Hernias

Question 1

What is a hernia?

Answer 1

Protrusion of peritoneum through an opening

(usually at a site of weakness)

Question 2

protrusion of peritoneum through an opening, what is it?

Answer 2

hernia

Question 3

contents of hernia may be at risk of what? (2 things)

Answer 3

incarceration and strangulation

Question 4

what is a sign of incarceration?

Answer 4

not reducible back into abdomen/pelvis

Question 5

how can you check for incarceration of a hernia?

Answer 5

try to reduce hernia back into abdomen/pelvis

Question 6

what are signs of strangulation of a hernia?

Answer 6

ischemia and necrosis

Question 7

hernia is ischemic and necrotic. what is going on?

Answer 7

strangulation

Question 8

how can complicated hernias present?

Answer 8

tenderness, erythema, fever

Question 9

diaphragmatic hernia: what is this?

Answer 9

abdominal structures entering the thorax

Question 10

abdominal structures entering the thorax: what is this?

Answer 10

diaphragmatic hernia

Question 11

diaphragmatic hernia: what are the most common causes of in infants?

Answer 11

congenital defect of pleuroperitoneal membrane

Question 12

diaphragmatic hernia in children: which side?

Answer 12

mostly left, because right is mostly protected by the liver

Question 13

congenital defect of pleuroperitoneal membrane: causes what?

Answer 13

diaphragmatic hernia in children

Question 14

diaphragmatic hernia in adults: what is the cause?

Answer 14

laxcity(looseness)/defect of phrenoesophageal membrane

leads to hiatal hernia (hernia of stomach through esophageal hiatus)

Question 15

defect of phrenoesophageal membrane -> leads to what?

Answer 15

hiatus hernia (diaphragmatic hernia) in adults

Question 16

what is a hiatal hernia?

Answer 16

herniation of stomach through esophageal hiatus

Question 17

herniation of stomach through esophageal hiatus: what is this?

Answer 17

hiatus hernia

diaphragmatic hernia in adults

Question 18

Sliding hiatal hernia: what is this?

Answer 18

gastroesophageal junction is displaced upward as gastric cardia slides into hiatus

Question 19

what slides into hiatus in a ‘sliding hiatal hernia’?

Answer 19

cardia of the stomach

Question 20

hourglass stomach: which type of hernia?

Answer 20

sliding hiatal hernia

Question 21

what is the most common type of a hiatal hernia?

Answer 21

sliding hiatal hernia

Question 22

which type of hernia is associated with GERD?

GERD = gastroesophageal reflux disease

Answer 22

sliding hiatal hernia

Question 23

sliding hiatal hernia: associated with what?

Answer 23

GERD (gastroesophageal reflux disease)

Question 24

what are the 2 types of a hiatal hernia?

Answer 24

sliding hiatal hernia
paraesophageal hiatal hernia

Question 25

what is a paraesophageal hiatal hernia?

Answer 25

gastric fundus protrudes into thorax, gastroesophagea junction usually normal

Question 26

gastric cardia protrudes into thorax. what is this?

Answer 26

sliding hiatal hernia

Question 27

gastric fundus protrudes into thorax. what is this?

Answer 27

paraesophageal hiatal hernia

Question 28

Indirect inguinal hernia: slides through which structures?

Answer 28

internal (deep) inguinal ring, external (superficial) inguinal ring, into the groin

Question 29

Indirect inguinal hernia: medial or lateral of inferior epigastric vessels?

Answer 29

lateral

Question 30

which hernia is lateral of inferior epigastric vessels?

Answer 30

indirect inguinal hernia

Question 31

which hernia slides through internal (deep) inguinal ring, external (superficial) inguinal ring, into the groin?

Answer 31

indirect inguinal hernia

Question 32

what causes a congenital indirect inguinal hernia?

Answer 32

failure of processus vaginalis to close

Question 33

failure of processus vaginalis to close -> which hernia?

Answer 33

indirect inguinal hernia

Question 34

failure of processus vaginalis to close can cause indirect hernia what other structure can form in boys?

Answer 34

hydrocele

Question 35

what is a hydrocele?

Answer 35

collection of fluid in the scrotum

Question 36

collection of fluid in the scrotum, what is this?

Answer 36

hydrocele

Question 37

indirect inguinal hernia: more common in males or females?

Answer 37

males

Question 38

can an indirect inguinal hernia be noticed in both infants and adults?

Answer 38

yes

Question 39

indirect inguinal hernia: follows pathway of what?

Answer 39

testicular descent

Question 40

indirect inguinal hernia: covered by what?

Answer 40

3 layers of spermatic fascia

Question 41

what are the 3 layers of the spermatic fascia?

Answer 41

1. external spermatic fascia 2. cremasteric fascia 3. internal spermatic fascia (van buiten naar binnen tijdens het snijden)

Question 42

external spermatic fascia: derived from what?

Answer 42

external oblique aponeurosis

Question 43

cremasteric fascia: derived from what?

Answer 43

internal oblique aponeurosis

Question 44

internal spermatic fascia: derived from what?

Answer 44

fascia transversalis

Question 45

direct inguinal hernia: protrudes through what?

Answer 45

inguinal triangle (Hesselbach)

Question 46

Hesselbach triangle: what are the 3 walls?

Answer 46

medial: rectus abdominis lateral: inferior epigastic vessels inferior: inguinal ligament

Question 47

hernia through triangle of Hesselbach: which type?

Answer 47

direct inguinal hernia

Question 48

direct inguinal hernia: goes through which (ring) structure?

Answer 48

external/superficial inguinal ring only

Question 49

direct inguinal hernia: covered by which fascia?

Answer 49

external spermatic fascia

Question 50

direct inguinal hernia: common in who?

Answer 50

older males due to acquired weakness of transversalis fascia

Question 51

older males due with acquired weakness of transversalis fascia: which hernia?

Answer 51

direct inguinal hernia

Question 52

direct inguinal hernia: bulges where?

Answer 52

directly through parietal peritoneum

Question 53

direct inguinal hernia: medial or lateral of inferior epigastric vessels?

Answer 53

medial

Question 54

direct inguinal hernia: medial or lateral of rectus abdominis?

Answer 54

lateral

Question 55

mnemonic: MD's don't LIe

Answer 55

MD: medial, direct hernia LI: lateral, indirect hernia

Question 56

MD: medial, direct hernia LI: lateral, indirect hernia which mnemonic?

Answer 56

MD's don't LIe

Question 57

Femoral hernia: protrudes where?

Answer 57

below inguinal ligament, through femoral canal

Question 58

femoral hernia: orientation with respect to pubic tubercle?

Answer 58

lateral and below

Question 59

femoral hernia: more common in males or females?

Answer 59

females (but overall inguinal hernias are the most common in females)

Question 60

most common hernia in females?

Answer 60

inguinal hernia

Question 61

below inguinal ligament, through femoral canal what type of hernia?

Answer 61

femoral hernia

Question 62

which hernia is more likely to present with incarceration or strangulation: femoral or inguinal?

Answer 62

femoral hernia

Question 63

femoral hernia: which complications are more likely? (vs inguinal hernia)

Answer 63

incarceration and strangulation