EOR GI part 2: hernias Flashcards
(47 cards)
What is a hernia?
Protrusion of a peritoneal sac through a musculoaponeurotic barrier; a fascial defect
What are the precipitating factors of a hernia?
Increased intra-abdominal pressure Straining at defecation or urination Obesity Pregnancy Ascites Valsalvagenic (cough) COPD An abnormal congenital anatomic route
Why should hernias be repaired?
To avoid complications of incarceration/strangulation, bowel necrosis, SBO, pain
What is more dangerous: a small or large hernia defect?
Small defect is more dangerous because a tight defect is more likely to strangulate if incarcerated
Reducible hernia
Ability to return the displaced organ or tissue/hernia contents to their usual anatomic site
Incarcerated hernia
Swollen or fixed within the hernia sac
May cause intestinal obstruction
Strangulated hernia
Incarcerated hernia with resulting ischemia
Will result in signs and sx of ischemia and intestinal obstruction or bowel necrosis
Complete hernia
Hernia sac and its contents protrude all the way through the defect
Incomplete hernia
Defect present without sac or contents protruding completely through it
What is reducing a hernia en masse?
Reducing the hernia contents and hernia sac
Incisional hernia
Hernia through an incisional site
MCC is a wound infection
Femoral hernia
Hernia medial to femoral vessels (under inguinal ligament)
Indirect inguinal hernia
Inguinal hernia lateral to Hesselbach’s triangle
Direct inguinal hernia
Inguinal hernia within Hesselbach’s triangle
Hiatal hernia
Hernia through esophageal hiatus
What are the boundaries of Hesselbach’s triangle?
- Inferior epigastric vessels (lateral border)
- Inguinal ligament (base)
- Lateral border of the rectus sheath (medial border)
Floor consists of internal oblique and the transversus abdominis muscle
What are the layers of the abdominal wall?
Skin Subcutaneous fat Scarpa's fascia External oblique Internal oblique Transversus abdominus Transversalis fascia Preperitoneal fat Peritoneum
What is the DDx for a mass in a healed C-section incision?
Hernia
Endometrioma
What is the DDx of a groin mass?
LAD Hematoma Seroma Abscess Hydrocele Femoral artery aneurysm EIC Undescended testicle Sarcoma Hernias Testicular torsion
What is the cause of a direct hernia?
Acquired defect from mechanical breakdown over the yrs
What nerve runs with the spermatic cord in the inguinal canal?
Ilioinguinal nerve
What is the cause of an indirect hernia?
Patent processus vaginalis
How is an inguinal hernia diagnosed?
Relies mainly on hx and PE with index finger invaginated into the external ring and palpation of hernia
Examine the pt standing up if dx is not obvious
DDx of inguinal hernia
LAD Psoas abcess Ectopic testis Hydrocele of the cord Saphenous varix Lipoma Varicocele Testicular torsion Femoral artery aneurysm Abscess
