Flashcards in Hernias Deck (41):
What are the most common surgeries for hernias, from the most common to least?
What are natural openings in the body that can herniate?
Inguinal, femoral, umbilicus, oesophageal hiatus and obturator.
What are some natural areas that may stretch and herniate?
Epigastric and paraumbilical.
What are two surgically induced hernias?
Incisional and parastomal.
What can predispose people to hernias?
Heavy lifting, coughing, constipation, prostatism (enlarged prostate), pregnancy and obesity.
What two categories do we divide hernias into?
Reducible and irreducible.
What are the two different types of irreducible hernia?
Obstructed and incarcerated.
What can happen to an obstructed hernia?
What is strangulation of a hernia?
Is due to compromise of blood supply of the contents. The low pressure venous system is occluded first and then the arterial supply becomes occluded, with the development of gangrene.
What are the hernias of the abdominal wall?
Incisional, paraumbilical, epigastric paediatric umbilical, paediatric inguinal hernia, femoral and inguinal.
What factors can contribute to the development of an incisional hernia?
Age, obesity and general debility e.g. Malignancy.
Post operative wound infection or haematoma, suturing technique and type of incision (vertical more than transverse).
Raised intra-abdominal pressure and steroids.
What can we do to avoid an incisional hernia in predisposed patients?
Use tension sutures and mass close the linea alba.
What three types of hydrocele hernias do we have?
Hydrocele of the cord, communicating hydrocele and hydrocele of the tunica vaginalis.
What is a hydrocele?
A collection of fluid in the scrotum.
What is an epigastric hernia?
Who most commonly gets them?
Arise from a congenital weakness of the linea alba, usually containing extra peritoneal fat.
Male 3:1 female.
What are the symptoms of epigastric hernias and how do we repair them?
Usually Asymptomatic or local symptoms.
Repair with sutures or mesh.
What is the treatment for congenital umbilical hernias?
Monitored to see if they resolve by the age of three, if aged over three then they will operate.
What paediatric patients are more prone to having an inguinal hernia?
30% under the age of a year.
Male:female ratio is 9:1
More common in preterm and LBW infants.
On What side are paediatric inguinal hernias more common?
Right sided more common.
What are the complications of paediatric inguinal hernias?
20% chance of developing a contralateral hernia.
Increased risk of strangulation under the age of 1 and so they are urgently operated on.
What kind of patients should we consider having a femoral hernia?
Thin elderly females. Look for a loss of groin crease.
How much more common are femoral hernias in females than males?
What is the most common type of hernia?
What must we exclude when examining for an inguinal hernia?
Exclude scrotal swelling.
How do we differentiate between an inguinal and femoral hernia on examination?
Find the pubic tubercle, if above and medial it is inguinal.
If it below and lateral its femoral.
How do we differentiate between direct and indirect inguinal hernias on examination?
Put pressure over the deep inguinal ring and ask the patient to cough.
Place a little finger in the canal behind the cord and ask the patient to cough.
If there is a palpable bulge this means there is an indirect hernia.
How do we differentiate between an indirect and direct hernia in surgery?
Direct is medial to inferior epigastric vessels.
Indirect is lateral to inferior epigastric vessels.
If a hernia reaches into the scrotum what type is it most likely to be?
What type of inguinal hernias are congenital?
Which inguinal hernias are often bilateral?
Where are the deep and superficial rings found in relation to the patients surface anatomy?
Deep - mid inguinal point.
Superficial - above and medial to the pubic tubercle.
What is hesselbachs triangle?
Inguinal ligament inferiorly.
Inferior epigastric vessels laterally.
Lateral border of rectus sheath medially.
What inguinal hernia is more common in younger men?
What inguinal hernia is more common in older men?
When will we operate on an inguinal hernia?
Risk of complication even if Asymptomatic.
Hernias with previous symptoms of obstruction.
Hernia interfering with lifestyle.
What are the complications of inguinal hernia?
Haematoma (wound or scrotum)
Acute urinary retention.
Chronic neurogenic pain
Testicular pain and atrophy.
What types of operations are done on inguinal hernias?
Suture e.g. Bassini.
Open mesh e.g. Lichtenstein.
Laparoscopic TAPS or TEPS (intraperitoneal or extraperitoneal).
What are the post operative instructions after inguinal hernia operation?
No driving for a week and no heavy lifting for a month (1hand lift only)
What is a herniotomy?
Excision of the peritoneal sac.
Done for congenital inguinal hernias.
What is a herniorraphy?
Repair of the defect of the wall.