Hernias Flashcards by Deema Baks

What are the hernia classifications?

external and internal

EXTERNAL 
- groin 
(inguinal & femoral)
- ventral 
(umbilical & paraumbilical & incisional & epigastric) 
- rare 
(spigelian & obturator & lumbar)

INTERNAL

hernia-en-recesses
hiatal hernia
diaphragmatic hernia

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How does a patient discover they have an internal hernia?

accidentally or a complaint due to obstruction

caused by
- defect in mesentery

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What is the most common groin hernia?

Indirect inguinal hernia
- occurs through deep inguinal ring into inguinal canal then out through the superficial ring and may extend into scrotum

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What are the relations of inguinal hernias to inferior epigastric vessels?

indirect hernia is lateral to inferior epigastric vessels

- direct hernia is medial to inferior epigastric vessels

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Which hernia occurs through the posterior wall of the inguinal canal through Hesselbach’s triangle?

Direct inguinal hernia

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Which inguinal hernia is more common in middle aged and elderly?

direct inguinal hernia

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what are the 3 anatomical sites of an indirect inguinal hernia?

congenital
infantile
adult -bubonocele
- funicular
- complete

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What are the borders of Hesselback’s triangle?

MEDIALLY
- lateral wall of rectus abdominis muscle

INFERIORLY
- inguinal ligament

LATERALLY
- inferior epigastric vessels

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What is the clinical picture of a patient presenting with an inguinal hernia?

vague pain/discomfort preceding appearance
swelling
dragging pain
accidentally discovered
complicated hernia
acute inguinal hernia

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What is the most medial structure in the femoral sheath?

femoral canal

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What is the anatomical location of the femoral canal?

extends from femoral ring to saphenous opening containing fat and lymph node of cloquet

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How to differentiate between and inguinal hernia and a femoral hernia?

bulge below inguinal crease in the middle of the thigh

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Which hernia is more common in women and is at a higher risk for strangulation and irreducibility?

femoral hernia

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What is the clinical picture of a femoral hernia?

obstructed or strangulated
intestinal obstruction
small groin swelling that is not reducible
no cough impulse
difficult to feel in obese women

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How do u describe a pantaloon hernia?

both indirect and direct inguinal hernia occuring at the same time

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Which hernia contains the anti-mesenteric portion of the bowel strangulated but does not produce obstruction?

Richter’s hernia

most common with femoral hernia

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which hernia contains a W-shaped loop strangulated and the loop within the abdomen may be gangrenous? How should it be treated?

Maydl’s hernia

pull the whole hernia out before reducing it to make sure the loop inside the abdomen is not gangrenous

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Which hernia contains a strangulated Meckel’s diverticulum with no intestinal obstruction?

Littre’s hernia

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What is a sliding hernia? how is it treated?

part of the hernial sac is formed of an organ (usually urinary bladder)

widen constricting ring and reduce the hernial sac without herniotomy

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How can you differentiate between an omentocele and an enterocele?

OMENTOCELE ENTEROCELE

doughy - soft
gurgling absent - gurgling present
late difficult reduction - 1st difficult reduction
dull - resonant

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What is the inguinal canal?

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oblique passage in the lower part of the anterior abdominal wall
extends from deep inguinal ring to superficial inguinal ring (4cm)

What are the boundaries of the inguinal canal?

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ANTERIOR 
- external oblique aponeurosis & conjoined muscle laterally 
POSTERIOR 
- fascia transversalis & conjoined tendon 
SUPERIOR 
- conjoined muscle 
INFERIOR 
inguinal ligament

What is the location of the superficial inguinal ring?

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triangular aperature in the extenral oblique aponeurosis

1.25cm above pubic tubercle

What is the location of the deep inguinal ring?

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U shaped condensation of fascia transversalis

1.25cm above mid inguinal point

What are the contents of the inguinal canal?

- spermatic cord (or round ligament) - vas deferens - testicular & cremasteric arteries - pampiniform plexus - lymphatics - ilioinguinal nerve - genital branch of genitofemoral nerve

What are the defense mechanisms of the inguinal canal?

