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Surgery finals > Hernias > Flashcards

Hernias Flashcards

1
Q

Define hernia

A

A hernia occurs when an organ/tissue protrudes through the wall of the cavity containing it

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2
Q

Describe the epidemiology of hernias

A

Inguinal: Very common!! M&raquo_space;> F

Umbilical: Children

Hiatus: Very common - 10-20%

Femoral: F > M

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3
Q

Identify the types of hernias

A 
Inguinal 
Femoral
Umbilical
Hiatus
Incisional
Spigelian
Obturator 
Epigastric
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4
Q

Describe the types of inguinal hernia

A

Inguinal hernias can be 2 types

1) Direct: do not pass through the deep inguinal ring, herniates through weakness in the abdo wall at Hesselbach’s triangle
2) Indirect: pass through the inguinal canal

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5
Q

Describe the boundaries of the inguinal canal

A

Anterior: aponeurosis of the external oblique
Posterior: transversalis fascia
Floor: inguinal ligament (rolled apon. of EO)
Roof: transversalis fascia, IO, transversus abdominus

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6
Q

Describe the anatomy of the inguinal rings

A

Deep inguinal ring: above the midpoint of the inguinal ligament
Superficial inguinal ring: superior to the pubic tubercle

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7
Q

Describe the location of the mid-inguinal point and the midpoint of the inguinal ligament + relevance

A

Mid-inguinal point: halfway between pubic symphysis and ASIS. Palpate femoral pulse
Midpoint of the inguinal ligament: halfway between the pubic tubercle and ASIS. Location of the deep inguinal ring

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8
Q

Describe the normal contents of the inguinal canal

A

M: spermatic cord
F: round ligament
Nerves

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9
Q

Describe the pathophysiology of inguinal hernias

A

Indirect:
Patent processus vaginalis -> pathway for abdominal viscera to reach the scrotum
Direct:
Weakness in transversalis fascia -> protrusion of viscera

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10
Q

How do you differentiate between two types of inguinal hernias on examination?

A

Reduce the hernia, then cover the deep inguinal ring

Valsalva -> protrusion of a direct hernia NOT indirect

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11
Q

What is a Richter’s hernia?

A

Occurs when only one side of the bowel herniates through an opening, causing only one part to become ischaemic if strangulated

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12
Q

What is a Maydl’s hernia?

A

Herniation of two loops of bowel through the abdominal wall

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13
Q

Describe the boundaries of the femoral triangle

A

Sartorius muscle- laterally
Aductor longus- medially
Inguinal ligament- superiorly

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14
Q

Describe the contents of the femoral triangle

A 
Lateral -> medial
Femoral nerve
Femoral artery
Femoral vein
Femoral canal
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15
Q

Describe the difference between inguinal and femoral hernias on examination

A

Femoral: inferolateral to the pubic tubercle
Inguinal: superomedial to the pubic tubercle

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16
Q

Define strangulation and incarceration of hernias

A

Incerceration: when the contents of a hernia are no longer reducible
Strangulation: when the contents of a hernia loses its arterial supply and risks ischaemia

17
Q

Describe the presentation of abdominal hernias

A

May be asymptomatic lump on the abdominal wall
-Can have dull dragging discomfort

Or present w strangulation:

  • Severe colicky abdo pain
  • Tender, red, irreducible lump
  • Vomiting + abdo distension
18
Q

Describe the investigation for hernias

A

Clinical diagnosis

Imaging if unclear: USS -> CT

19
Q

Describe the management of hernias

A

Conservative:

  • Lifestyle: weight loss, exercises
  • Watchful waiting: minimal symptoms/asymp, unsuitable for Sx

Surgical: definitive Mx

  • Open mesh repair (low risk, v effective)
  • Laparoscopic surgical repair
20
Q

Describe the types of hiatus hernia

A

1) Sliding: protrusion of the GOJ + stomach through the oesophageal hiatus
2) Rolling: herniation of the fundus/body of stomach through oesophageal hiatus
3) Sliding + rolling
4) Herniation of multiple organs

21
Q

Describe the presentation of hiatus hernia

A

May be asymptomatic
Most commonly GORD + heartburn, possibly exacerbated by bending over, etc
-Difficulty swallowing, early satiety, bloating

22
Q

Describe the investigations for hiatus hernia

A

Diagnosis by investigation only

  • CXR
  • Upper gi contrast series is best (contrast swallow + XR)
23
Q

Describe the management of hiatus hernia

A

Conservative:
-Lifestyle: weight loss, diet, raising head of the bed, etc

Medical:
-PPIs/H2RA

Surgical: for recurrent/persistent
-Laparoscopic fundoplication, reduction, mesh repair etc

24
Q

Describe the complications of hernias

A

Strangulation/incarceration- rare in inguinal, ^ in femoral + Spigelian
Hiatus: Barrett’s, Ca, gastric volvulus

Surgical complications
Recurrence following surgery

25
Q

Describe the signs of hernia on examination

A

Bulge/lump on abdominal wall (can extend into scrotum if inguinal)
Soft and smooth, non-tender, unable to get above the lump, reducible (unless incarcerated)
After reduction can be elicited with Valsalva

Surgery finals (16 decks)

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