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Surgery.(General 1).Hernia > 10. Umbilical Hernia > Flashcards

10. Umbilical Hernia Flashcards

1
Q

TYPES of Umbilical Hernia

A

1- Congenital umbilical hernia

2- Infantile umbilical hernia

3- Adult umbilical hernia

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2
Q

Congenital umbilical hernia in TYPES of Umbilical Hernia

A
  • Alternative names
  • ETIOLOGY
  • Pathology
  • ASSOCIATED CONGENITAL ANOMALIES
  • Differential Diagnosis
  • SCREENING
  • Treatment
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3
Q

Alternative names for Congenital umbilical hernia in TYPES of Umbilical Hernia

A
  • Exomphalos

* Omphalocele

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4
Q

ETIOLOGY of Congenital umbilical hernia in TYPES of Umbilical Hernia

A

Unobliterated physiological umbilical hernia of the fetus.

It is normal for the intestines to protrude from the abdomen, into the umbilical cord at the 4th week of pregnancy, after which they return to inside the fetal abdomen at the 10th week.

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5
Q

Pathology of Congenital umbilical hernia in TYPES of Umbilical Hernia

A
  1. Exomphalos Minor

2. Exomphalos Major

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6
Q

Exomphalos Minor Pathology of Congenital umbilical hernia in TYPES of Umbilical Hernia

A
  • Defect
  • Sac
  • Contents
  • Coverings
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7
Q

Defect in Exomphalos Minor Pathology of Congenital umbilical hernia in TYPES of Umbilical Hernia

A

Small ( < 5 cm ) at the centre of the umbilicus.

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8
Q

Sac in Exomphalos Minor Pathology of Congenital umbilical hernia in TYPES of Umbilical Hernia

A

Peritoneum

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9
Q

Contents in Exomphalos Minor Pathology of Congenital umbilical hernia in TYPES of Umbilical Hernia

A

Usually intestine

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10
Q

Coverings in Exomphalos Minor Pathology of Congenital umbilical hernia in TYPES of Umbilical Hernia

A

Wharton’s jelly and a layer of amniotic membrane.

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11
Q

Exomphalos Major Pathology of Congenital umbilical hernia in TYPES of Umbilical Hernia

A
  • Defect
  • Sac
  • Contents
  • Coverings
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12
Q

Defect in Exomphalos Major Pathology of Congenital umbilical hernia in TYPES of Umbilical Hernia

A

Large ( > 5 cm ) at the center of the abdominal wall usually above the umbilicus.

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13
Q

Sac in Exomphalos Major Pathology of Congenital umbilical hernia in TYPES of Umbilical Hernia

A

Peritoneum

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14
Q

Contents in Exomphalos Major Pathology of Congenital umbilical hernia in TYPES of Umbilical Hernia

A

Many viscera +/- liver which Causes downward transposition of the cord

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15
Q

Coverings in Exomphalos Major Pathology of Congenital umbilical hernia in TYPES of Umbilical Hernia

A

Only a layer of amniotic membrane & there is danger

of rupture of the sac followed by peritonitis.

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16
Q

ASSOCIATED CONGENITAL ANOMALIES of Congenital umbilical hernia in TYPES of Umbilical Hernia

A
  • Congenital heart disease
  • Cleft palate.
  • Musculoskeletal abnormalities.
  • Dental malocclusion
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17
Q

Differential Diagnosis of Congenital umbilical hernia in TYPES of Umbilical Hernia

A

Gastroschisis

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18
Q

Gastroschisis in Differential Diagnosis of Congenital umbilical hernia in TYPES of Umbilical Hernia

A
  • Has no sac
  • Is a type of inherited congenital abdominal wall defect in which the intestines and sometimes other organs develop outside the fetal abdomen
    through an opening in the abdominal wall.
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19
Q

SCREENING of Congenital umbilical hernia in TYPES of Umbilical Hernia

A
  • Elevated maternal alpha fetoprotein at the beginning of the 2nd trimester.
  • In utero fetal U.S.
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20
Q

Treatment of Congenital umbilical hernia in TYPES of Umbilical Hernia

A
  1. Exomphalos Minor

2. Exomphalos Major

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21
Q

Exomphalos Minor Treatment of Congenital umbilical hernia in TYPES of Umbilical Hernia

A
  1. Cord is twisted & the contents are reduced and returned to the abdomen
  2. The sac is excised
  3. Defect is repaired in layers
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22
Q

Exomphalos Major Treatment of Congenital umbilical hernia in TYPES of Umbilical Hernia

A

A. Cases of intact sac

B. Cases of ruptured sac

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23
Q

cases of intact sac in Exomphalos Major Treatment of Congenital umbilical hernia in TYPES of Umbilical Hernia

A
  1. Cicatrizing agents (old method)

2. Silo bug

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24
Q

Cicatrizing agents In cases of intact sac in Exomphalos Major Treatment of Congenital umbilical hernia in TYPES of Umbilical Hernia

A
  • procedure

* Disadvantage

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25
Q

procedure of Cicatrizing agents In cases of intact sac in Exomphalos Major Treatment of Congenital umbilical hernia in TYPES of Umbilical Hernia

