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7- Surgery > Inguino Scrotal Swellings / Hernias > Flashcards

Inguino Scrotal Swellings / Hernias Flashcards

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1
Q

Hernia definition

A

Protrusion of viscus from cavity from which it is enclosed through abnormal or weak opening in wall cavity

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2
Q

Commonest cause of small bowel intestinal obstruction in Ghana and other developing countries

A

Hernia

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3
Q

What is an external hernia

A

Sac protrudes through abdominal wall

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4
Q

What is an internal hernia

A

Sac does not protrude outside trunk even when well formed

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5
Q

Percentage of inguinal hernia in all hernia

A

80-92%

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6
Q

Percentage of femoral hernia

A

2-5 %

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7
Q

Where is femoral hernia more common

A

Europe / North America

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8
Q

What is umbilical hernia

A

Protrusion of viscus thorugh blended linea alba in the umbilicus

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9
Q

Where is umbilical hernia more common in the world

A

Developing countries

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10
Q

What is a para umbilical hernia

A

Protrusion above, below or by the side of umbilicus

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11
Q

What is an epigastric hernia

A

Protrusion through linea alba between xiphisternum and the umbilicus

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12
Q

What is an incisional hernia

A

Protrusion through abdominal surgical scar

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13
Q

What is a spigelian hernia

A

Protrusion in spigelian zone between the muscular fibres and aponeurosis of transversus abdominis lateral to rectus sheath

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14
Q

What is lumbar hernia

A

Protrusion through inferior or superior lumbar triangle

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15
Q

What is obturator hernia

A

Protrusion in the obturator canal

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16
Q

What is a sciatic hernia

A

Protrusion through the greater or lesser sciatic foramen

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17
Q

Predisposing factor of hernia

A

Defect or weakness of the wall of te abdominal cavity

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18
Q

Precipitating factor of hernia

A

Repeated increased intra abdominal pressure leading to protrusion of viscus

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19
Q

5 causes of defects or weakness of abdominal wall

A

Embryological or anatomical

Ageing, infection with weak scars , multiple pregnancies , obesity

Site of penetration of blood vessel weakened

Weakened muscle due to nerve damage

Straining / injury leading to muscular tear

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20
Q

Causes of increased intra abdominal pressure

A

Chronic cough
chronic urinary obstruction
chronic constipation
heavy Manual work
weightlifting
frequent pregnancies

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21
Q

Parts of hernia sac

A

Mouth
Neck
Body
Fundus

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22
Q

What content could you find in hernial sac

A

Omentum
Small intestine
Parts of colon
Appendix
Uterine Adnexa
Part of bladder

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23
Q

What is a reducible hernia

A

If content return completely into abdomen when patient lies down or pressure applied to it

