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Flashcards in Hernias Deck (49):
1

Patho of Hernia

protrusion of an organ as part of an organ through the body wall that normally contains it

2

Most common type of hernia

groin

3

Most common hernia

inguinal

4

Types of groin hernias

inguinal and femoral

5

Types of ventral hernias

umbilical, epigastric, spigelian

6

Incisional hernias are due to? What type of hernia?

- Due to open abdominal procedure and incision through the abdominal wall
- Ventral hernia

7

Reducible Hernia

tissue is easily movable and can be reduced from the sac and easily pushed back in

8

Incarcerated Hernia

Trapping of hernia within the sac without compromise of vasculature

9

Strangulated Hernia

Circulation of hernia contents is compromised

10

What do we worry about with strangulated hernias?

ischemia--> dead bowel--> sepsis

11

2 types of inguinal hernias

direct and indirect

12

Direct inguinal hernia

- inferior to epigastric vessels and doesn't pass through inguinal canal
- ACQUIRED

13

Indirect inguinal hernia

- passes through the inguinal ring
- CONGENITAL

14

Femoral hernia

inferior to the inguinal ligament

15

Hesselbach's triangle contains

inguinal ligament, epigastric vessel and rectus muscle

16

Cause of Acquired groin hernias

weakening or disruuption of fibromuscular tissue due to:
- trauma
- drugs
- connective tissue abnormality (Marfan/ DE)
- chronic overstretching of musculoaponeurotic structures

17

Age of groin hernias for men/women

Women get it later in life 60-80; men 50-70

18

Risk factor for groin hernia

- HX of hernia or repair
- old age
-male
- white
- chronic constipation
- abdominal wall injury
- smoking
- family history of hernias

19

Clinical Presentation/PE of groin hernia

- bulge in the groin that may be tender to palpate but generally has no pain
- heavy/discomfort in groin
- slight pelvic pain in women
- worst at end of day/ prolonged sitting
- radiating twinge of pain with sitting/standing

20

Who is more likely to get groin hernias?

patients who work in manual/physically active professions

21

Clinical presentation of reducable hernias

- some pain
- asymptomatic

22

Clinical presentation of incarcaerated hernias

- +/- N/V, pain, block
- tenderness, bowels may not move due to obstruction
- fever

23

Clinical presentation of strangulated hernias

- painful
- +/- N/V, pain, block
ischemia--> pain out of proportion

24

How do you examine inguinal canal?

use small finger to go into it and have patient cough.
If you feel bulge next to finger--> direct
If you feel bulge hit finger--> indirect

25

Dx Groin Hernias

H/PE
Use US if occult, differentiation, determining if strangulation/incarceration

26

Tx groin hernias

ASx- monitor
Surgical:
- moderate to severe sx
- Urgent- incarceration
- Emergency- strangulation, bowel obstruction
- Laproscopic/open
- Mesh: durable and longevity
- Aloderm: human cadaver skin; less likely to get infected

27

Tx Femoral Hernia

Surgery

28

Pantaloon Hernia

both direct and indirect hernia on the same side

29

How do you see an incisional hernia?

Have ptn lay down and sit up a little--> pop out

30

Umbilical hernia is a protrusion through?

umbilical ring

31

Who gets umbilical hernias?

Adults- acquired
Children- congenital; close spontaneously by 1.5yr

32

RF for umbilical hernia

obesity
pregnant
ascites

33

Where is an epigastric hernia?

in the epigastrium (upper/central abdomen)

34

Where does the Spigelian hernia form?

through the spigelian fascia; ACQUIRED

35

Clinical Spigelian hernia

- swelling lateral to the rectus muscle
- pain is dull/ constant

36

Dx Spigelian hernia

US

37

Tx Spigelian hernia

surgical because very painful and complicated; trapped easily

38

Patho Richter's Hernia

- Part of circumference of bowel becomes incarcerated
- little piece of bowel wall is stuck in hernia-- weakening of the bowel wall, ischemia, or rupture

39

Most common site of Richter's Hernia

femoral canal

40

Clinical Richter's Hernia

- local inflammation
- overtime ischemia, gangrene, perforation

41

Tx Richter's Hernia

- surgical

42

Parastomal hernia common in patients with?

stoma (ileostomy or colostomy)

43

Tx Parastomal hernia

based on sx

44

Clinical Parastomal hernia

- bowels and intestine protrude out of stoma
- skin is clean and normal looking
- patient comfortable

45

What is not a true hernia and why?

Rectus Abdominus Diastasis; not a break in the rectal wall only a seperation of the walls

46

Biggest RF for Rectus Abdominus Diastasis

Pregnancy

47

Cause Rectus Abdominus Diastasis

- weak/stretched abdominal wall fascia due to pregnancy/ obesity
- some association with aneurysmal disease

48

Dx Rectus Abdominus Diastasis

PE- prominent ridge between two rectus abdominous while sitting

49

Tx Rectus Abdominus Diastasis

conservative- weight loss, abdominal exercise
surgical- cosmetic/ severe sx