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Flashcards in Hernias Deck (42):
1

Definiteion of a hernia

An abnormal protrusion of a viscus outwith its normal body cavity

2

What is the most common type of hernia

Inguinal

3

How might abdoninal wall hernias arise?

From natural opening or weak areas, caused by stretching or sirgical incision

4

Name some predisposing factors for abdominal hernias?

Heavy lifting
Coughing
Constipation
Prostatism – commonly bilateral inguinal
Pregnancy
Obesity

5

What do predispising factors for abdominal hernias all have in common?

They raise the intraabdominal pressure

6

How can we classify hernias?

Reducible (going back in and flatten) or irreducible (may obstruct)

7

What happens to the contents of an irreducible hernia?

May become incarcerated or strangulated

8

What is strangulation and describe the appearance

It denotes compromiseof the blood supply of the contents
and its development increase morbidity and mortality
Purple looks like its going to burst

9

Name some of the causes of incisional hernias

Age
Obesity
general debiliility
Post op wound infection
post op haematoma
raised intra abdominal pressure

10

What type of hernias do children get

True umbilical hernias

11

What type of hernias do adults get?

Para - umbilical hernia

12

What treatment do we give for umbilical hernias

If the defect is very small, we can put some stitches in it
More than 2cm then we need some mesh in place to firm up the area

13

What age group of people are prone to epigastric hernia

Teenagers - mid 20s usually males

14

What do we do for umbilical hernias for under 3 year olds

Leave them - they usually resolve themselves

15

If the child is more than 3 and the hernia has not resolved, what do we do?

Operate

16

What is the risk of an inguinal hernia in a child
What do we do for inguinal hernias

Obstructing or strangling the bowel
Operate in the next couple of months unless obstructing or strangling the bowel

17

What causes hernias in kids?

Potent Processus Vaginalis

18

What side is a hernia more common in?

Right

19

What is a Herniotomy

Where you cut off the hernia

20

Who is most likely to get a femoral hernia

Thin elderly female

21

What is the main symptom for a femoral hernia?

Loss of groin crease

22

Describe the anatomy of the femoral hernia

Defect through the femoral canal
below and lateral to the pubic tubercle
Usually flatten the groin crease

23

How much more likely is it that a female wil develop a femoral hernia?

10 times more likely

24

Describe the anatomy of an inguinal hernia

Above pubic tubercle - increases the groin crease

25

If you can feel above the scrotal swelling? what is the most likely diagnosis?

epididymal cyst
ie. not a hernia

26

Name 4 causes of scrotal swellings

Inguino-scrotal hernia (indirect)
hydrocoele
Epididymal cyst
Testicular swelling

27

How do you examine a patient for an inguinal hernia?

Examine the patient upright
Find the pubic tubercle - above and medial = inguinal.
below and lateral = femoral
Ask the patient to cough

28

how do you differentiate clinically between indirect and direct inguinal hernias?

Pressure over the deep inguinal ring get patient to cough
Place the little finger in the canal

29

How do you differentiate at operation between direct and indirect inguinal hernias?

Medial to inferior epigastric vessels = direct
Lateral to inferior epigastric vessels = indirect

30

Describe an indirect inguinal hernia

Lateral to the inferior epigastric vessels and with the cord
May reach to the scrotum
Congenital hernias are indirect
10 times more likely in males

31

Describe a direct inguinal hernia

Posterior bulge through transversalis fascia
Medial to the inferior epigastric (branch of external iliac)
Often bilateral

32

What type of hernia is often bilateral?

Direct inguinal hernia

33

Who is most likely to develop an indirect inguinal hernia?

Young men

34

who is most likely to develop a direct inguinal hernia

Older men

35

Describe digital pressure in both types of ingiunal hernias

Indirect - controlled by digital pressure over the internal ring
Direct - poorly controlled by digital pressure

36

When should we operate on inguinal hernias?

If there are risks of complications even with no symptoms (femoral)
previous symptoms of obstruction
If it interferes with lifestyle

37

Name some of the complications with inguinal hernias

Haematoma
Acute urinary retention
Wound infection
Testicular pain and atrophy

38

What 3 types of operations can be performed on inguinal hernias?

Suture (eg. Bassini)
Open mesh (Lichtenstein)
Laparoscopic (intra or extra)

39

When can a post op hernia patient drive again?

1 week after

40

When can a post op hernia patient heavy lift again?

1 month (1 hand only)

41

What surgical procedures can be carried out to repair a hernia

Hernioctomy (excision of peritoneal sac)
Herniorraphy (repair of the defect of the wall)
Congenital - Herniotomy

42

How do you consent a patient for an inguinal hernia operation

Warn them of wound infection
Placing a mesh
Recurrence rate of <5%
15% chance of neurogenic pain post op

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