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Year 4 General surgery > Hernias > Flashcards

Hernias Flashcards

1
Q

define hernia

A

abnormal protrusion of a body part through the wall that normally contains it

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2
Q

the inguinal canal runs superior/inferior and parallel to the inguinal ligament

A

superior and parallel

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3
Q

define mid-inguinal point

A

halfway between ASIS and pubic symphysis

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4
Q

define midpoint of the inguinal ligament

A

halfway between the ASIS and pubic tubercle

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5
Q

What makes up the superior border of the inguinal canal

A

2Ms
internal oblique Muscle
transversus abdominus Mucle

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6
Q

what makes up the anterior border of the inguinal canal

A

2As

external and internal oblique aponeuroses

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7
Q

What makes up the inferior border of the inguinal canal

A

2Ls
inguinal Ligament
Lacunar Ligament

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8
Q

what makes up the posterior border of the inguinal canal

A

2Ts
Transversalis fascia
conjoint Tendon

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9
Q

what is the deep inguinal ring and where is it found

A

found at the midpoint of the inguinal ligament, lateral to the inferior epigastric artery
opening in the transversalis fascia

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10
Q

what is the superficial inguinal ring and where is it found

A

opening in the external oblique aponeurosis

found superior and medial to pubic tubercle

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11
Q

what are the contents of the inguinal canal in males

A

spermatic cord
- 3 arteries: vas, testicular, cremasteric
- 3 nerves: GF, symp, cremasteric
- 3 fascia: external, cremasteric, internal
- 3 others: vas deferens, paminiform plexus, lymphatics
ilioinguinal nerve is found in the canal but not in the spermatic cord

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12
Q

what are the contents of the inguinal canal in females

A

ilioinguinal nerve

round ligament of the uterus

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13
Q

what nerve is at risk of damage in hernia surgery

A

ilioinguinal nerve

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14
Q

what are the borders of the Hesselbach triangle

A 
medially = lateral border of rectus abdominus 
laterally = inferior epigastric artery 
inferiorly = inguinal ligament
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15
Q

indirect / direct inguinal hernias protrude through Hesselbach’s triangle

A

DIRECT

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16
Q

borders of the femoral canal

A 
laterally = femoral vein 
medially = lacunar ligament 
anteriorly = inguinal ligament 
posteriorly = pectineus
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17
Q

contents of the femoral triangle from lateral to medial

A 
NAVEL 
femoral Nerve 
femoral Artery 
femoral Vein 
Empty space - femoral canal 
Lymphatics
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18
Q

the femoral sheath encloses all structures of the femoral triangle except which structure?

A

femoral nerve

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19
Q

define irreducible hernia

A

unable to push hernia back into the right place, not necessarily strangulated

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20
Q

differential for transient scrotal swelling

A

hernia

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21
Q

define incarcerated hernia

A

hernial sac stuck by adhesions

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22
Q

define obstructed hernia

A

bowel contents are unable to pass

23
Q

define strangulated hernia

A

there is ischaemia

24
Q

RF for inguinal hernias

A 
male 
age 
chronic cough - smoker 
constipation 
previous surgery 
heavy lifting 
previous hernia 
ascites
25
Q

an in/direct inguinal hernia passes through the deep inguinal ring and superficial inguinal ring

A

INDIRECT hernia

26
Q

in/direct inguinal hernias are lateral to the inferior epigastric artery

A

INDIRECT

27
Q

which is more likely to strangulate, an in/direct hernia

A

indirect

28
Q

what is the pathology behind a direct hernia

A

it protrudes through a weakness in the posterior wall of the inguinal canal

29
Q

in/direct inguinal hernias are medial to the inferior epigastric artery

A

DIRECT

30
Q

when a patient is standing and you have reduced the hernia and asked the patient to cough, what would happen if it was an indirect hernia

A

it would not reappear

31
Q

when a patient is standing and you have reduced the hernia and asked the patient to cough, what would happen if it was a direct hernia

A

it would reappear

32
Q

management of inguinal hernias

A

conservative - smoking cessation, weight loss

operative - open mesh repair, laparoscopic

33
Q

what is a femoral hernia

A

bowel passes through the femoral canal resulting in a mass

34
Q

RF for femoral hernias

A

female
middle aged - elderly
present with SBO having had no previous surgery

35
Q

what is a severe risk of femoral hernias

A

irreducible and can strangulate

36
Q

an inguinal hernia is superior/inferior and medial/lateral to the pubic tubercle

A

superior and medial

37
Q

a femoral hernia is superior/inferior and medial/lateral to the pubic tubercle

A

inferior and lateral

38
Q

what should you consider in a PWID with groin pain

A

psoas abscess

39
Q

which artery is a marker of the deep inguinal ring

A

inferior epigastric artery

40
Q

in babies, what defect can predispose them to an inguinal hernia

A

patent processus vaginalis

41
Q

why are inguinal hernias more common on the RHS

A 
previous appendicectomies (historic now)
right kidney is lower down because of the liver
42
Q

indications for inguinal hernia repair

A

pain
cosmesis
impairment of everyday activities

43
Q

what are patients at high risk of following hernia surgery

A

chronic pain

44
Q

list immediate complications of hernia repair surgery

A

incise the femoral vein or testicular artery

45
Q

list early complications of hernia repair surgery

A

wound infection
haematoma
wound dehiscence

46
Q

list late complications of hernia repair surgery

A

DVT/PE

47
Q

why are femoral hernias more common in females

A

women in their 60s generally have more fat which occupies the femoral canal
when they reach their 80s, they lose that fat which makes space for bowel to herniate

48
Q

what should you do if you have an elderly lady complaining of umbilical pain and all her investigations are normal

A

check for femoral hernias

49
Q

how should you carry out a hernia examination

A

ask the patient to stand and face the wall
stand to the side of the patient
ask them to show you their hernia and reduce it if they can
ask them to cough and observe if it reappears

50
Q

what is palpated at the midinguinal point

A

femoral artery

51
Q

what is found at the midpoint of the inguinal ligament

A

deep inguinal ring

52
Q

why would you be scared of infection in a mesh repair

A

mesh is a foreign material which bacteria can grow on despite antibiotics
more complicated as you have to remove the mesh and then operate again in 6 months

53
Q

chronic coughers are more likely to have an in/direct hernia

A

direct

54
Q

differentials for a groin lump in PWID

A

groin abscess –> drain by gen surg

pseudoaneurysm –> vascular

Year 4 General surgery (14 decks)

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