Untitled Deck Flashcards
(138 cards)
1
Q
Q: What does the term ‘hernia’ mean?
A
A: ‘To bud’ or ‘to protrude’; ‘off shoot’ (Greek); ‘rupture’ (Latin).
2
Q
Q: How is a hernia defined?
A
A: As an area of weakness or disruption of the fibromuscular tissues of the body wall.
3
Q
Q: What is another way to define a hernia?
A
A: An actual anatomical weakness or defect.
4
Q
Q: What percentage of abdominal wall hernias are groin hernias?
A
A: 75%.
5
Q
Q: What is the prevalence of groin hernias in males?
A
A: 15%.
6
Q
Q: What is the prevalence of groin hernias in females?
A
A: 5%.
7
Q
A
8
Q
A
9
Q
Q: What is the lifetime risk of inguinal hernia in men?
A
A: 27%.
10
Q
Q: What is the lifetime risk of inguinal hernia in women?
A
A: 3%.
11
Q
Q: What is the incidence pattern of inguinal hernias in males?
A
A: Bimodal distribution, with peaks before the first year of age and after age 40.
12
Q
Q: What is the most common subtype of groin hernia in both men and women?
A
A: Indirect inguinal hernia.
13
Q
Q: How is a hernia defined?
A
A: An abnormal protrusion of viscera or a part of a viscera through an opening, artificial or natural, with a sac covering it.
14
Q
Q: What is the commonest type of hernia?
A
A: Inguinal hernia (73%).
15
Q
Q: Why is inguinal hernia the most common type?
A
A: Due to weak muscular anatomy in the inguinal region and natural weaknesses like the deep ring and cord structures.
16
Q
Q: What percentage of hernias are femoral hernias?
A
A: 17%.
17
Q
Q: What percentage of hernias are umbilical hernias?
A
A: 8.5%.
18
Q
“Q: What percentage of hernias are classified as ‘others
A
19
Q
Q: What are common etiological factors for hernias?
A
A: Straining, lifting heavy weights, chronic cough, chronic constipation, urinary causes.
20
Q
Q: What urinary causes contribute to hernias in old age?
A
A: BPH and carcinoma of the prostate.
21
Q
Q: What urinary causes contribute to hernias in young age?
A
A: Stricture of the urethra.
22
Q
Q: What urinary causes contribute to hernias in very young age?
A
A: Phimosis and meatal stenosis.
23
Q
Q: What other factors contribute to hernia development?
A
A: Obesity, multiple pregnancy, smoking, ascites.
24
Q
Q: How can appendicectomy affect hernia risk?
A
A: It may injure the ilioinguinal nerve, causing right-sided direct inguinal hernia.
25
Q: What birthweight is associated with increased hernia risk?
A: Birthweight <1500 g.
26
Q: What familial factors increase hernia risk?
A: Family history of a hernia.
27
Q: Name congenital connective tissue disorders associated with hernias.
A: Osteogenesis imperfecta, Marfan’s syndrome, Ehlers-Danlos syndrome.
28
Q: What childhood condition is associated with hernias?
A: Congenital hip dislocation.
29
Q: Which kidney condition is linked to hernias?
A: Polycystic kidney disease.
30
Q: What results from the failure of the peritoneum to close?
A: A patent processus vaginalis (PPV).
31
Q: Why is there a high incidence of indirect inguinal hernias in preterm babies?
A: Due to the presence of a patent processus vaginalis (PPV).
32
Q: What are the components of a hernia?
A: Covering, sac, and content.
33
Q: What is the sac in a hernia?
A: A diverticulum of peritoneum with a mouth, neck, body, and fundus.
34
Q: How does the neck of an indirect sac compare to a direct sac?
A: The neck is narrow in an indirect sac but wide in a direct sac.
35
Q: What is an example of a hernia without a sac?
A: Epigastric hernia, which is a protrusion of an extra-peritoneal pad of fat.
36
Q: What are the coverings of the sac?
A: The layers of the abdominal wall through which the sac passes.
