Small Animal Soft Tissue Surgery Q&A 14]]
 |literature search = [http://www.cabdirect.org/search.html?rowId=1&options1=AND&q1=Hiatal+&occuring1=title&rowId=2&options2=AND&q2=Hernia&occuring2=title&rowId=3&options3=AND&q3=&occuring3=freetext&x=55&y=10&publishedstart=yyyy&publishedend=yyyy&calendarInput=yyyy-mm-dd&la=any&it=any&show=all Hiatal Hernia publications]

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 ==Introduction==
 A hiatal hernia is an abnormality of the diaphragm that allows part of the stomach and the abdominal oesophagus to displace into the thoracic cavity.  Two types of hiatal hernia have been recognised in the dog and cat:
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 {{review}}
 [[Category:Oesophagus_-_Pathology]]
 [[Category:Oesophageal Diseases - Cat]][[Category:Peritoneal Cavity Diseases - Cat]][[Category:Peritoneal Cavity Diseases - Dog]][[Category:Oesophageal Diseases - Dog]]

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 {{Learning
 |flashcards = [[Small Animal Soft Tissue Surgery Q&A 14]]
 }}
 ==References==
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 Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''
 {{review}}

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 ==Introduction==
 A hiatal hernia is an abnormality of the diaphragm that allows part of the stomach and the abdominal oesophagus to displace into the thoracic cavity.  Two types of hiatal hernia have been recognised in the dog and cat:
-*'''Sliding hiatal hernia''' - Cranial displacement of the distal oesophagus and stomach into the mediastinum through the oesophageal hiatus of the diaphragm.  This is the most common form and it can occur in the dog and cat as a congenital or acquired lesion. Congenital hernias result from the incomplete fusion of the ''septum transversum'' (which forms the diaphragm) during early embryonic development.
+:'''Sliding hiatal hernia''' (type I) - Cranial displacement of the distal oesophagus and stomach into the mediastinum through the oesophageal hiatus of the diaphragm.  This is the most common form and it can occur in the dog and cat as a congenital or acquired lesion. Congenital hernias result from the incomplete fusion of the ''septum transversum'' (which forms the diaphragm) during early embryonic development.
+:'''Para-oesophageal''' or '''Rolling hiatal hernia''' (type II) - Cranial displacement of the gastric fundus into mediastinum through the oesophageal hiatus but adjacent to the oesophagus and gastric cardia which remain in their normal positions.  This form of hernia is rare in animals.
 ==Signalment==
-'''Acquired''' hernias can occur in any breed of dog or cat and these often occur with disorders that cause increases in intra-abdominal pressure (such as chronic vomiting) or decreases in intrathoracic pressure (such as intermittent airway obstruction seen with laryngeal paralysis and brachycephalic obstructive airway syndrome (BOAS)).
+'''Acquired''' hernias can occur in any breed of dog or cat and these often occur with disorders that cause increases in intra-abdominal pressure (such as chronic vomiting) or decreases in intrathoracic pressure (such as intermittent airway obstruction seen with [[Laryngeal Paralysis|laryngeal paralysis]] and [[Brachycephalic Airway Syndrome|brachycephalic obstructive airway syndrome]] (BOAS)).
 Breeds of dog that develop '''congenital''' sliding hernias include Chinese Shar-peis and Chow-chows whereas brachycephalic dogs (such as English and French bulldogs) often develop acquired hernias.
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 ===Clinical Signs===
 Some animals may be asymptomatic but otherwise clinical signs include:
-*'''Regurgitation''' due to impaired function of the herniated lower oesophageal sphincter
-*'''Hypersalivation''' related to regurgitation
+'''Regurgitation''' due to impaired function of the herniated lower oesophageal sphincter
-*'''Dyspnoea''' and '''coughing''' if the hernia is large and impinges on the lungs or if the animal develops aspiration pneumonia as a result of regurgitation
-*'''Dehydration''' and '''weight loss''' due to chronic regurgitation
+'''Hypersalivation''' related to regurgitation
 ===Diagnostic Imaging===
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 Medical management should be initiated to reduce [[Oesophagitis|oesophagitis]] caused by regurgitation.  Medical management can be continued for cases with acquired hernias and it may achieve success in some cases with congenital hernias.  This approach involves the use of:
-*'''[[Gastroprotective Drugs]]''' including oral sucralfate suspensions and gastric acid secretory inhibitors such as cimetidine, ranitidine or omeprazole.
+:'''[[Gastroprotective Drugs]]''' including oral sucralfate suspensions and gastric acid secretory inhibitors such as cimetidine, ranitidine or omeprazole.
-*A '''low fat diet''' fed from a height will increase the tone of the lower oesophageal sphincter and increase the speed of gastric emptying, reducing the likelihood of regurgitation.
+:A '''low fat diet''' fed from a height will increase the tone of the lower oesophageal sphincter and increase the speed of gastric emptying, reducing the likelihood of regurgitation.
-*'''Metaclopramide''' may also be used to increase the tone of the lower oesophageal sphincter.
+:'''Metaclopramide''' may also be used to increase the tone of the lower oesophageal sphincter.
-*'''Antibiotics, nebulisation and coupage''' may be used to manage aspiration pneumonia.
+:'''Antibiotics, nebulisation and coupage''' may be used to manage aspiration pneumonia.
 ===Surgical Management===
-Surgical management can be used with congenital cases (after medical management has been attempted) and to treat the underlying cause in acquired cases.  '''Hernia repair''' is achieved via a cranial ventral coeliotomy.  The oesophageal hiatus is exposed by transection of left triangular ligament (between the liver and diaphragm) and retraction of the liver.  The phreno-oesophageal ligament is partially incised and the oesophagus is retracted into the abdomen until the lower oesopageal sphincter is identified.  Sutures are then placed to reduce the size of the oesophageal hiatus.   An '''oesophagopexy''' may also be performed (tacking the oesophagus to the left body wall) or a '''fundic gastropexy'''.  A tube gastropexy has the added advantage of allowing cases to be fed if they are suffering from severe [[Oesophagitis|oesophagitis]] or oesophageal ulceration.  '''Laryngeal surgery or correction of BOAS''' may be performed if this has contributed to the hernia.
+Surgical management can be used with congenital cases (after medical management has been attempted) and to treat the underlying cause in acquired cases.
 ==Prognosis==
-Prognosis is good after surgical repair or aggressive medical management.
+Prognosis is good after surgical repair or aggressive medical management, but complete relief of clinical signs may not be possible.
 ==Literature Search==
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 Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''
 {{review}}

← Older revision		Revision as of 17:27, 3 March 2011
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	[[Category:Expert_Review]]		[[Category:Expert_Review]]
	[[Category:Peritoneal_Cavity_-_Developmental_Pathology]]		[[Category:Peritoneal_Cavity_-_Developmental_Pathology]]
		+	[[Category:Muscles - Developmental Pathology]]

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 [[Category:Oesophagus_-_Pathology]]
-[[Category:Cat]][[Category:Peritoneal Cavity Diseases - Dog]][[Category:Oesophageal Diseases - Dog]]
+[[Category:Oesophageal Diseases - Cat]][[Category:Peritoneal Cavity Diseases - Cat]][[Category:Peritoneal Cavity Diseases - Dog]][[Category:Oesophageal Diseases - Dog]]
 [[Category:Expert_Review]]
 [[Category:Peritoneal_Cavity_-_Developmental_Pathology]]