Flashcards in Hernias Deck (76):
1
What is an abnormal protrusion of a viscus outwith its normal body cavity?
Hernia
2
Name 4 hernias, most common first?
1. Inguinal
2. Umbilical
3. Incisional
4. Femoral
3
What may arise from natural openings or weak areas, caused by stretching or surgical inscision?
Abdominal wall hernias
4
What type of hernias are inguinal, femoral, umbilicus, oesophageal hiatus and obturator?
Natural abdominal wall hernias
5
What are incisional, parastomal, epigastric and paraumbilical herias a type of?
Weak area abdominal wall hernia
6
What is the physiological predisposing factor of abdominal hernias?
Raised intra-abdominal pressure
7
What can pregnancy and obesity lead to?
Abdominal hernias
8
What predisposing factor of abdominal hernias can leads to bilateral inguinal hernia?
Prostatism
9
Can constipation, coughing and heavy lifting cause abdominal hernias?
Yes
10
What may hernias be classified as?
Reducible or irreducible
11
If the hernia is irreducible, what may happen to its contents?
Incarcerated or strangulated
12
What denotes compromise of the blood supply of the contents and its development increases morbidity and mortality?
Strangulation
13
With strangulation hernias, what system is occluded first?
Low pressure venous system, then arterial supply
14
When the arterial supply of a hernia becomes occluded, what can develop?
Gangrene
15
In predisposed patients, to prevent an incisional hernia, what surgical measures are taken?
Tension sutures plus "mass closure" of the linea alba
16
If you have a malignancy are you more likely to develop an incisional hernia?
Yes
17
What two aetiological causes related to after an operation can be predisposing factors for incisional hernias?
Post-operative wound infection
Post-operative wound haematoma
18
What does an ileus do that increases the chance of an incisional hernia?
Raises the intra-abdominal pressure
19
What class of drug can be a predisposing factor for incisional hernias?
Steroids
20
Is a vertical or transverse incision more likely to cause an incisional hernia?
Vertical
21
What type of hernia is common in adult, obese patients?
Paraumbilical
22
What to epigastric hernias arise from?
Congenital weakness of the linea alba
23
What type of hernia usually contains extraperitoneal fat?
Epigastric
24
What type of hernia has a male:female ration of 3:1 and occurs usually in late teens/early adult hood?
Epigastric hernia
25
How do you repair an epigastric hernia?
With sutures or mesh
26
What type of hernia is an umbilical hernia?
Congenital
27
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
28
What male:female ratio does a paediatric inguinal hernia have?
9:1
29
What type of hernias are more common in pre-term and low birth weight infants?
Paediatric inguinal hernias
30
What side are paediatric inguinal hernias commonly found on and what is there a 20% chance of developing?
Right side, developing a contralateral hernia
31
With paediatric inguinal hernias, what is there an increased risk of aged
Strangulation
32
What type of hernia is common in a thin, elderly female?
Femoral hernia
33
What sign is there, of a femoral hernia?
Loss of groin crease
34
What is the anatomical defect of a femoral hernia?
Defect through the femoral canal
35
What are the 4 boundaries of the femoral canal?
Anterior - inguinal ligament
Medial - lacunar ligament
Lateral - femoral vein
Posterior - pectinate ligament
36
What hernias are below and lateral to the pubic tubercle and usually flatten the groin crease?
Femoral hernias
37
What hernia is present in a thin, elderly female with small bowel obstruction and no previous surgery?
Femoral hernia
38
What type of hernia occurs above the pubic tubercle and increases the groin crease?
Inguinal hernia
39
Name a type of inguinal hernia?
Inguino-scrotal
40
With scrotal swellings, if you cannot get above the swelling what does it suggest?
Hernia
41
What are 4 causes of scrotal swellings?
1. Inguino-scrotal hernia (indirect)
2. Hydrocoele
3. Epididymal cyst
4. Testicular swelling
42
How should you examine a patient for an inguinal hernia?
Examine the patient upright
43
If the hernia is to scrotum, what does it suggest?
Indirect
44
If a hernia is above and medial to the pubic tubercle, what is it?
Inguinal
45
If a hernia is below and lateral to the pubic tubercle, what does it suggest?
Femoral
46
When examining inguinal hernias, what should you ask the patient to do?
Pressure over the deep inguinal ring and get patient to cough
47
When trying to differentiate clinically between indirect and direct, where should you place a little finger?
In the canal (behind cord)
48
When differentiating between direct and indirect hernias at operation, what does medial to inferior epigastric vessels suggest?
Direct
49
When differentiating between direct or indirect hernias during operation, what does lateral to inferior epigastric vessels suggest?
Indirect
50
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
51
What hernia is this: psoterior bulge through transversalis fascia, medial to inferior epigastric (branch of ext iliac) and often bilateral?
Direct inguinal hernia
52
Where is the deep inguinal ring located?
Mid-inguinal point
53
Where is the superficial inguinal ring located?
Above and medial to pubic tubercle
54
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)
55
What is Hesselbach's triangle boundaries?
1. Inguinal ligament inferiorly
2. Inferior epigastric vessels laterally
3. Lateral border of rectus sheath medially
56
Who are indirect inguinal hernias more common in?
Young men
57
How are indirect inguinal hernias controlled?
By digital pressure over the internal ring
58
What hernias are poorly controlled by digital pressure, more common in older men and have a 0.3% per annum strangulate?
Direct inguinal hernias
59
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
60
What complication of an inguinal hernia occurs in relation to the wound or scrotum?
Haematoma
61
What complications of inguinal hernias are related to testicles?
Testicular pain and atrophy
62
What are chronic neurogenic pain, hernia recurrence, wound infection and acute urinary retention complications of?
Inguinal hernias
63
What are the three types of inguinal hernia operations?
1. Suture (bassini)
2. Open mesh (Lichtenstein)
3. Laparoscopic (intraperitoneal - TAPS, extraperiotneal - TEPS)
64
What is herniotomy?
Excision of peritoneal sac
65
What is herniorraphy?
Repair of the defect of the wall
66
What surgical repair method is used for congenital hernias?
Herniotomy
67
What is an embryonic development outpouching of the peritoneum?
Processus vaginalis
68
What does inguinal hernia in children result from?
Patent processus vaginalis, failed to obliterate after the descent of the testis through it.
69
Why do femoral hernias almost always require surgical management?
Due to risk of strangulation
70
In obturator hernias, where does the abdominal contents protrude through?
The obturator foramen
71
What patients are obturator hernias more common in?
Females getting older and losing weight
72
What hernia is the Howship-Romberg sign typical of?
Obturator hernia (pain in medial thigh is provoked by thigh extension, medial rotation and abduction)
73
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?
Spigelian
74
What hernias are small, but there risk of strangulation is high, therefore are almost always surgically repaired unless contra-indicated?
Spigelian
75
What is an inguinal hernia laying medial to the epigastric vessels?
Direct
76