37
Q: What are common contents of the sac?
A: Omentum, intestine, Richter’s hernia, urinary bladder, ovary, and Meckel’s diverticulum.
38
Q: What is an omentocele?
A: A hernia containing omentum.
39
Q: What is an enterocele?
A: A hernia containing intestine, commonly small bowel but sometimes large bowel.
40
Q: What is Richter’s hernia?
A: A hernia where a portion of the bowel circumference is the content.
41
Q: What is a cystocele?
A: A hernia where the urinary bladder is part of the content or the posterior wall of the sac.
42
Q: What is Littre’s hernia?
A: A hernia containing Meckel’s diverticulum.
43
Q: What types of fluid can be found in the sac?
A: Fluid from congested bowel or omentum, which may be infected, ascitic fluid, or blood from a strangulated sac.
44
Q: What is the first classification of hernia?
A: Classification I (Clinical).
45
Q: What is a reducible hernia?
A: A hernia that can be reduced on its own, by the patient, or by the surgeon; intestine reduces with gurgling.
46
Q: What is an irreducible hernia?
A: A hernia where contents cannot be returned to the abdomen due to narrow neck, adhesions, or overcrowding.
47
Q: What are the risks associated with irreducible hernias?
A: They predispose to strangulation.
48
Q: What is an obstructed hernia?
A: An irreducible hernia with obstruction, but without interference to blood supply; it may eventually lead to strangulation.
49
Q: What is an inflamed hernia?
A: A hernia due to inflammation of the contents, e.g., appendicitis; it is tender but not tense, with red and edematous skin.
50
Q: What is a strangulated hernia?
A: An irreversible hernia with obstruction to blood flow; the swelling is tense, tender, with no impulse on coughing.
51
Q: In which types of hernias may features of intestinal obstruction be absent?
A: Omentocele, Richter’s hernia, Littre’s hernia.
52
Q: What is Classification II of hernias?
A: Congenital and acquired.
53
Q: What is included in Classification III according to contents?
A: Omentocele (omentum), enterocele (intestine), cystocele (urinary bladder), Littre’s hernia (Meckel’s diverticulum), sliding hernia, Richter’s hernia (part of the bowel wall).
54
Classification IV: Based on sites:
* Inguinal hernia—occurring in inguinal canal.
* Femoral hernia—occurring in femoral canal.
* Obturator hernia. * Diaphragmatic hernia.
* Lumbar hernia.
* Spigelian hernia.
* Umbilical hernia.
* Epigastric hernia.
55
56
Q: What are the contents of the spermatic cord?
A: Vas deferens & artery to vas, testicular and cremasteric artery, genital branch of genitofemoral nerve, pampiniform plexus of veins, remains of processus vaginalis, sympathetic plexus around the artery to vas.
57
Q: What is the inguinal canal called in females?
A: Canal of Nuck.
58
Q: What is the anatomical classification of inguinal hernia?
A: Indirect hernia and direct hernia.
59
Q: What is an indirect inguinal hernia?
A: It comes out through the internal ring along with the cord and is lateral to the inferior epigastric artery.
60
Q: What is a direct inguinal hernia?
"A: It occurs through the posterior wall of the inguinal canal via
61
Q: What are the boundaries of Hesselbach’s triangle?
A: Medially by the lateral border of the rectus muscle, laterally by the inferior epigastric artery, and below by the inguinal ligament.
62
Q: What are the classifications of inguinal hernia according to extent?
A: Incomplete and complete.
63
Q: What is a bubonocele?
A: An incomplete hernia where the sac is confined to the inguinal canal.
64
Q: What is a funicular hernia?
A: An incomplete hernia where the sac crosses the superficial inguinal ring but does not reach the bottom of the scrotum; contents can be felt separately from the testis.
65
Q: What characterizes a complete inguinal hernia?
A: The sac descends to the bottom of the scrotum.
66
Q: What is a saddle-bag or pantaloon hernial sac?
A: A bilateral complete inguinal hernia with both medial and lateral components.
