Hernias Flashcards
(111 cards)
1
Q
What is a hernia?
A
A protrusion of a viscus or part of a viscus through the wall which is designed to contain it
2
Q
What is a viscus?
A
Internal organ of the body
3
Q
What do hernias consist of?
A
Sac, coverings of the sac, contents
4
Q
What does the hernia sac consist of?
A
Peritoneum
5
Q
What are coverings of the hernia sac?
A
Skin, fat and fascia
6
Q
What are common contents of a hernia?
A
Small bowel or omentum
7
Q
What are the two most common hernias?
A
Femoral and inguinal
8
Q
What is an inguinal hernia?
A
Bulge through the inguinal canal
9
Q
What is a femoral hernia?
A
Bulge through the femoral canal
10
Q
What is the most common groin hernia?
A
Inguinal
11
Q
Why are inguinal hernias more common in men?
A
Passage of the testes through the inguinal canal during development makes it wider and more susceptible
12
Q
Who are femoral hernias more common in?
A
Women with lots of children
13
Q
Which type of hernia is more commonly an emergency presentation?
A
Femoral
14
Q
What is the purpose of the inguinal canal?
A
None in females but allows the passage of the testes in males
15
Q
What allows the passage of the spermatic cord through the inguinal canal?
A
Oblique intermuscular slit
16
Q
What forms the roof of the inguinal canal?
A
Transversalis fascia, internal oblique, transversus abdominus
17
Q
What makes up the posterior wall of the inguinal canal?
A
Transversalis fascia
18
Q
What makes up the floor of the inguinal canal?
A
Inguinal ligament, lacunar ligament
19
Q
What makes up the anterior wall of the inguinal canal?
A
Aponeurosis of the external oblique, internal oblique
20
Q
Where does the inferior epigastric artery arise from?
A
External iliac artery
21
Q
What supplies the muscles of the abdominal wall?
A
Inferior epigastric artery
22
Q
Where does the inguinal ligament run from?
A
ASIS to pubic tubercle
23
Q
What does the deep inguinal ring do?
A
Allows entry of the vas deferens, arteries, veins and nerves
24
Q
Where is the deep inguinal ligament found?
A
2cm up from the midpoint of the inguinal ligament
25
What does the superficial ring do?
Allows exit of its contents into the scrotum
26
What is the rule associated with the spermatic cord?
3 arteries, 3 nerves, 3 other things
27
What are the 3 arteries of the spermatic cord?
Testicular artery, artery to vas deferens, (deferential artery), cremasteric artery (to cremasteric artery)
28
What are the 3 nerves of the spermatic cord?
Nerve to cremaster (genital branch of genitofemoral nerve), testicular nerve (sympathetic), ilioinguinal nerve (technically outside cord)
29
What are the 3 other things on the spermatic cord?
Vas (ductus) deferens, pampiniform plexus, lymphatic vessels
30
What are the risk factors for an inguinal hernia?
Male, increased age, obesity, chronic cough, previous hernia, heavy lifting, constipation, pregnancy
31
When is the peak incidence of inguinal hernias?
6th decade
32
Which side and type of inguinal hernias are more common?
Right side, indirect
33
Where are direct hernias in relation to the inferior epigastric vessels?
Medial
34
What happens in a direct hernia?
Abdominal contents herniate through a weak spot in the fascia of the posterior wall of the inguinal canal
35
Which type of hernia is more common in older men?
Direct
36
Where are indirect hernias in relation to the inferior epigastric vessels?
Lateral
37
What happens in an indirect hernia?
Abdominal contents protrude through the deep inguinal ring
38
What can be a cause of an indirect hernia?
Failure of embryonic closure of the processus vaginalis
39
What type of hernia can pass into the scrotum and how?
Indirect- through the inguinal canal
40
What is the process for differentiating between direct and indirect hernias?
Ask patient to stand up, press on hernia and cover deep ring, ask patient to cough
41
If the hernia does not bulge out on a cough, what is it?
Indirect
42
If a hernia does bulge out on a cough, what is it?
Direct
43
What is a risk of hernia (uncommon though)?
Incarceration (something getting stuck and causing loss of blood supply)
44
Do hernias always need to be treated?
No
45
What happens in terms of treatment in incarceration?
The hernia cannot be pushed back in manually
46
What is open hernia surgery (Lichtenstein method)?
Inserting mesh over the site of the hernia once it has been pushed back in
47
What type of anaesthetic is required for an open hernia repair?
Local or spinal
48
What are the advantages of laparoscopic surgery?
Less pain, shorter recovery and less chance of infection
49
What are the disadvantages of laparoscopic surgery?
Harder procedure to do/learn and cannot be done in emergencies
50
What type of anaesthetic is needed for laparoscopic surgery?
General
51
What is a major complication of the Lichtenstein method?
Damage to the ilioinguinal nerve which can cause chronic pain for a few years
52
What are other complications of surgery?
Recurrence, urinary retention, bleeding.haematoma, numbness, testicular atrophy, wound infection
53
What are types of emergency hernia?
Irreducible, strangulating or causing obstruction
54
What is the first step to treating an emergency hernia?
Give patient analgesia and try to force it back in
55
What is the second step (if the fist doesn't work) in treating an emergency hernia?
surgery
56
What type of hernias often have an acute emergency presentation?
