Casefiles 9: hernias, GB disease Flashcards
(45 cards)
indirect inguinal hernia goes through where?
presentation in men vs women
through the internal inguinal ring through a patent processus vaginalis into the inguinal canal
In men, the hernia sacs follow the spermatic cord and may descend into the scrotum
In women may present as labial swelling
direct inguinal hernia goes through where?
through the Hesselbach triangle and medial to the ipsilateral inferior epigastric vessels
The Hesselbach’s triangle is defined by ?
the edge of the rectus muscle medially, the inguinal ligament inferolaterally, and inferior epigastric vessels superiolaterally
subtle difference between femoral hernia and inguinal hernia is that the femoral hernia is located ?
borders of femoral canal?
below the inguinal ligament
bound by the inguinal ligament superiorly, the femoral vein laterally, and the pyriformis and pubic ramus medially
umbilical hernias result from ? or ?
the improper closure of the abdominal wall defect where the umbilical cord was in utero
OR acquired hernias, where subclinical defects increase in size due to increased intra-abdominal pressures (eg, pregnancy, ascites, or excess weight gain)
any type of hernia that contains a Meckel diverticulum
Littre hernia
an inguinal hernia that contains the appendix
Amyand’s hernia
a femoral hernia that contains the appendix
De Garengeot’s hernia
Richter’s hernia
herniation of part of the bowel wall through any hernia defect
unique because it may or may not be associated with intestinal obstruction, and that this type of hernia is often smaller and can be more difficult to diagnose.
The area of incarcerated intestine can develop ischemia and necrosis when the process goes undiagnosed.
hernia just lateral to the rectus sheath and located at the semilunar line, or the lower limits of the posterior rectus sheath
Spigelian hernia
Obturator hernia
herniation along the obturator canal alongside the obturator vessels and obturator nerve
occurs most commonly in women, particularly multiparous women with history of recent weight loss
A mass can be palpable in the medial thigh, particularly with hip flexed, externally rotated, and abducted.
The Howship–Romberg sign is associated with approximately 50% of the patients with ?
obturator hernias, and this is pain along the inner thigh produced by hip flexion, abduction, internal rotation, or external rotation
obturator neuralgia produced by nerve entrapment by an obturator hernia
an indirect inguinal hernia with a hernia sac containing either sigmoid colon (left) or cecum (right)
Sliding hernia
-The indirect hernia sac in this type of hernia will contain the attachment of the intestines. -High-ligation of the sac without clearly identifying a hernia as a sliding hernia can cause ischemic injury to the intestine within the sac
the femoral canal is between ?
the inguinal ligament, Cooper’s ligament, and the femoral vein
watchful waiting vs. repair
safe and cost-effective to observe individuals with minimally symptomatic or asymptomatic inguinal hernias
except for femoral hernias; nearly 1/3rd developed acute events requiring emergency repairs
causes of chronic postoperative pain following inguinal hernia repairs
hernia recurrence (generally 1%-5%), mesh-related pain, nerve irritation, and infections
When contamination or spillage of intestinal contents occur, don’t use ? in the repair
permanent prosthetic material is usually avoided
Gallston disease complications
gallbladder complications: acute and/or chronic cholecystitis
complications related to the passage of stones from the gallbladder into the biliary duct: choledocholithiasis, cholangitis, and biliary pancreatitis or stone passage into the GI tract (gallstone ileus)
why should you get a diabetic patient to cholecystectomy quickly if they have cholecystitis?
Diabetic patients are highly susceptible to develop stress-induced hyperglycemia, and with hyperglycemia, leukocyte functions are compromised, thus increasing risk of infectious complications from acute cholecystitis
Patient comes in with suspected cholecystitis, what to do?
Admission, NPO, IV fluids, IV antibiotics, followed rather quickly by laparoscopic cholecystectomy (LC)
pts have biliary colic because ?
or rarely due to ?
their gallbladders are stimulated to contract but are unable to empty either because there is a gallstone obstruction at the gallbladder neck or cystic duct
cholecystokinin (CCK) stimulation of a dysfunctional gallbladder, such as in the case of biliary dyskinesia
The most common organisms involved in acute cholecystitis are ?
Escherichia coli, Klebsiella, Proteus, and Steptococcus faecalis
Cholecystitis presents with ?
US findings?
persistent RUQ pain, +/- fever, focal gallbladder tenderness, mild leukocytosis or normal WBC count, and normal LFTs or nonspecific abnormalities in the LFTs
Gallstones in gallbladder; may have pericholecystic fluid; may or may not have CBD dilation
acalculous cholecystitis
what is it?
typically affects who?
gallbladder inflammation and infection secondary to biliary stasis, responsible for less than 5%
hospitalized patients undergoing other medical treatments
