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A - MSRA Gastrointestinal [7] > [25] Other Hernias > Flashcards

[25] Other Hernias Flashcards

1
Q

What is a hernia defined as?

A

The protrusion of part or a whole of an organ or tissue through the wall of the cavity that normally contains it

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2
Q

Where does an epigastric hernia occur?

A

In the midline through the fibres of the linea alba

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3
Q

How common are epigastric hernias?

A

Relatively common, with a prevalence of up to 10%

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4
Q

Who do epigastric hernias most commonly affect?

A

Middle-aged men

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5
Q

How do epigastric hernias present?

A

They are typically asymptomatic, but may present as a midline mass that disappears when lying on the back

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6
Q

What is an important differential for epigastric hernias?

A

Divarication of the recti

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7
Q

What is divarication of the recti?

A

A cosmetic condition where the linea alba becomes widened, resulting in a palpably increased distance between the rectus muscles and a subsequent midline buldge

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8
Q

Where does a paraumbilical hernia occur?

A

Through the linea alba around the umbilicus (not through the umbilicus itself)

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9
Q

What are paraumbilical hernias typically secondary too?

A

Chronic raised intra-abdominal pressure, such as with obesity, pregnancy, or ascites

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10
Q

How do paraumbilical hernias present?

A

As a painful lump around the umbilicus, which will worsen with an increased intra-abdominal pressure such as straining or coughing

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11
Q

What can umbilical hernias form as in infants?

A

Ventral wall abnormalities

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12
Q

Give two examples of ventral wall abnormalities in infants

A

Omphalocele

Gastroschisis

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13
Q

What is a spigelian hernia?

A

A rare form of abdominal hernia that occurs at the semilunar line around the level of the arcuate line

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14
Q

What is the rectus abdominis muscle enclosed by?

A

The rectus sheath

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15
Q

Where is the arcuate line?

A

At the lower limit of the posterior layer of the rectus sheath (about 1/3 of the distance between the umbilicus and pubic symphysis)

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16
Q

What is the semilunar line?

A

The tendinous lateral border of the rectus, where the aponeuroses fuse

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17
Q

How do spigelian hernias present?

A

As a small tender mass at the lower lateral edge of the rectus abdominus

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18
Q

Why should spigelian hernias be repaired?

A

Due to the high risk of strangulation

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19
Q

What % of cases of spigelian hernias in male infants have cryptorchidism also present?

A

75%

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20
Q

What is cryptochidism and spigelian hernias in male infants likely associated with?

A

Failure in gubernaculum development

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21
Q

What is an obturator hernia?

A

A hernia of the pelvic floor, occurring at the obturator foramen, into the obturator canal

22
Q

Who are obturator hernias more common in?

A

Women

Middle-aged patients

23
Q

Why are obturator hernias more common in women?

A

Due to wide pelvis

24
Q

What side do obturator hernias typically occur on?

A

Right side

25
Q

What do obturator hernias often present following?

A

A period of rapid weight loss

26
Q

Why do obturator hernias often present following a period of rapid weight loss?

A

Due to the substantial amount of fat that is contained within the obturator canal, as loosing this fat results in a larger space for potential herniation to develop

27
Q

How are obturator hernias often diagnosed?

A

Intra-operatively, in patients presenting with bowel obstruction

28
Q

How do patients with obturator hernias classically present?

A

With a mass in the upper medial thigh

Howship-Romberg side

29
Q

What % of patients with Howship-Romberg side present with Howship-Romberg sign?

A

Around 50%

30
Q

What is Howship-Rombergs sign?

A

Hip and knee pain exacerbated by thigh extension, medial rotation, and abduction

31
Q

What causes Howship-Rombergs sign in obturator hernias?

A

Compression of the obturator nerve passing through the obturator canal

32
Q

Where is the obturator canal formed?

A

In the obturator foramen

33
Q

What is the obturator foramen?

A

A large opening between the ischium and the pubis bones

34
Q

What is the obturator canal formed by?

A

The gap through the obturator membrane

35
Q

Where does the obturator canal pass?

A

Into the medial thigh

36
Q

What does the obturator canal contain?

A

Obturator nerve
Obturator artery
Obturator vein

37
Q

What is a Littre’s hernia?

A

A very rare form of abdominal hernia, whereby there is herniation of Meckel’s diverticulum

38
Q

Where does a Littre’s hernia most commonly occur?

A

At the inguinal canal

39
Q

Is there a high risk of strangulation with Littre’s hernias?

A

Yes

40
Q

What is a lumbar hernia?

A

A rare posterior hernia

41
Q

What causes lumbar hernias?

A

They can occur spontaneously through an area of weakness, or iatrogenically following surgery

42
Q

How do lumbar hernias present?

A

As a posterior mass with associated back pain

43
Q

Where are the common areas of physiological weakness in the lumbar posterior wall that lumbar hernias most often occur?

A

Superior lumbar triangle

Inferior lumbar triangle

44
Q

What is true of most lumbar hernias?

A

They are incisional

45
Q

What surgery to lumbar hernias classically follow?

A

Renal surgery

46
Q

What is a Richter’s hernia?

A

A partial herniation of small bowel, whereby only the anti-mesenteric border becomes strangulated, and therefore only part of the lumen is within the hernia

47
Q

How will a Richter’s hernia present?

A

As a tender, irreducible mass at the herniating oriface, with varying levels of obstruction

48
Q

What is the level of obstruction caused by a Richter’s hernia dependant on?

A

How much of the bowel circumference is involved

49
Q

Why are Richter’s hernias often surgical emergencies?

A

Due to obstruction

50
Q

What care must be taken during surgery to repair a Richter’s hernia?

A

To identify the hernia, so as not to damage the bowel during surgery

A - MSRA Gastrointestinal [7] (44 decks)

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