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1004 Upper Airway Obstruction

Etiology and Pathophysiology Acute General Treatment • Damage to herniated contents may change
• Umbilical hernia results when the lateral • Conservative management the prognosis.
VetBooks.ir and fascia, fail to fuse or have delayed fusion have no hernial contents do not require PEARLS & CONSIDERATIONS
folds, principally the rectus abdominis muscle
○ Small hernias that are easily reducible or
after the midgut relocates in the sixth week
repair.
of gestation.
• Herniation is usually limited to falciform ○ An umbilical hernia identified early in Comments
life should be monitored.
• Umbilical hernias are typically an incidental
ligament or omentum. Rarely are organ ○ Spontaneous closure may occur as late as finding and usually can be repaired in an
contents herniated. 6 months of age. elective manner.
• Umbilical hernia may diminish in size as the • Simple umbilical hernias can be repaired • Entrapment of abdominal viscera should be
animal ages. Minimal size is usually achieved primarily. higher concern for larger defects.
at approximately 6 months of age. ○ Incision is made over the hernia, and • Always examine patients with umbilical
contents are replaced into the abdomen. hernias for other congenital defects.
DIAGNOSIS ○ The edges do not need to be freshened
before closure. Prevention
Diagnostic Overview ○ Primary closure is usually achieved as part • Do not breed affected dogs or cats because
Diagnosis is typically made on physical exam of the closure of the abdominal cavity. this is likely an inherited defect.
alone. Radiographs can be performed in cases • Complicated hernia • Minimal traction should be applied to
of large hernia or if concerned about hernia ○ Immediate surgical correction with evalu- umbilicus during parturition.
contents. ation of herniated viscera
○ If hernia is chronic or extremely large, Technician Tips
Differential Diagnosis muscle flaps or mesh may be needed to • Umbilical hernias can usually wait until
• Abscess close abdominal cavity. elective sterilization procedure to be repaired.
• Neoplasia (unlikely) • Changes in size of the hernia can be an
• Supraumbilical hernia Possible Complications indication of changes in hernia contents
• Patent urachal remnant • Incisional dehiscence and may warrant more rapid intervention.
○ Rare
Initial Database ○ Large defect Client Education
CBC and chemistry panel are usually unremark- ○ Excessive tension on repair • Treatment may be conservative or hernior-
able, except if bowel is incarcerated. • Gastroschisis and omphalocele rhaphy to prevent complications.
○ Early neonatal death due to contamination • Veterinarians should train breeders in proper
Advanced or Confirmatory Testing of abdominal cavity neonatal care.
• For complicated hernias, radiographs can be
taken to determine the hernia contents. Recommended Monitoring SUGGESTED READING
• Ultrasound can also be used if concern exists When noted early in life, should be monitored Smeak DD: Abdominal wall reconstruction and
for abscess, although rarely used. frequently to determine if closure is necessary. hernias. In Johnston SA, et al, editors: Veterinary
Enlargement or acute swelling may indicate surgery: small animal, ed 2, St. Louis, 2017,
TREATMENT incarceration of abdominal viscera, which Elsevier, pp 1564-1591.
warrants immediate veterinary evaluation. AUTHOR: Jacob A. Rubin DVM, DACVS
Treatment Overview EDITOR: Elizabeth A. Swanson DVM, MS, DACVS
Treatment is aimed at replacement of herni- PROGNOSIS & OUTCOME
ated contents and closure of the defect with a
tension-free closure. This is most commonly • Excellent with simple, uncomplicated hernias
performed during at the time of routine • Guarded prognosis if large, complicated, or
sterilization procedure. open

Upper Airway Obstruction Client Education
Sheet

BASIC INFORMATION • Neoplastic obstruction more likely in older ASSOCIATED DISORDERS
adult dogs or cats Brachycephalic airway syndrome, laryngeal
Definition paralysis, neoplasia, nasopharyngeal polyp,
Inability to move air effectively through nose/ GENETICS, BREED PREDISPOSITION pulmonary edema
mouth, pharynx, larynx, and/or trachea • Brachycephalic animals are predisposed to Clinical Presentation
airway obstruction.
Epidemiology • Breed predispositions exist for laryngeal DISEASE FORMS/SUBTYPES
SPECIES, AGE, SEX paralysis (p. 574). • Supraglottic structures: brachycephalic
• Airway foreign body (FB) more likely in airway syndrome (p. 128), laryngeal
young dogs RISK FACTORS paralysis (unilateral/bilateral), foreign bodies
• Nasopharyngeal polyps more likely in young Environmental factors: excitement, heat, and (pharyngeal/laryngeal), nasopharyngeal polyp
cats and (rarely) dogs exercise, especially in animals with predisposi- (p. 681), laryngeal collapse, laryngeal edema
• Laryngeal paralysis more likely in older dogs tion to obstruction (e.g., brachycephalic airway or hemorrhage, laryngeal neoplasia (p. 573),
and (rarely) cats syndrome, laryngeal paralysis) epiglottic entrapment

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