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Clin Med I- GI > Hernias > Flashcards

Hernias Flashcards

1
Q

Which type of hernia is surgical emergency?

A

strangulated- vascular compromise of hernia contents

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2
Q

Hernias more common in males

A

Groin and epigrastric

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3
Q

Most common location of hernias

A

Inguinal region in men and women

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4
Q

Hernias more commonly seen in women

A

Femoral, umbilical, incisional. Inguinal most common

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5
Q

Which hernias are more common on the R

A

Inguinal and femoral hernias

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6
Q

Why doesn’t femoral hernia occur on L, and mostly seen just on R?

A

Because sigmoid colon on L inhibits femoral hernia

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7
Q

Fixing a hernia=

A

Herniorrhaphy/Herniaplasty

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8
Q

Types of mesh used in hernia repair

A

Polyester, polypropylene, and biologic

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9
Q

Caution with polyester and polypropylene mesh

A

Are non-absorbable, so if they get infected have to be taken out

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10
Q

Which type of mesh is preferred?

A

regular- polyester and polypropylene

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11
Q

Hesselbach’s triangle bordered by

A

epigastric vessels, rectus sheath, and inguinal ligament

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12
Q

Landmark for differentiating direct from indirect hernias

A

Inferior epigastric vessels

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13
Q

Inguinal hernia external vs. internal ring

A

External ring- external oblique aponeurosis. Internal ring- Internal oblique muscle and transversus abdominis muscle

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14
Q

Direct inguinal hernias occur…

A

through Hesselbach’s triangle (rupture)- failure of the floor musculature

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15
Q

Indirect inguinal hernias occur…

A

lateral to the epigastric vessels- dilation of something that is already there

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16
Q

Which inguinal hernia is congenital?

A

Indirect

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17
Q

Which nerves lie deep to the external oblique aponeurosis?

A

Iliohypogastric nerve and ilioinguinal nerve

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18
Q

Injury of iliohypograstric and ilioinguinal nerves result in…

A

numbness or chronic pain of skin of groin, base of penis, and ipsilateral upper medial thigh (supplied by these nerves). No effect on erectile function

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19
Q

Indirect + direct hernia=

A

combined hernia aka pantaloon hernia, or saddle-bag hernia

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20
Q

Pantaloon hernia gets its name from…

A

hernia sacs of direct and indirect hernias being separated by the inferior epigastric vessels

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21
Q

Patient presents with bulge in groin, especially with activity. There is also severe pain and paresthsias in groin region. You suspect…

A

Inguinal hernia. severe pain is sign of incarceration or strangulation. Paresthsia results form compression of or irritation of ilioinguinal or iliohypogastric nerves.

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22
Q

Neuralgia paresthesia often present in

A

overweight ppl that lean on tables a lot

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23
Q

How to diagnose inguinal hernia on male or female

A

Patient standing. male- “turn head and cough” . Valsalva in females

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24
Q

Patient with inguinal hernia - during PE what do you check for?

A

Do supine and standing. Check if mass is reducible or not, firm or soft, fixed or mobile. Note location in relation to inguinal ligament. have patient turn and cough or valsalva if female. If cannot be reproduced, ask patient to walk around and lift something heavy. Come back, or get an US

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25
Q

US is good to check for which type of hernias?

A

Direct, indirect, and femoral, and excluding recurrent hernias

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26
Q

US to check for hernia must be done in which position

A

While patient is coughing or during valsalva

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27
Q

If groin pain, cause might be…

A

hernia or consider inguinal nerve injury or entrapment

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28
Q

If find hernia- do surgery unless small, asymptomatic. what does non-operative tx include?

A

Truss or binder to hold the hernia contents in place

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29
Q

complications of non-opertative management of surgery

A

testicular atrophy, progression of hernia to incarceration/strangulation, or inguinal neuritis

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30
Q

Operant management is elective vs. emergent for…

A

elective for reducible or incarcerated hernias. Emergent for strangulated hernias.

31
Q

What are the signs of strangulated hernia in patient?

A

N/V, Change in skin color over the hernia, increasing pain

32
Q

Most common anterior repair with decreased recurrence rate

A

Tension free repair using prosthetic mesh

33
Q

“anterior hernia repair” - what surgery technique is used

A

Open inguinal herniorrhaphy- incision made directly over the hernia

34
Q

Type of surgery for inguinal or femoral hernia

A

Open inguinal herniorrhaphy and laparoscopic posterior repair

35
Q

Where does laparoscopic repair for inguinal hernias occur?

A

from the peritoneal surface or from within the preperitoneal space

36
Q

clear benefit of doing laparoscopic repair over open repair

A

If patient has bilateral inguinal hernia or recurrent hernias

37
Q

You think patient has inguinal hernia. Patient is very obese so it is hard to tell.. what else could it be?