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24
Q

Complications of hernia

A

Irreducibility
Strangulation
Fistula
Rupture

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25
Main cause of hernial irreducibility
Formation of adhesion between sac and contents Accumulation of impacted faeces in herniated colon
26
Percentage of inguinal hernia and femoral hernia that strangulate
5%- inguinal 30% - femoral
27
2 types of groin hernia
Inguinal hernia Femoral hernia
28
What is the inguinal canal
Oblique passage downwards and forwards above groin
29
Content of inguinal canal
Testicular vessels Spermatic cord Ilioinguinal nerve Genital branch of the genito-femoral nerve - male Round ligament - female
30
Length of inguinal canal in adults
4cmm
31
Most lateral ring of inguinal canal
Internal inguinal ring
32
Most medial ring in inguinal canal
External inguinal ring
33
Shape of internal inguinal ring
U shaped
34
What is the internal inguinal ring made of
Evagination in transversalis fascia
35
Anatomical location of internal inguinal ring
1.25cm above mid inguinal point Perpendicular to mid inguinal point 1.25 cm above midpoint to inguinal ligament Medial to inguinal ligament t
36
Length of opening of internal inguinal ring
12-20mm high 6-10 mm wide
37
Boundaries of internal inguinal ring
Superior - lower arching fibers of internal oblique Inferior / medial - inferior epigastric vessels
38
Type of inguinal hernia going though internal inguinal ring
Indirect inguinal hernia
39
Percentage of recurrence in indirect inguinal hernia repair
60-75%
40
Location of external inguinal ring
Above and lateral to pubic tubercle Opening in external oblique aponeurosis
41
Shape of external inguinal ring
Triangular Apex upwards and laterally Base above pubic tubercle
42
Size of external inguinal ring
2.5x1.25 cm
43
Boundaries of inguinal canal
Anterior - external oblique aponeurosis Laterally - muscular fibers of internal oblique Posterior - transversalis fascia
44
Name of triangle close to external inguinal ring
Hesselbach’s triangle
45
Boundaries of hesselbach’s triangle
Lateral - inferior epigastric arteru Medial - lateral border of rectum sheath Inferior - inguinal ligament Posterior. - transversalis fascia
46
Type of inguinal hernia going though hesselbach triangle
Direct inguinal hernia
47
Boundaries of femoral triangle
Superior - inguinal ligament Medial - adductor longus Lateral - sartorius Lateral floor - iliopsoas Medial floor - pectineus Anterior - skin , superficial fascia , deep fascia lata
48
Content of femoral triangle
Femoral canal femoral vein femoral artery femoral nerve lymph nodes
49
Length of the femoral canal
1.25-3cm
50
Which testes descend later than the other , right or left
Right
51
Percentage of incense with incomplete descent of testes
4%
52
Processes vaginalis becomes which structure in the scrotum soon after birth
Tunica vaginalis
53
Consequences of failure of obliteration of the processus vaginalis
Indirect inguinal hernia Encysted hydrocele of the cord infantile hydrocele -noncommunicating congenital hydrocele communicating
54
Percentage of male with inguinal hernia
16%
55
Percentage of male and female with inguinal hernia
95% of hernia in males 40-50% of hernia in females
56
Percentage of indirect hernia between 20 to 49 years old
60%
57
 Direct inguinal hernia is twice as common on the right or the left side
On the right side
58
Percentage of indirect inguinal hernia that are bilateral
10 %
59
 True or false , direct inguinal hernia are as common on the right as on the left in both sexes
True
60
Main cause of indirect hernia
Congenital - due to patient processus vaginalis
61
Main cause of direct inguinal hernia
Ageing or trauma or congenital deficiencies lead to weakening of transversalis fascia
62
Is there often strangulation of direct inguinal hernia
No -> large neck
63
Main symptoms of inguinal hernia
Swelling in the groin pain in the groin
64
Signs of inguinal hernia
Swelling in the groin Swelling in the groin when coughing Direct or indirect coughing test Direction of hernia Complete ( enters scrotum or labium majus ), incomplete
65
How do you differentiate a direct from an indirect inguinal hernia in examination
Reduce swelling Place finger over site of internal inguinal ring Ask patient to cough -> if appears then most likely direct inguinal hernia Oblique direction of hernia -> indirect Directly forwards into canal. -> direct
66
Type of inguinal hernial who can be complete
Indirect
67
Differential diagnosis of inguinal hernia in male
Femoral hernia vagina hydrocele encysted hydrocele of the cord malgaigne’s bulges ectopic or undescended testes cyst of the epididymis inguinal lymphadenopathy Saphena varix sebaceous cysts lipoma
68
Differential diagnosis of inguinal hernia in the female
Femoral hernia cyst of the Canal of Nuck lipoma
69
Treatment of inguinal hernia
Surgery
70
Read about inguinal hernia repair
71
Sex more at risk of femoral hernia
Female
72
Women at risk of femoral hernia
Multifarious Elderly
73
Causes of femoral hernia
Stretching , weakness and breach of transversalis fascia near femoral ring due to increased intra abdominal pressure
74
Shape of course of femoral hernia from its descent from abdominal cavity
J shaped
75
Main symptoms of femoral hernia
Swelling in the groin Discomfort or pain in the groin
76
Signs of femoral hernia
Swelling below inguinal ligament t Visible and palpable cough impulse No lump disappearances possible when lying down Reducible or irreducible
77
Differential diagnosis of femoral hernia
Inguinal hernia saphena varix psoas abscess lipoma enlarged inguinal lymph nodes femoral aneurysm sebaceous cyst
78
Treatment of femoral hernia
Surgery
79
Types of umbilical hernia
Congenital (exomphalos) - defect through umbilicus with jelly like substance Infantile - through blended aponeurosis of linea alba in umbilicus Para umbilical - above or by the side of umbilicus
80
Types of exomphalos
Major - sac diameter > 5cm Minor - sac diameter < 5 cm
81
What is gastroschisis
Full thickness tear of anterior abdominal wall on the right of the umbilicus
82
Second most common hernia type in Ghana for female
Para umbilical hernia

7- Surgery (13 decks)

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