67
Q: Where is the inguinal hernia located relative to the pubic tubercle?
A: Above and medial to the pubic tubercle.
68
Q: Where is the femoral hernia located relative to the pubic tubercle?
A: Below and lateral to the pubic tubercle.
69
Q: What is the male to female ratio of inguinal hernia?
A: 10:1.
70
Q: What is the prevalence of inguinal hernia in males?
A: 25%.
71
Q: What is the prevalence of inguinal hernia in females?
A: 2%.
72
Q: What is the most common type of hernia?
A: Indirect inguinal hernia (65% of cases).
73
Q: In which age group is indirect inguinal hernia more common?
A: In younger age groups.
74
Q: How does the incidence of indirect inguinal hernia differ by age?
A: It is more common in younger individuals, while direct inguinal hernia is more common in the elderly.
75
Q: In which decade is indirect inguinal hernia more common on the right side?
A: In the 1st decade.
76
Q: What is the incidence of indirect inguinal hernia on both sides in the 2nd decade?
A: The incidence is equal on both sides.
77
Q: What percentage of indirect inguinal hernias are bilateral?
A: 30%.
78
Q: What are the characteristics of the sac in an indirect inguinal hernia?
A: The sac is thin, with a narrow neck that lies lateral to the inferior epigastric vessels.
79
Q: What is the sensitivity of ultrasound (US) in detecting inguinal hernia?
A: 86%.
80
Q: What is the specificity of ultrasound (US) in detecting inguinal hernia?
A: 77%.
81
Q: What is the ring invagination test used for?
A: To assess inguinal hernia and determine if it is reducible.
82
Q: How is the ring invagination test performed?
A: After reduction of hernia, the examiner's little or index finger is invaginated from the bottom of the scrotum, pushed up and rotated to enter the superficial inguinal ring.
83
Q: What is felt during the ring invagination test?
A: An impulse on coughing at the tip of the invaginated finger.
84
Q: In which gender is the ring invagination test performed?
A: Only in males.
85
Q: What do these maneuvers reveal during the ring invagination test?
A: An abnormal bulge that helps determine whether the hernia is reducible.
86
Q: Where is the internal ring located?
A: Half an inch above the mid-inguinal point (the center point between ASIS and pubic symphysis).
87
Q: How is the internal ring occlusion test performed?
A: After reducing the contents, the internal ring is occluded with the thumb while the patient lies down.
88
Q: What does the patient do during the internal ring occlusion test?
A: The patient is asked to cough.
89
Q: What does a controlled impulse during the test suggest?
A: An indirect hernia.
90
Q: What does persistent herniation during the test suggest?
A: A direct hernia.
91
Q: What does it indicate if a swelling appears medial to the thumb?
A: It is a direct hernia.
92
Q: What does it indicate if swelling does not appear when releasing the thumb but appears during coughing?
A: It is an indirect hernia, confirmed in standing position.
93
3 types based on reducability and obstruction
incarcerated obstructed and strangulated
94
Q: What is the inguinal ligament?
A: The ligamentous portion of the external oblique aponeurosis that extends from the anterior superior iliac spine to the pubic tubercle.
95
Q: What is the deep ring?
A: A 'U' shaped defect in the fascia transversalis that forms the posterior wall of the inguinal canal, lying 1.25 cm above the midpoint of the inguinal ligament.
96
Q: What is the external (superficial) ring?
A: A triangular defect in the external oblique aponeurosis, bounded by the lateral and medial crura, with the base formed by the pubic crest.
97
Q: What is the inguinal canal?
A: A 4 cm canal extending from the deep inguinal ring to the superficial inguinal ring.
98
Q: What are inguinal defense mechanisms?
A: Factors that protect against the development of hernia.
99
Q: How does the obliquity of the inguinal canal contribute to hernia prevention?
A: The inguinal canal is straight in children, which helps protect against hernia.
100
Q: What happens during straining or coughing that aids in preventing hernia?
A: The conjoined tendon contracts, closing the inguinal canal with a shutter or sphincter-like effect.