- fascia transversalis - weak areas are covered with strong structures - obliquity of the canal - shutter mechanism due to conjoined tendon contraction - valvular mechanism - cremasteric mechanism - transversus abdominis effect

What are the CLINICAL types of a hernia?

- reducible - irreducible - obstructed - strangulated - inflammed

What are the risk factors of developing a hernia?

INFANTS - prematurity (patent processus vaginalis) - male (spermatic cord) ADULTS - obesity (weak abdominal muscle - constipation (straining) - male - chronic cough - heavy lifting - smoking - urinary obstructive symptoms

What are the causes of a hernia?

- unobliterated processus vaginalis - weakness of fascia transversalis - any condition that increases pressure of abdominal cavity - femoral ring may become dilated during pregnancy - destruction of connective tissue

a posterior wall defect is considered which type in the NYHUS classification?

Type III - direct inguinal hernia - indirect inguinal hernia with dilated internal ring (massive scrotal or sliding hernia) - femoral hernia

Type IV in NYHUS classification is?

any recurrent hernia

an indirect inguinal hernia with a dilated internal ring but intact posterior wall is which type?

Type II

an Indirect inguinal hernia with a normal internal ring is which type according to the NYHUS classification?

Type I | simple pediatric hernia

What are the complications of a hernia?

IRREDUCIBILITY - due to adhesions - sliding hernia - tender irreducible OBSTRUCTION - irreducible hernia that contains bowel due to obstruction - blood supply is unaffected - tender irreducible with obstruction STRANGULATION - irreducible obstructed hernia + cut off blood supply due to edges or intrasaccular adhesions - NO impulse on cough INFLAMMATION - due to content (Meckle's) or truss HERNIA TAXIS COMPLICATIONS RUPTURE HYDROCELE OF HERNIAL SAC

which type of hernia is more likely to affect an individual based on their age?

indirect hernia: children & young adults | direct hernia: old age

What occupation will most likely lead to a hernia?

laborious occupations

How can u clinically diagnose a swelling as a hernia?

if the swelling is insidious and intermittent and appears on standing but reduces on lying down

When does pain occur in a hernia?

usually before appearance | in large & complicated hernias it appears later

How do we know if the bowel is associated with the hernia?

- chronic constipation | - acute IO with obstructed strangulated hernias

What are the causes of urinary symptoms in a hernia?

sliding hernia | COULD BE prostatism predisposing to hernia

What are the types of umbilical hernias? and how are they treated?

- congenital - infantile - aquired paraumbilical THEY RESOLVE IN 2 YEARS TTT: do not wait if defect admits more than 2 fingers OR if patient is older than 2 years preform herniorraphy

What are the types of repairs in case of paraumbilical hernia?

Mayo's repair & Keel repair | they are herniorraphy

What causes a paraumbilical hernia in adults?

- obesity - weak abdominal muscles - multiparity - tense ascites

What type of hernia could occur postoperatively?

incisional hernia

What is the cause of an epigastric hernia?

- defect in linea alba between xiphoid process and umbilicus

What are the 2 types of an epigastric hernia?

FATTY HERNIA TRUE EPIGASTRIC HERNIA - only fat - contains peritoneal sac - no impulse on cough - impulse on cough

What are the clinical features of an epigastric hernia?

- swelling with or without pain | - similar to peptic ulcer pain

Which hernia occurs through the aponeurotic layer between rectus abdominis medially & semilunar line laterally?

Spigelian Hernia

at what level does the spigelian hernia develop?

at or below arcuate line because of lack of posterior rectus sheath AT HIGH RISK OF STRANGULATION

What are the 2 types of the Lumbar hernias and where do they occur?

- petit's hernia: inferior lumbar triangle | - Grynfeltt's hernia: superior lumbar triangle

How is an obturator hernia discovered?

doesn't show any bulge but acts like a bowel obstruction and causes nausea and vomiting very rare and occurs mostly in women

Hernias Flashcards

(51 cards)