A

Attempts to dry the sac by painting with cicatrizing agents until creeping epithelialization occurs

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26
Q

Disadvantage of Cicatrizing agents in cases of intact sac in Exomphalos Major Treatment of Congenital umbilical hernia in TYPES of Umbilical Hernia

A

a prolonged procedure often punctured by septic episodes

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27
Q

Silo bug In cases of intact sac in Exomphalos Major Treatment of Congenital umbilical hernia in TYPES of Umbilical Hernia

A
  • The extruded organs are placed in a sterile silastic bag “silo bug”
  • Twisted daily to the let the abdominal cavity accommodate the contents
  • Followed later by definitive repair
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28
Q

Cases of ruptured sac in Exomphalos Major Treatment of Congenital umbilical hernia in TYPES of Umbilical Hernia

A

Urgent operation

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29
Q

Urgent operation in Cases of ruptured sac in Exomphalos Major Treatment of Congenital umbilical hernia in TYPES of Umbilical Hernia

A
  • The reason why it’s urgent

* Principle

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30
Q

The reason why it’s urgent in Urgent operation in Cases of ruptured sac in Exomphalos Major Treatment of Congenital umbilical hernia in TYPES of Umbilical Hernia

A

because of

  • Risk of infection.
  • Risk of perforation.
  • Heat & fluid loss.
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31
Q

Principle of Urgent operation in Cases of ruptured sac in Exomphalos Major Treatment of Congenital umbilical hernia in TYPES of Umbilical Hernia

A
  1. Skin flaps are used for closure

2. release incisions in the flanks are needed.

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32
Q

Infantile Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Incidence
  • ETIOLOGY
  • PATHOLOGY
  • CLINICAL PICTURE
  • TREATMENT
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33
Q

Incidence of Infantile Umbilical Hernia in TYPES of Umbilical Hernia

A

20%

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34
Q

ETIOLOGY of Infantile Umbilical Hernia in TYPES of Umbilical Hernia

A
  1. Weakness of the umbilical scar from infection (omphalitis).
  2. Increased intra abdominal pressure from coughing or constipation
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35
Q

PATHOLOGY of Infantile Umbilical Hernia in TYPES of Umbilical Hernia

A
  • The defect
  • The sac
  • Coverings
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36
Q

The defect in PATHOLOGY of Infantile Umbilical Hernia in TYPES of Umbilical Hernia

A

exactly at the umbilicus

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37
Q

The sac in PATHOLOGY of Infantile Umbilical Hernia in TYPES of Umbilical Hernia

A

The neck of the peritoneal sac is wide.

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38
Q

Coverings in PATHOLOGY of Infantile Umbilical Hernia in TYPES of Umbilical Hernia

A

Extra peritoneal fat & umbilical scar

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39
Q

CLINICAL PICTURE of Infantile Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Symptoms

* Examination

40
Q

Symptoms in CLINICAL PICTURE of Infantile Umbilical Hernia in TYPES of Umbilical Hernia

A

Umbilical protrusion with cough or crying.

41
Q

Examination in CLINICAL PICTURE of Infantile Umbilical Hernia in TYPES of Umbilical Hernia

A

Edge of the defect can be palpated as firm ring.

42
Q

TREATMENT of Infantile Umbilical Hernia in TYPES of Umbilical Hernia

A

1- Reassurance of the parents

2- Operation

43
Q

Reassurance of the parents in TREATMENT of Infantile Umbilical Hernia in TYPES of Umbilical Hernia

A

as in most cases the defect closes spontaneously within 2 years.

44
Q

Operation in TREATMENT of Infantile Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Indication

* Principle

45
Q

Indication of Operation in TREATMENT of Infantile Umbilical Hernia in TYPES of Umbilical Hernia

A
  • if the defect is more than 2 fingers

* when hernia persists after the age of 2 years.

46
Q

Principle of Operation in TREATMENT of Infantile Umbilical Hernia in TYPES of Umbilical Hernia

A

Anatomical repair with prolene sutures

47
Q

Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Alternative names
  • ETIOLOGY
  • PATHOLOGY
  • CLINICAL PICTURE
  • Investigations
  • TREATMENT
48
Q

Alternative names for Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

Paraumbilical Hernia

49
Q

ETIOLOGY of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Obese

* Multiparous females

50
Q

PATHOLOGY of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Site
  • The defect
  • The sac
  • The contents
51
Q

Site in PATHOLOGY of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

More common above the umbilicus

52
Q

The reason why It’s more common above the umbilicus in Site in PATHOLOGY of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

because linea alba is thinner and wider above umbilicus than below

53
Q

The defect in PATHOLOGY of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Small defect in the linea alba

* so there is increased incidence of irreducibility and strangulation

54
Q

The sac in PATHOLOGY of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Narrow neck

* commonly multilocular sac

55
Q

The reason why it’s commonly multilocular sac in The sac in PATHOLOGY of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Multiple defects in linea alba.

* Adhesions between the omentum & the fundus of the sac.

56
Q

Pathogenesis of Adhesions between the omentum & the fundus of the sac.

