Flashcards in Hernias Deck (76):
What is an abnormal protrusion of a viscus outwith its normal body cavity?
Name 4 hernias, most common first?
What may arise from natural openings or weak areas, caused by stretching or surgical inscision?
Abdominal wall hernias
What type of hernias are inguinal, femoral, umbilicus, oesophageal hiatus and obturator?
Natural abdominal wall hernias
What are incisional, parastomal, epigastric and paraumbilical herias a type of?
Weak area abdominal wall hernia
What is the physiological predisposing factor of abdominal hernias?
Raised intra-abdominal pressure
What can pregnancy and obesity lead to?
What predisposing factor of abdominal hernias can leads to bilateral inguinal hernia?
Can constipation, coughing and heavy lifting cause abdominal hernias?
What may hernias be classified as?
Reducible or irreducible
If the hernia is irreducible, what may happen to its contents?
Incarcerated or strangulated
What denotes compromise of the blood supply of the contents and its development increases morbidity and mortality?
With strangulation hernias, what system is occluded first?
Low pressure venous system, then arterial supply
When the arterial supply of a hernia becomes occluded, what can develop?
In predisposed patients, to prevent an incisional hernia, what surgical measures are taken?
Tension sutures plus "mass closure" of the linea alba
If you have a malignancy are you more likely to develop an incisional hernia?
What two aetiological causes related to after an operation can be predisposing factors for incisional hernias?
Post-operative wound infection
Post-operative wound haematoma
What does an ileus do that increases the chance of an incisional hernia?
Raises the intra-abdominal pressure
What class of drug can be a predisposing factor for incisional hernias?
Is a vertical or transverse incision more likely to cause an incisional hernia?
What type of hernia is common in adult, obese patients?
What to epigastric hernias arise from?
Congenital weakness of the linea alba
What type of hernia usually contains extraperitoneal fat?
What type of hernia has a male:female ration of 3:1 and occurs usually in late teens/early adult hood?
How do you repair an epigastric hernia?
With sutures or mesh
What type of hernia is an umbilical hernia?
By what age has an umbilical hernia usually resolved, and what action is taken if it hasn't by then?
Age 3, if > 3 operate
What male:female ratio does a paediatric inguinal hernia have?
What type of hernias are more common in pre-term and low birth weight infants?
Paediatric inguinal hernias
What side are paediatric inguinal hernias commonly found on and what is there a 20% chance of developing?
Right side, developing a contralateral hernia
With paediatric inguinal hernias, what is there an increased risk of aged
What type of hernia is common in a thin, elderly female?
What sign is there, of a femoral hernia?
Loss of groin crease
What is the anatomical defect of a femoral hernia?
Defect through the femoral canal
What are the 4 boundaries of the femoral canal?
Anterior - inguinal ligament
Medial - lacunar ligament
Lateral - femoral vein
Posterior - pectinate ligament
What hernias are below and lateral to the pubic tubercle and usually flatten the groin crease?
What hernia is present in a thin, elderly female with small bowel obstruction and no previous surgery?
What type of hernia occurs above the pubic tubercle and increases the groin crease?
Name a type of inguinal hernia?
With scrotal swellings, if you cannot get above the swelling what does it suggest?
What are 4 causes of scrotal swellings?
1. Inguino-scrotal hernia (indirect)
3. Epididymal cyst
4. Testicular swelling
How should you examine a patient for an inguinal hernia?
Examine the patient upright
If the hernia is to scrotum, what does it suggest?
If a hernia is above and medial to the pubic tubercle, what is it?
If a hernia is below and lateral to the pubic tubercle, what does it suggest?
When examining inguinal hernias, what should you ask the patient to do?
Pressure over the deep inguinal ring and get patient to cough
When trying to differentiate clinically between indirect and direct, where should you place a little finger?
In the canal (behind cord)
When differentiating between direct and indirect hernias at operation, what does medial to inferior epigastric vessels suggest?
When differentiating between direct or indirect hernias during operation, what does lateral to inferior epigastric vessels suggest?
What type of inguinal hernia is this: lateral to the inferior epigastric vessels and with the cord, may reach to the scrotum (inguino-scrotal), congenital hernias are indirect and MF ratio is 10:1?
Indirect inguinal hernia
What hernia is this: psoterior bulge through transversalis fascia, medial to inferior epigastric (branch of ext iliac) and often bilateral?
Direct inguinal hernia
Where is the deep inguinal ring located?
Where is the superficial inguinal ring located?
Above and medial to pubic tubercle
What are the four bondaries for the inguinal canal?
Anterior - external oblique aponeurosis
Floor - inguinal and lacunar ligament
Roof - conjoint tendon coming over
Posterior - transversalis fascia and conjoint tendon (med)
What is Hesselbach's triangle boundaries?
1. Inguinal ligament inferiorly
2. Inferior epigastric vessels laterally
3. Lateral border of rectus sheath medially
Who are indirect inguinal hernias more common in?
How are indirect inguinal hernias controlled?
By digital pressure over the internal ring
What hernias are poorly controlled by digital pressure, more common in older men and have a 0.3% per annum strangulate?
Direct inguinal hernias
What are the three factors for operating on an inguinal hernia?
1. Hernia at risk of complications even if no symptoms (e.g. femoral)
2. Hernia with previous symptoms of obstruction
3. Hernia interfering with life-style
What complication of an inguinal hernia occurs in relation to the wound or scrotum?
What complications of inguinal hernias are related to testicles?
Testicular pain and atrophy
What are chronic neurogenic pain, hernia recurrence, wound infection and acute urinary retention complications of?
What are the three types of inguinal hernia operations?
1. Suture (bassini)
2. Open mesh (Lichtenstein)
3. Laparoscopic (intraperitoneal - TAPS, extraperiotneal - TEPS)
What is herniotomy?
Excision of peritoneal sac
What is herniorraphy?
Repair of the defect of the wall
What surgical repair method is used for congenital hernias?
What is an embryonic development outpouching of the peritoneum?
What does inguinal hernia in children result from?
Patent processus vaginalis, failed to obliterate after the descent of the testis through it.
Why do femoral hernias almost always require surgical management?
Due to risk of strangulation
In obturator hernias, where does the abdominal contents protrude through?
The obturator foramen
What patients are obturator hernias more common in?
Females getting older and losing weight
What hernia is the Howship-Romberg sign typical of?
Obturator hernia (pain in medial thigh is provoked by thigh extension, medial rotation and abduction)
What hernia is uncommon and occurs below the level of the umbilicus/arcuate line, as there is a lcak of posterior retus sheath here, between the rectus muscle medially and semilunar line laterally?
What hernias are small, but there risk of strangulation is high, therefore are almost always surgically repaired unless contra-indicated?
What is an inguinal hernia laying medial to the epigastric vessels?