A

Femoral hernia in obese patient or large femoral hernia often confused with inguinal hernia

38
Q

Open repair in femoral hernia involves…

A

removal of hernia sac and Cooper’s ligament repair or mesh repair of the femoral canal

39
Q

When do you repair an umbilical hernia in babies?

A

at 5 years of age, earlier only if strangulation hernia

40
Q

Where do umbilical hernias occur?

A

Occurs at the site where the umbilical vein entered the abdomen during gestation

41
Q

Tx in umbilical hernia

A

repair either with open or laparoscopically. Mesh placed for any defect larger than 3cm.

42
Q

Avoid mesh in what population for umbilical hernias

A

avoided in women of childbearing age

43
Q

Epigastric hernia involves…

A

herniation of the falciform ligament through the linea alba

44
Q

No hernia sac in which hernia type?

A

Epigastric hernia

45
Q

Diastesis recti

A

NOT a hernia. Patulence of the linea alba following stretching and parting of the rectus abdominus muscle bellies.

46
Q

Patient presents with palpable bulge at site of previous incision. Has difficulty sitting up and climbing stairs, indicating loss of abdominal strength

A

Incisional/ventral hernia

47
Q

Risk factors for incisional/ventral hernia

A

Infection after sugery, increased tension on abdominal wall, COPD, diabetes, steroid use

48
Q

How does loss of domain occur in incisional/ventral hernias

A

over time, hernia can become very large and recuts muscles can separate, causing loss of domain

49
Q

What to do to fix loss of domain problem

A

Component separation- cut external oblique muscles to make room, reconstructs linea alba

50
Q

Where does spigelian hernia develop?

A

arises where the arcuate line intersects with the lateral border of the rectus abdominis , usually at or below arcuate line

51
Q

Spigelian hernias are often “interparietal” meaning…

A

they don’t go through all the muscle layers

52
Q

50 year old woman presents with localized pain near arcuate line. NO palpable bulge. US or CT might show…

A

spigelian hernia

53
Q

OBturator hernia

A

Union of pubic bone and ischium. Canal covered by thin membrane- weakening of membrane-enlargement of canal- hernia sac formation

54
Q

Howhsip-Romberg sign

A

compression of the obturator nerve causing pain in medial thigh- might see this in obturator hernia

55
Q

Lumbar hernia can occur through…

A

superior lumbar triangle (Grynfeltt’s) or inferior lumbar triangle (Petit’s)

56
Q

superior triangle bounded by…

A

12th rib, paraspinal muscles, and internal oblique muscle

57
Q

Inferior triangle bounded by…

A

iliac crest, latissimus dorsi, and external oblique

58
Q

What might come through lumbar hernia?

A

perirenal fat

59
Q

Mesh or suture repair in lumbar hernias?

A

Mesh repair

60
Q

Patient presents with enlarging mass in gluteal or intragluteal area. ..

A

Sciatic hernia. Sciatic nerve pain may also occur..

61
Q

Mesh or suture repair in sciatic hernia

A

Mesh

62
Q

Small hernias can be closed with…, while large ones require…

A

sutures, mesh- larger

63
Q

which hernia might occur after APR or perineal prostatectomy

A

Perineal hernia-hernia sac protruding through pelvic diaphragm

64
Q

When to internal hernias happen

A

When the viscera herniate through an opening inside of the peritoneal cavity

65
Q

Developmental types of internal hernias

A

Mesocolic or mesenteric hernias

66
Q

Acquired internal hernias

A

due to defects in the mesentery left by surgeons or from adhesions that form following surgery

67
Q

Diaphragmatic hernias

A

Congenital. Bockdalek-posterior and Morgagni- anterior

68
Q

Complications of hernia repair

A

Wound infection, ischemic orchitis, neuralgia/inguinodynia, hematoma/seroma, PE, hemorrhage, testicular atrophy, recurrence

69
Q

What increases risk of wound infection after hernia repair?

A

infection at a distant site, like bladder infection

70
Q

Ischemic orchitis results from

A

thrombosis of the small veins of the pampiniform plexus leading to venous congestion, testicular atrophy

71
Q

Orchiectomy

A

taking out testicles, rarely a consequence of ischemic orchitis

72
Q

How can neuralgia occur after hernia repair?

A

d/t traction, cautery, entrapment by suture or mesh

73
Q

hernia recurrence most common technical causes

A

excessive tension, missed hernias first time around, improper mesh size, failure to suture the mesh to enough tissue or to close the internal ring

Clin Med I- GI (10 decks)

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