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GS Medbear > Hernia > Flashcards

Hernia Flashcards

1
Q

Common contents of umbilical hernia?

A

Extraperitoneal fat or omentum.
Even though hernial contents are often strangulated, bowel is not obstructed or damaged.

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2
Q

Femoral hernias commoner in which gender?

A

Females - 70%

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3
Q

Why is femoral hernia commoner in females?

A

Pelvis is wider and canal is larger

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4
Q

Does femoral hernia have a cough impulse?

A

No

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5
Q

What makes femoral hernia unique from inguinal hernia?

A

Not reducible
High risk of strangulation due to narrow neck
Usually no cough impulse

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6
Q

3 approaches for open repair of femoral hernia?

A

Infrainguinal
Trans-inguinal
Supra-inguinal - for suspected strangulation

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7
Q

Prevalence for inguinal hernia?

A

Male x10
2/3 are indirect
Peak at 5 years [indirect], 70-80 years direct
Obesity inversely related
Wrong collagen metabolism

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8
Q

What does incarcerated inguinal hernia present?

A

Pain
Abdominal distension
N/V

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9
Q

Complications of inguinal hernia pathway

A

Reducible -> Irreducible/Incarcerated -> Obstructed -> strangulated

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10
Q

What does strangulated hernia cause

A

Ischemic bowel!
4-6 hours to gangrene

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11
Q

In what hernia will there be no signs of IO even with strangulation?

A

Richter’s hernia. Hernia only involves part of bowel rather than entire circumference

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12
Q

Imaging for inguinal hernia

A

Dynamic US with Valsalva
AXR (supine) if suspected IO 2! to IH

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13
Q

Why use Valsalva in US for inguinal hernia?

A

To accentuate small hernia

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14
Q

When do u use imaging for inguinal hernia?

A

When clinical findings is inconclusive

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15
Q

Which hernia goes through Hasselbach?

A

Direct inguinal hernia

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16
Q

2 options for surgical hernia repair?

A

Totally Extra-peritoneal repair = TAP
Trans-abdominal preperitoneal repair = TAPP

17
Q

Early complications of hernia op?

A

ARU
Hematoma
Seromas
Nerve injury

18
Q

Late complications of hernia op?

A

Chronic post-op groin pain
Vas Deferens injury - infertility
Recurrence 5%
Ischaemic orchitis
Testicular atrophy
Meshoma

19
Q

Where is McBurney’s point

A

2/3 the distance from ASIS to pubic symphysis

20
Q

Commonest hernia in females?

A

Direct inguinal hernia

21
Q

Name of simultaneously direct and indirect hernias?

A

Pantaloon hernias

22
Q

What hernia contains meckel’s diverticulum?

A

Littres hernia

23
Q

What does Howship-Rhomberg sign show?

A

Obturator nerve irritation causing inner thigh pain that can extend to knee on internal rotation of hip.
OBTURATOR HERNIA !!

24
Q

What is Spigelian Hernia?

A

Primary ventral hernias secondary to a defect in the Spigelian aponeurosis (fascia) that is comprised of the transversus abdominis and internal oblique aponeuroses.
Borders of the Spigelian aponeurosis are the rectus muscle medially and the linea semilunaris laterally

25
Q

Layers of abdominal wall?

Superficial to deep

A

Camper’s fascia
Scarpa’s fascia
Abdominal wall muscle
Transversalis fascia
Extra-peritoneal fat
Parietal peritoneum

26
Q

Define hernia!

A

Abnormal protrusion of viscus through an abnormal opening in wall of cavity inside its normal container

27
Q

Where is deep inguinal ring?

A

2cm above midpoint of inguinal ligament
Defect in transversalis fascia.

28
Q

Where is superficial inguinal ring?

A

Above and medial pubic tubercle.
Defect in aponeurosis of external oblique

29
Q

Contents of inguinal canal?

A

Spermatic cord
Testicular vessels
Round ligament of uterus
Ilioinguinal nerve
Genital branch of genitofemoral nerve

30
Q

Where is femoral pulse?

A

Mid-inguinal point

31
Q

Where is inguinal ligament?

A

Between ASIS and pubic tubercle

32
Q

Landmarks for Hasselbach’s triangle?

A

Medial = Lateral end of rectus abdominis
Superior = Inferior epigastric vessels
Inferior = Inguinal ligament

33
Q

Indirect vs Direct inguinal hernia anatomy?

A

Indirect = Neck is lateral to inferior epigastric vessels
Direct = neck is medial to inferior epigastric vessels

34
Q

Boundaries of inguinal canal

A

Anterior = Ext oblique aponeurosis
Posterior = Transversalis fascia
Floor = Inguinal ligament
Roof = Arching fibres of IO and TA

35
Q

What is inguinal ligament?

A

Inferior most edge of ext oblique aponeurosis

36
Q

Risk factors for inguinal hernia?

A

Male gender
Age
Obesity
Family Hx
Connective tissue disorders
Chronic constipation
Smoking
COPD, chronic cough

GS Medbear (14 decks)

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