101
Q: How does increased intra-abdominal pressure prevent herniation?
A: It produces a plugging effect at the external ring and pulls the deep ring upwards and laterally, occluding the ring (ball-valve effect).
102
Q: What age group is typically associated with direct inguinal hernia?
A: Commonly elderly.
103
Q: What age group is typically associated with indirect inguinal hernia?
A: Any age group.
104
Q: What part of the abdominal wall is weak in direct inguinal hernia?
A: The weak posterior wall.
105
Q: What is the characteristic of the sac in direct inguinal hernia?
A: It is preformed.
106
Q: What happens when a direct inguinal hernia is observed in standing?
A: It pops out.
107
Q: What happens when an indirect inguinal hernia is observed in standing?
A: It doesn’t pop out.
108
Q: What percentage of direct inguinal hernias are bilateral?
A: Usually bilateral.
109
Q: What percentage of indirect inguinal hernias are bilateral?
A: Only 30% are bilateral.
110
Q: What is a common complication for direct inguinal hernia?
A: Rarely has complications.
111
Q: What is a common complication for indirect inguinal hernia?
A: Complications are common.
112
Q: Through which triangle does a direct inguinal hernia come through?
A: Hesselbach’s triangle.
113
Q: Through which ring does an indirect inguinal hernia come through?
A: The deep ring.
114
Q: How should the inspection for hernia be performed?
A: In the standing position, checking both sides.
115
Q: What should be noted during inspection?
A: Location, size, shape, and border.
116
Q: What does an expansile impulse during coughing indicate?
A: A hernia.
117
Q: What does peristalsis indicate during examination?
A: An enterocoele.
118
Q: What does a surgical scar indicate?
A: A recurrent hernia.
119
Q: What does a ragged scar suggest?
A: Infection.
120
Q: If a hernia pops out as soon as the patient stands, what does it indicate?
A: A direct hernia.
121
Q: What is the purpose of palpation in hernia examination?
A: To confirm inspection findings and search for other findings.
122
Q: What aspects should be assessed during palpation?
A: Size, shape, border, consistency, reducibility, and special tests.
123
Q: What does consistency typically indicate?
A: Softness, but an omentocele may be firm or granular.
124
Q: How is reducibility checked?
A: Ask the patient to lie down and see if the swelling becomes smaller or disappears.
125
Q: What does it mean if a hernia is irreducible?
A: It cannot be reduced after attempts.
126
Q: What is the external ring invagination test?
A: Skin is gathered and lifted at the root of the scrotum, invaginated into the external ring; impulse felt indicates direct or indirect hernia.
127
Q: How is the internal (deep) ring occlusion test performed?
A: Occlude the deep ring with the thumb and ask the patient to cough.
128
Q: What does it indicate if an impulse and swelling are seen during the internal ring occlusion test?
A: A direct hernia.
129
Q: What does it indicate if swelling is not seen during the internal ring occlusion test?
A: An indirect hernia.
130
Q: What does weakness of the oblique muscles indicate in the leg raising test?
A: Malgaigne's bulging, indicating need for hernioplasty.
131
Q: What is Zieman's (three fingers) method?
A: Index finger at deep ring, middle finger on posterior wall, ring finger at femoral ring; checking for impulse during coughing.
132
Q: Why should abdominal and respiratory examinations be performed after hernia tests?
A: To identify abdominal masses or respiratory diseases.
133
Q: What is a femoral hernia?
A: Herniation of intra-abdominal contents through the femoral canal.
134
Q: Which gender is more often affected by femoral hernia?
A: Women, with a 2:1 ratio compared to men.
135
Q: How does the ratio and risk of femoral hernia change in parous women?
A: The ratio and risk are doubled in parous women.
136
Q: Is a femoral hernia typically unilateral or bilateral?
A: Commonly unilateral.
137
Q: Which side is more often affected by femoral hernia?
A: The right side.
138
Q: What percentage of femoral hernias are bilateral?
A: About 15-20% of patients.
