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Year 4 General surgery > Hernias > Flashcards

Hernias Flashcards

(54 cards)

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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

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A

bowel contents are unable to pass

23
Q

define strangulated hernia

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A

there is ischaemia

24
Q

RF for inguinal hernias

Study These Flashcards
A 
male 
age 
chronic cough - smoker 
constipation 
previous surgery 
heavy lifting 
previous hernia 
ascites
25
an in/direct inguinal hernia passes through the deep inguinal ring and superficial inguinal ring
INDIRECT hernia
26
in/direct inguinal hernias are lateral to the inferior epigastric artery
INDIRECT
27
which is more likely to strangulate, an in/direct hernia
indirect
28
what is the pathology behind a direct hernia
it protrudes through a weakness in the posterior wall of the inguinal canal
29
in/direct inguinal hernias are medial to the inferior epigastric artery
DIRECT
30
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
it would not reappear
31
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
it would reappear
32
management of inguinal hernias
conservative - smoking cessation, weight loss | operative - open mesh repair, laparoscopic
33
what is a femoral hernia
bowel passes through the femoral canal resulting in a mass
34
RF for femoral hernias
female middle aged - elderly present with SBO having had no previous surgery
35
what is a severe risk of femoral hernias
irreducible and can strangulate
36
an inguinal hernia is superior/inferior and medial/lateral to the pubic tubercle
superior and medial
37
a femoral hernia is superior/inferior and medial/lateral to the pubic tubercle
inferior and lateral
38
what should you consider in a PWID with groin pain
psoas abscess
39
which artery is a marker of the deep inguinal ring
inferior epigastric artery
40
in babies, what defect can predispose them to an inguinal hernia
patent processus vaginalis
41
why are inguinal hernias more common on the RHS
``` previous appendicectomies (historic now) right kidney is lower down because of the liver ```
42
indications for inguinal hernia repair
pain cosmesis impairment of everyday activities
43
what are patients at high risk of following hernia surgery
chronic pain
44
list immediate complications of hernia repair surgery
incise the femoral vein or testicular artery
45
list early complications of hernia repair surgery
wound infection haematoma wound dehiscence
46
list late complications of hernia repair surgery
DVT/PE
47
why are femoral hernias more common in females
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
what should you do if you have an elderly lady complaining of umbilical pain and all her investigations are normal
check for femoral hernias
49
how should you carry out a hernia examination
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
what is palpated at the midinguinal point
femoral artery
51
what is found at the midpoint of the inguinal ligament
deep inguinal ring
52
why would you be scared of infection in a mesh repair
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
chronic coughers are more likely to have an in/direct hernia
direct
54
differentials for a groin lump in PWID
groin abscess --> drain by gen surg | pseudoaneurysm --> vascular

Year 4 General surgery (14 decks)

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