Femoral
57
What is the femoral canal in relation to the inguinal ligament?
Inferior border
58
What is the anterior border of the femoral canal?
Inguinal ligament
59
What is the posterior border of the femoral canal?
Pectineal line and ligament
60
What is the medial border of the femoral canal?
Lacunar ligament
61
What is the lateral border of the femoral canal?
Femoral vein
62
Which of the four borders of the femoral canal is not firm?
Femoral vein
63
What does the femoral canal contain?
Fat and lymph nodes
64
What is the low/Lockwood approach to treating femoral hernias?
Used for elective surgery, incision below the medial portion of the inguinal ligament
65
What is the high/McEvedy approach to treating femoral hernias?
Used for emergency surgey, incision transversely 2cm above the pubic tubercle and extending laterally
66
What is done to eliminate the weak structure during surgery for femoral hernias?
Inguinal ligament is sutured to the pectineal ligament
67
A hernia is a clinical diagnosis, but what tests can be done if need be?
Ultrasound or CT
68
What should happen when a patient with a hernia lies down?
It should go away
69
Where do inguinal hernias originate in relation to the pubic tubercle?
Above and medial
70
Where do femoral hernias originate in relation to the pubic tubercle?
Below and lateral
71
What is the difference in the urgency or treatment for inguinal and femoral hernias?
Inguinal- waiting list
| Femoral- ASAP
72
What causes an epigastric hernia?
A congenital defect in the linea alba between the xiphoid process of the sternum and the umbilicus
73
Where are paraumbilical hernias found?
Usually above the umbilicus
74
What are the risk factors for a paraumbilical hernia?
Obesity, pregnancy, ascites
75
What are incisional hernias?
Acquired rather than congenital and usually occur in the site of a previous abdominal incision
76
Who are incisional hernias more common in?
Older and frail people
77
An obturator hernia is a hernia through where?
Obturator foramen
78
What and who is an obturator hernia common in?
Cause of small bowel obstruction in elderly females
79
What type of pain will people with an obturator hernia experience and why?
Thigh pain due to obturator nerve disruption
80
What are common paediatric hernias and when do they usually resolve?
Umbilical hernias- by the age of 4
81
What happens if umbilical hernias persist past the age of 4?
They must be repaired
82
What hernias may baby boys also get?
Indirect inguinal hernias
83
When are indirect inguinal hernias more common in baby boys and when do they show up?
More common in premature baby boys and show up when they cry
84
What is a test for an indirect inguinal hernia in boys and how does this work?
Silk test- rubbing hand over groin will make a noise like bits of silk rubbing together
85
Do indirect inguinal hernias in baby boys always need repaired?
Yes as they have a high rate of incarceration
86
What technique is used to remove an indirect inguinal hernia from babies?
Herniotomy- hernia sac is ligated without any repair of the inguinal canal and no mesh is required
87
Where is the superficial ring in relation to the pubic tubercle?
Above and medial
88
What makes up Hesselbach's triangle?
- Inguinal ligament inferiorly
- Inferior epigastric vessels laterally
- Lateral border of the rectus sheath medially
89
Which type of hernia is a 'posterior bulge through the transversalis fascia'?
Direct inguinal
90
Which type of hernia can often be bilateral?
Direct inguinal
91
Which type of hernia is more common in younger men?
Indirect inguinal
92
Which type of hernia is more common in older men?
Direct inguinal
93
Which type of hernia can give scrotal swelling?
Indirect inguinal
94
Is a hernia the only cause for scrotal swelling?
No
95
Which type of inguinal hernia has a slightly higher risk of strangulation?
Indirect
96
Should you treat an asymptomatic hernia, which is at risk for complications?
Yes
97
What does strangulation of a hernia lead to?
Occlusion of the venous system, then the arterial system which leads to gangrene
98
What 2 things should patients not do after surgery and for how long?
No driving for a week
| No heavy lifting for a month
99
Which type of hernia increases the groin crease and which loses it?
Inguinal- increases
| Groin- loses
100
A thin old lady presents with a hernia. She has 4 children. What type is it most likely to be?
Femoral
101
What is another factor which makes a femoral hernia more likely, apart from being female with children?
Previous small bowel obstruction with no repair surgery
102
A female presents with a hernia. What type is it most likely to be?
Inguinal (although it is more common for femoral hernias to occur in women, it is still more likely that a woman will have an inguinal hernia)
103
What do epigastric hernias normally contain?
Extraperitoneal fat
104
Who are epigastric hernias most common in?
Males, late teens or young adults
105
What type of hernias are usually asymptomatic but may have local symptoms?
Epigastric
106
How can epigastric hernias be repaired?
Sutures or mesh
107
What is the main difference between umbilical and paraumbilical hernias?
Umbilical- children
| Paraumbilical- adults
108
Who is most likely to present with a paraumbilical hernia?
An obese adult (or pregnancy/ascites)
109
As well as old, frail people, who is more at risk for an incisional hernia?
Someone who has had a wound infection post-op
110
What is changed about the surgery in people at risk of incisional hernias?
Tension sutures are used and there is a mass closure of the linea alba
111
Which side is an inguinal hernia in babies most likely to be on?
The right
