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Abdo Surgery > Hernias > Flashcards

Hernias Flashcards

1
Q

Definition of a hernia

A

Protrusion of a viscus, or part of a viscus, through the walls of its containing cavity into an abnormal position

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2
Q

Definition of an incisional hernia

A

Protrusion through a previously acquired defect

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3
Q

Borders of Hesselbach’s triangle

A

Inferior epigastric artery, linea semilunaris (lateral border of the rectus muscle) and inguinal ligament

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4
Q

Floor of the inguinal canal

A

Inguinal ligament

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5
Q

Roof of the inguinal canal

A

Transversus abdominus and internal oblique

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6
Q

Medially to inguinal canal

A

Pubic tubercle

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7
Q

Laterally to inguinal canal

A

Deep inguinal ring (opening in transversals fascia at midpoint of inguinal ligament)

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8
Q

Anterior wall of inguinal canal

A

External oblique

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9
Q

Posterior wall of inguinal canal

A

Transversalis fascia and conjoint tendon (lateral 1/3rd)

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10
Q

Definition inguinal hernia

A

Emerges above and medial to pubic tubercle through superficial inguinal ring

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11
Q

Definition direct inguinal hernia

A

Enters inguinal canal directly through weakness or defect in posterior wall

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12
Q

Definition indirect inguinal hernia

A

Enters inguinal canal with spermatic cord structures through deep inguinal ring

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13
Q

Where does a femoral hernia arise?

A

Femoral ring

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14
Q

Characteristics of femoral hernia?

A 
Not reducible
No cough impulse
Often contains only omentum
More common on R
Inferior and lateral to pubic tubercle
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15
Q

Differentials for a femoral hernia?

A 
Inguinal hernia
Femoral artery aneurysm, false femoral aneurysm
Saphena varix
Lymphadenopathy
Psoas bursa 
Psoas abscess 
Lipoma
Sarcoma
Ectopic testis
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16
Q

Complications of open hernia repair?

A

Intraoperative:
Damage ileoinguinal nerve
Damage to cord structures e.g. vas def, testicular artery
Orchidectomy (To close posterior wall)

Early:
Urinary retention (pain)
Haematoma
Infection: mesh or wound

Late:
Recurrence
Cord damage –> testicular atrophy

17
Q

Advantages of mesh repair?

A

Low recurrence rate
Tension free repair
Reduced analgesic requirement

18
Q

Disadvantages of mesh repair?

A

Risk of infection- prophylactic abx

19
Q

Who are inguinal hernias most common in?

A

Young-80%

20
Q

What is the defect in inguinal hernias?

A

Congenital patent processus vaginalis

21
Q

Who are direct hernias more common in?

A

Elderly

22
Q

If a hernia descends into the scrotum what type is it most likely to be?

A

Indirect

23
Q

Which paper determined that 56% of direct hernias were incorrectly classified as indirect on clinical examination?

A

Cameron BJS 1994

24
Q

What surgery is recommended for inguinal hernia repair?

A

Lichtenstein tension free mesh repair

25
Q

What type of inguinal hernias is lap surgery best for?

A

Bilateral

26
Q

Who are femoral hernias more common in?

A

50% within one month- urgent surgery

27
Q

What procedures can be done for femoral hernia repair?

A

Low approach- elective

High approach- emergency

28
Q

What is the conservative mx of an incisional hernia?

A

Low risk strangulation, patients may not be fit for surgery
Truss/corset
Weight loss
Mx RFs e.g. chronic cough

29
Q

What is a paraumbilical hernia?

A

Defect in linea alba just above or below umbilicus

30
Q

RFs for paraumbilical hernia?

A

Anything for raised intra abdo pressure

E.g. fibroids, bowel distension

31
Q

How do you manage a paraumbilical hernia?

A

Advise surgery- mayo repair

32
Q

Who do umbilical hernias affect?

A

Congenital defect
Trisomy 21
Congenital hypothyroid
Afro-Caribbean

33
Q

What is an epigastric hernia?

A

Protrusion of abdominal contents through a defect in the lines alba between xiphisternum and umbilicus

34
Q

Who do epigastric hernias affect?

A

More common in young

Abdo Surgery (14 decks)

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