A

Small defect )> compression on venous drainage of omentum )> oxidation and transudation )> fluid rich in fibrinogen )> adhesions between omentum and fundus of the sac

57
Q

The contents in PATHOLOGY of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

Usually omentum, less commonly intestine

58
Q

CLINICAL PICTURE of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Symptoms

* Examination

59
Q

Symptoms in CLINICAL PICTURE of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  1. Painless paraumbilical swelling.

2. Dyspepsia

60
Q

Pathogenesis of Dyspepsia in Symptoms in CLINICAL PICTURE of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

Traction on the Greater omentum

61
Q

Examination in CLINICAL PICTURE of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Site
  • Size
  • Shape
  • Edge
  • Surface
  • Consistency
  • Special character
  • Reducibility
  • Very important note
62
Q

Site in Examination in CLINICAL PICTURE of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

Paraumbilical swelling

63
Q

Size in Examination in CLINICAL PICTURE of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Variable

* increases on straining & decrease on lying flat

64
Q

Shape in Examination in CLINICAL PICTURE of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

Usually rounded.

65
Q

Edge in Examination in CLINICAL PICTURE of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

well defined.

66
Q

Surface in Examination in CLINICAL PICTURE of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

Smooth or lobular due to multilocular sac

67
Q

Consistency in Examination in CLINICAL PICTURE of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

Soft or doughy.

68
Q

Special character in Examination in CLINICAL PICTURE of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

Expansile impulse on cough.

69
Q

Reducibility in Examination in CLINICAL PICTURE of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

Usually partially irreducible due to presence

of adhesions between the omentum & the fundus of the sac or between the contents itself.

70
Q

Very important note in Examination in CLINICAL PICTURE of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

Don’t forget to examine if there is divarication of recti or not

71
Q

Investigations of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

1) Investigations to detect underlying cause of increased abdominal pressure:
2) Routine preoperative investigations

72
Q

Investigations to detect underlying cause of increased abdominal pressure in Investigations of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

a. Chest x-ray & pulmonary function test.

b. Abdominal U.S.

73
Q

Abdominal U.S in Investigations to detect underlying cause of increased abdominal pressure in Investigations of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

may show

  • Ascites
  • splenomegaly
74
Q

Routine preoperative investigations in Investigations of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

a. Blood picture “CBC”
b. Blood chemistry.
c. P.T & P.T.T.
d. ECG.

75
Q

TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Surgery is the only line of treatment

* Operative details

76
Q

Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Incision

* Steps

77
Q

Incision in Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

Elliptical transverse incision is made over the hernia

78
Q

Steps in Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  1. Manipulation of the sac

2. Repair of the defect

79
Q

Manipulation of the sac in Steps in Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  1. Sac is dissected down to the neck
  2. Sac is opened “at its neck”
  3. Contents are dealt with and reduced to the abdomen or excised
  4. Sac is excised
80
Q

Sac is opened at its neck in Manipulation of the sac in Steps in Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

due to adhesions at the fundus

81
Q

Repair of the defect in Steps in Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

1- Mayo’s Repair

2- Anatomical repair

3- Hernioplasty

82
Q

Mayo’s Repair in Repair of the defect in Steps in Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Principle

* Disadvantages

83
Q

Principle of Mayo’s Repair in Repair of the defect in Steps in Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

The detect is closed by overlapping the upper flap over the lower flap of anterior rectus sheath.

84
Q

Disadvantages of Mayo’s Repair in Repair of the defect in Steps in Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

Seroma formation which predisposes to infection

85
Q

Pathogenesis of seroma formation in Disadvantages of Mayo’s Repair in Repair of the defect in Steps in Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

The Peritoneum of the upper flap is in contact with anterior rectus sheath )> Irritation & exudation of fluid )> seroma formation

86
Q

Principle of Anatomical repair in Repair of the defect in Steps in Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

Each layer is sutured separately.

87
Q

Hernioplasty in Repair of the defect in Steps in Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Methods of mesh application

* Advantages of in lay mesh

88
Q

Methods of mesh application of Hernioplasty in Repair of the defect in Steps in Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

a- On lay

b- In lay

89
Q

On lay in Methods of mesh application of Hernioplasty in Repair of the defect in Steps in Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

Anterior to the rectus sheath.

90
Q

In lay in Methods of mesh application of Hernioplasty in Repair of the defect in Steps in Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

Between the rectus muscle & the posterior rectus sheath

91
Q

Advantages of in lay mesh in Hernioplasty in Repair of the defect in Steps in Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A
  • Less incidence of infection.
  • Less incidence of seroma formation so we put a drain for short time
  • Better action.
92
Q

The reason of Less incidence of infection in Advantages of in lay mesh in Hernioplasty in Repair of the defect in Steps in Operative details in TREATMENT of Adult Umbilical Hernia in TYPES of Umbilical Hernia

A

As it’s deep

93
Q

True adult umbilical hernia

A
  • Type of patient

* Examination

94
Q

Type of patient of True adult umbilical hernia

A

Seen in patients with ascites or chronic liver disease

95
Q

Examination of True adult umbilical hernia

A

The umbilicus is flat or everted

Surgery.(General 1).Hernia (13 decks)

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