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JL Gastrointestinal > Hernias > Flashcards

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

What is an inguinal hernia laying lateral to the epigastric vessels?

Indirect