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Flashcards in Hernias Deck (19):

3 types of hernias (not locations)

reducible- can be returned to original body cavity
incarcerated- can't be returned
strangulated- contain tsu w compromised vascular supply; esp dangerous, can lead to tsu necrosis --> perf, sepsis, death.


Types of hernias by location

Indirect inguinal (50%)
Direct inguinal (25%)
Femoral (F>M)
Obdurator (rare)
Overall, 5:1 M:F


What are the 3 fasical layers that keep abd contents intraperitoneal?

Innermost- transversalis
Middle- internal oblique
Outer- external oblique


What is the border of the internal ring?

Transversalis and internal oblique
plus the pubic tubercle
Superior aspect is formed by arch of the transversalis


Describe testicular descention during devt

Testes start intraperitoneally
Descend thru internal ring, taking a layer of periotneum with them, forming a hollow tube- this is the processus vaginalis.
Processus vaginalis collapses from a tube into a cord, plus transversalis maintains integrity of ring- so this is how hernias don't occur.


What is the cause of an indirect inguinal hernia?

When the processus vaginalis doesn't obliterate into a cord (it stays a tube, where bowel can come through) from the intraperitoneum


What is the cause of a direct inguinal hernia?

Weakened transversalis
Abd contents hernia directly thru the fascia


T/F the external oblique has no fn in the pathogenesis of hernias

It inserts onto the pubic tubercle and bounds the external(!) ring.


Px of hernia

Intermittent bulge in groin/scrotum (reducible)
persistent bulge w nausea/vom (incarceration)
severe pain at hernia site/in abd w naus/vom (strangulation)


PhysEx for hernia

Put finger on pubic tubercle and push upward to find superficial ring- feel bulge/prs when pt coughs
Reducible hernias can be pushed back, incarcerated can't.
Strangulated hernias are tender, can be w abd distention or peritoneal signs (rebound, guarding)


Indications for hernia repair

prevent bowel obstruction d/t incarceration of intestine
prevent bowel strangulation/perf
relieve sx


T/F reducible inguinal hernias need to be repaired urgently

False. Can be repaired on elective basis. Either open or laproscopic


What are the indications for lap hernia repair?

Bilateral or recurrent


T/F strangulated hernias should not be reduced

Reduction is contraindicated- reducing necrotic bowel into abd can cause perf and sepsis.
Do emergency surgery.


T/F the incidence of umbilical hernias is higher in caucasians.

false. africans.


Indications for operation of umbilical hernia

incarceration, strangulation, cosmetic.
most regress by age 2
but, if very large- can become incarcerated, so surgery indicated.


Where do femoral hernias occur? ventral hernias?

Femoral- femoral canal
Ventral- midline


When/where do internal hernias occur?

After abd operations- bowel gets trapped dt adesions or new anatomy.
Major cause of bowel obstruction


Where do obdurator hernias occur? In what pts?

Thru obdurator canal, which has obdurator nerve, artery, and vein.
Most asx, but nerve compressio can cause paresthesias or Howship-Romberg sign: pain radiating down middle thigh.
Occur in thin elderly women.