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Gastroentrology > 2: Body Wall Hernias > Flashcards

2: Body Wall Hernias Flashcards

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1
Q

Define a hernia

A

protrusion of whole or part of an organ through cavity that usually contains it

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2
Q

Define a para-umbilical hernia

A

protrusion of hernia through linea alba

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3
Q

in which population are para-umbilical hernias more common

A

children

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4
Q

what causes para-umbilical hernias

A

increase intra-abdominal pressure

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5
Q

what typically causes para-umbilical hernias in children

A

Failure of guts contents to return to the abdomen during development.

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6
Q

what age do umbilical hernias spontaneously close in children

A

5-years

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7
Q

what are 3 risk factors for umbilical hernias

A
  1. Obesity
  2. Pregnancy
  3. Intra-abdominal tumours
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8
Q

how do umbilical hernias present in adults

A

Mass adjacent to the umbilicus

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9
Q

how do umbilical hernias present in children

A

Mass penetrating through umbilicus. Exacerbated by coughing-sneezing. Hernia can be completely reduced.

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10
Q

What is an inguinal hernia

A

protrusion of abdominal contents through inguinal canal

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11
Q

What are the two types of inguinal hernia

A
  1. Direct

2. Indirect

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12
Q

What is the most common type of inguinal hernia

A

Indirect inguinal hernia (85%)

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13
Q

What % of inguinal hernias are direct

A

20%

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14
Q

What is an indirect inguinal hernia

A

When abdominal contents enter the inguinal canal via the deep inguinal ring

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15
Q

What is a direct inguinal hernia

A

Abdominal contents enter inguinal canal directly through weakening in posterior inguinal canal wall

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16
Q

Which population are more likely to have direct inguinal hernias and why

A

Elderly - due to weakening in abdominal wall and increased intra-abdominal pressure

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17
Q

What causes indirect inguinal hernias

A

patent processes vaginalis

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18
Q

What is processus vaginalis

A

out pouching of peritoneum - enabling embryonic testicular tissue descent

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19
Q

What are 5 risk factors for indirect inguinal hernias

A
  1. Age
  2. Male
  3. Raised intra-abdominal pressure chronic cough, heavy lifting
  4. Chronic constipation
  5. Obesity
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20
Q

How will inguinal hernias present

A

Lump in the groin that is reducible - may disappear if the patient lies down

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21
Q

What is an incarcerated hernia

A

Where contents of hernia have adhered to hernial sac and therefore become irreducible

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22
Q

What are the symptoms of an incarcerated hernia

A

Painful

Erythematous
Tender to palpation
Absent cough impulse

Possible Bowel obstruction

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23
Q

What will not be present in incarcerated abdominal hernia

A

Cough Impulse

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24
Q

What is the cough impulse

A

Enlargement of hernia on coughing

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25
What is a strangulated hernia
ischaemia and necrosis of the hernia due to compromised blood supply
26
What are the symptoms of a strangulated hernia
- Pain is out-of-proportion to clinical signs - Irreducible - Tender lump
27
Where are inguinal hernias in relation to the pubic tubercle
Superior-medial to the pubic tubercle
28
What is used as a landmark for distinguishing direct and indirect hernias
Inferior epigastric vessels
29
How can direct inguinal hernias be identified
Medial to inferior epigastric vessels
30
How can indirect inguinal hernias be identified
Lateral to inferior epigastric vessels
31
Explain how direct and indirect inguinal hernias can be distinguished
- Reduce the hernia - Place pressure over deep inguinal ring - Ask patient to cough - If the hernia protrudes it is a direct hernia (does not pass through the canal). If not, it is indirect.
32
How are hernias usually diagnosed
Clinically
33
What are the two options for managing inguinal hernias
1. Laparoscopic Inguinal hernia repair | 2. Open mesh repair
34
What are the two laparoscopic procedures offered for inguinal hernias called
TEP = total extraperitoneal TAPP = transabdominal pre-peritoneal
35
When is laparoscopic repair of inguinal hernias preferred
1. Bilateral inguinal hernias 2. Recurrent inguinal hernias 3. Females with inguinal hernias 4. Young patients: this is because there is a higher risk of chronic pain with open mesh repair.
36
Why is laparoscopic repair of inguinal hernias preferred in females
Due to risk of it being a femoral hernia - which is more common in females
37
When is open mesh repair of inguinal hernias preferred
1. Primary unilateral inguinal hernia
38
What are 3 emergency complications of inguinal hernias
incarceration obstruction strangulation
39
What is incarceration
where a hernia cannot be reduced
40
What is obstruction
herniation of abdominal contents results in bowel obstruction
41
How will obstruction present
absolute constipation
42
What % of inguinal hernias strangulate
3
43
How will strangulation present clinically
pain out-of-proportion to clinical findings
44
How is strangulation managed
emergency surgical exploration
45
What is a long-term complication of hernia repair
chronic pain
46
What may happen intra-operatively as a complication of hernia repair
damage to vas deferens causing ischaemia, sub-fertility and orchitis.
47
Define an incisional hernia
Protrusion of contents through a previously made incision in compartment wall
48
What type of surgery are incisional hernias associated with
Abdominal surgery
49
Give 5 risk factors for incisional hernia
1. Emergency surgery 2. Wound type 3. BMI >25 4. Midline incision 5. Wound Infection 6. Post-operative chemotherapy 7. Intra-operative blood transfusion 8. Age 9. Pregnancy
50
How will an incisional hernia present clinically
Non-tender, Reducible mass through a previously made incision
51
Explain pathophysiology of incisional hernias
Layers of the abdominal wall aim to maintain integrity of cavity. Incision damages and weakness these structures leading to protrusion
52
How are incisional hernias diagnosed
Clinically
53
What are three indications for surgery for incisional hernias
1. Painful 2. Patient is fit for surgery 3. Obstruction
54
How may incisional hernias be repaired
Sutures Laparoscopic mesh Open mesh
55
Define a femoral hernia
protrusion of abdominal viscera or omentum through femoral ring into femoral contal
56
In which gender are femoral hernias more common and why
Females - due to wider pelvis
57
In which gender are inguinal hernias more common
Males
58
What are 3 risk factors for femoral hernia
1. Raised intra-abdominal pressure: obesity, pregnancy, heavy lifting, chronic cough 2. Female 3. Age
59
How do femoral hernias present clinically
Small non-reducible lump in the groin
60
What % of femoral hernias strangulate
30
61
What is the anatomical relation of femoral hernias to the pubic tubercle
Inferior-lateral
62
What is the anatomical location of inguinal hernias to the pubic tubercle
Superior-medial
63
How are femoral hernias investigated
1. USS 2. Surgical exploration As all femoral hernias are operated on - objective investigations should be performed.
64
Why are all femoral hernias surgically operated
Due to high risk of strangulation - due to narrow neck
65
What is the time frame to operate on femoral hernias
2-4W
66
What are the two surgical approaches for managing femoral hernia
High approach | Low approach
67
What is the low approach
Approach from under the inguinal ligament
68
What is the advantage of low approach
Inguinal structures are intact - but limits space for returning bowel
69
What is the high approach
Approach from above inguinal ligament
70
When is a high approach preferred
In an emergency - due to more space to return bowel

Gastroentrology (18 decks)

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