Hernia – Hiatal in Dogs

I have heard about Hiatal hernias in people. What are they and do dogs get them?

A hernia occurs when one part of your body or part of an organ protrudes through a gap or opening into another part of the body. Many types of hernias occur in the abdominal area. Hiatal hernias, also known as diaphragmatic hernias, form at the opening (hiatus) in the diaphragm where the food tube (esophagus) joins the stomach. When the muscle tissue around the hiatus becomes weak, the upper part of the stomach may bulge through the diaphragm into the chest cavity. Hiatal hernia refers to the protrusion of the abdominal contents into the chest cavity through the esophageal hiatus of the diaphragm.

What causes a hiatal hernia?

In most veterinary patients, a hiatal hernia appears to be a congenital or birth defect. Trauma can also cause a hiatal hernia. The Bulldog and Chinese Shar Pei seem to have a higher incidence of Hiatal hernias than other breeds, although any breed can be affected. Male dogs are thought to be at greater risk for having a hiatal hernia.

What are the clinical signs of a hiatal hernia?

Many dogs that have small Hiatal hernias have no accompanying clinical signs. The symptoms most commonly associated with Hiatal hernias include vomiting, regurgitation, excessive salivation, bloody vomiting, and difficulty breathing.

How is a hiatal hernia diagnosed?

Diagnosis is based on medical history, clinical signs, and radiographs. Most dogs will require a special radiographic dye study or contrast fluoroscopy for definitive diagnosis. Esophagoscopy and gastroscopy may also be performed.

How is a hiatal hernia treated?

Conservative medical treatment will usually be recommended when the condition is first diagnosed. Medications to help control esophagitis and its accompanying clinical signs are used at the start of treatment. Acid-blocking medications and/or medications to relax the lower esophageal sphincter may be prescribed. Antibiotics are used as needed to combat any secondary infections, especially if aspiration pneumonia develops. In severe or chronic cases, surgery is recommended.

What is the prognosis for a dog diagnosed with a hiatal hernia?

The prognosis for hiatal hernia is guarded. Many dogs will develop secondary conditions such as aspiration pneumonia. Your veterinarian will be able to give you a better prognosis based on your pet’s specific condition and clinical signs.

Hernia – Diaphragmatic in Cats

What is a diaphragmatic hernia?

The diaphragm is the muscular partition that separates the abdomen and the chest. Tearing or disruption of this thin muscle is called a diaphragmatic hernia or diaphragmatic rupture. The terms can be used synonymously with diaphragmatic hernia incorporating congenital forms such as peritoneal-pericardial diaphragmatic hernia (PPDH). PPDH may be due to the defective development of the fetus. This condition is most often found in puppies or kittens and should be considered separately from the traumatic type of diaphragmatic hernia or rupture. Once a tear in the diaphragm is present, abdominal contents such as the stomach, liver, and intestines may enter the chest cavity. The abdominal contents compress the lungs and prevent them from fully inflating, causing respiratory distress. The abdominal tissues may irritate the heart muscle, which may cause abnormal heart rhythms. Fluid may leak into the chest cavity, further complicating and worsening heart and lung function.

What causes a diaphragmatic hernia or rupture?

“The most common cause of diaphragmatic hernia is blunt force trauma.”

The most common cause of diaphragmatic hernia is blunt force trauma. This type of trauma can occur after a fall from a high place (such as out of a window), an automobile accident, or a blow to the abdomen. Congenital diaphragmatic hernias are less commonly seen.

What are the clinical signs of diaphragmatic hernia?

Clinical signs are dependent on the severity of the herniation. With small tears or in cats born with a diaphragmatic hernia, there may be no discernable clinical signs. Many pet owners report mild breathing difficulties, especially when the cat is stressed, and periods of mild gastrointestinal upset. In severe or acute cases, there is often respiratory distress, an abnormal heart rhythm, muffled heart and lung sounds, and other signs of systemic shock. The abdomen may feel empty when palpated.

How is a diaphragmatic hernia diagnosed?

Diagnosis is based on medical history, physical examination findings, and radiographs. Blood and urine tests may be performed if the patient is showing signs of shock. In certain cases, ultrasound or special radiographic dye studies will be required for a definitive diagnosis.

What is the treatment for diaphragmatic hernia?

“Once the patient is stable, the hernia must be corrected surgically.”

Treatment is first directed at stabilizing the cat if trauma has recently occurred. Some patients will require immediate thoracocentesis (a chest ‘tap’) to remove any fluid that has accumulated in the chest cavity. Once the patient is stable, the hernia must be corrected surgically. In congenital forms, surgical intervention as early as possible is important to prevent organ entrapment or scarring between the intestines and the chest cavity. Many congenital diaphragmatic hernias are discovered during ovariohysterectomy (spaying) and are corrected at that time.

What is the prognosis?

The prognosis for any patient with a diaphragmatic hernia is always initially guarded. It improves if the patient has been stabilized and if the heart rhythm is normal. After surgery, the risk of a condition called re-expansion pulmonary edema may occur. Thus, a guarded prognosis must be given for at least twenty-fours after an apparently successful surgery. The prognosis for a young kitten with a congenital diaphragmatic hernia is guarded to good, depending on the specific diaphragmatic defect and the abnormalities found during the surgical correction.

If the patient stabilizes with medical treatment, is it possible to avoid surgery?

“The longer the corrective surgery is delayed, the more complicated and dangerous it becomes.”

In trauma cases, adhesions may form between the lungs and any herniated abdominal contents after approximately seven days.  These adhesions will affect the ability of the lungs to inflate properly. The longer the corrective surgery is delayed, the more complicated and dangerous it becomes.  However, each case needs to be assessed individually.