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Gastroentrology > 2: Body Wall Hernias > Flashcards

2: Body Wall Hernias Flashcards

1
Q

Define a hernia

A

protrusion of whole or part of an organ through cavity that usually contains it

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2
Q

Define a para-umbilical hernia

A

protrusion of hernia through linea alba

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3
Q

in which population are para-umbilical hernias more common

A

children

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4
Q

what causes para-umbilical hernias

A

increase intra-abdominal pressure

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5
Q

what typically causes para-umbilical hernias in children

A

Failure of guts contents to return to the abdomen during development.

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6
Q

what age do umbilical hernias spontaneously close in children

A

5-years

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7
Q

what are 3 risk factors for umbilical hernias

A
  1. Obesity
  2. Pregnancy
  3. Intra-abdominal tumours
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8
Q

how do umbilical hernias present in adults

A

Mass adjacent to the umbilicus

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9
Q

how do umbilical hernias present in children

A

Mass penetrating through umbilicus. Exacerbated by coughing-sneezing. Hernia can be completely reduced.

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10
Q

What is an inguinal hernia

A

protrusion of abdominal contents through inguinal canal

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11
Q

What are the two types of inguinal hernia

A
  1. Direct

2. Indirect

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12
Q

What is the most common type of inguinal hernia

A

Indirect inguinal hernia (85%)

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13
Q

What % of inguinal hernias are direct

A

20%

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14
Q

What is an indirect inguinal hernia

A

When abdominal contents enter the inguinal canal via the deep inguinal ring

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15
Q

What is a direct inguinal hernia

A

Abdominal contents enter inguinal canal directly through weakening in posterior inguinal canal wall

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16
Q

Which population are more likely to have direct inguinal hernias and why

A

Elderly - due to weakening in abdominal wall and increased intra-abdominal pressure

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17
Q

What causes indirect inguinal hernias

A

patent processes vaginalis

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18
Q

What is processus vaginalis

A

out pouching of peritoneum - enabling embryonic testicular tissue descent

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19
Q

What are 5 risk factors for indirect inguinal hernias

A
  1. Age
  2. Male
  3. Raised intra-abdominal pressure chronic cough, heavy lifting
  4. Chronic constipation
  5. Obesity
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20
Q

How will inguinal hernias present

A

Lump in the groin that is reducible - may disappear if the patient lies down

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21
Q

What is an incarcerated hernia

A

Where contents of hernia have adhered to hernial sac and therefore become irreducible

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22
Q

What are the symptoms of an incarcerated hernia

A

Painful

Erythematous
Tender to palpation
Absent cough impulse

Possible Bowel obstruction

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23
Q

What will not be present in incarcerated abdominal hernia

A

Cough Impulse

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24
Q

What is the cough impulse

A

Enlargement of hernia on coughing

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25
Q

What is a strangulated hernia

A

ischaemia and necrosis of the hernia due to compromised blood supply

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26
Q

What are the symptoms of a strangulated hernia

A
  • Pain is out-of-proportion to clinical signs
  • Irreducible
  • Tender lump
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27
Q

Where are inguinal hernias in relation to the pubic tubercle

A

Superior-medial to the pubic tubercle

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28
Q

What is used as a landmark for distinguishing direct and indirect hernias

A

Inferior epigastric vessels

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29
Q

How can direct inguinal hernias be identified

A

Medial to inferior epigastric vessels

30
Q

How can indirect inguinal hernias be identified

A

Lateral to inferior epigastric vessels

31
Q

Explain how direct and indirect inguinal hernias can be distinguished

A
  • Reduce the hernia
  • Place pressure over deep inguinal ring
  • Ask patient to cough
  • If the hernia protrudes it is a direct hernia (does not pass through the canal). If not, it is indirect.
32
Q

How are hernias usually diagnosed

A

Clinically

33
Q

What are the two options for managing inguinal hernias

A
  1. Laparoscopic Inguinal hernia repair

2. Open mesh repair

34
Q

What are the two laparoscopic procedures offered for inguinal hernias called

A

TEP = total extraperitoneal

TAPP = transabdominal pre-peritoneal

35
Q

When is laparoscopic repair of inguinal hernias preferred

A
  1. Bilateral inguinal hernias
  2. Recurrent inguinal hernias
  3. Females with inguinal hernias
  4. Young patients: this is because there is a higher risk of chronic pain with open mesh repair.
36
Q

Why is laparoscopic repair of inguinal hernias preferred in females

A

Due to risk of it being a femoral hernia - which is more common in females

37
Q

When is open mesh repair of inguinal hernias preferred

A
  1. Primary unilateral inguinal hernia
38
Q

What are 3 emergency complications of inguinal hernias

A

incarceration
obstruction
strangulation

39
Q

What is incarceration

A

where a hernia cannot be reduced

40
Q

What is obstruction

A

herniation of abdominal contents results in bowel obstruction

41
Q

How will obstruction present

A

absolute constipation

42
Q

What % of inguinal hernias strangulate

A

3

43
Q

How will strangulation present clinically

A

pain out-of-proportion to clinical findings

44
Q

How is strangulation managed

A

emergency surgical exploration

45
Q

What is a long-term complication of hernia repair

A

chronic pain

46
Q

What may happen intra-operatively as a complication of hernia repair

A

damage to vas deferens causing ischaemia, sub-fertility and orchitis.

47
Q

Define an incisional hernia

A

Protrusion of contents through a previously made incision in compartment wall

48
Q

What type of surgery are incisional hernias associated with

A

Abdominal surgery

49
Q

Give 5 risk factors for incisional hernia

A
  1. Emergency surgery
  2. Wound type
  3. BMI >25
  4. Midline incision
  5. Wound Infection
  6. Post-operative chemotherapy
  7. Intra-operative blood transfusion
  8. Age
  9. Pregnancy
50
Q

How will an incisional hernia present clinically

A

Non-tender, Reducible mass through a previously made incision

51
Q

Explain pathophysiology of incisional hernias

A

Layers of the abdominal wall aim to maintain integrity of cavity. Incision damages and weakness these structures leading to protrusion

52
Q

How are incisional hernias diagnosed

A

Clinically

53
Q

What are three indications for surgery for incisional hernias

A
  1. Painful
  2. Patient is fit for surgery
  3. Obstruction
54
Q

How may incisional hernias be repaired

A

Sutures
Laparoscopic mesh
Open mesh

55
Q

Define a femoral hernia

A

protrusion of abdominal viscera or omentum through femoral ring into femoral contal

56
Q

In which gender are femoral hernias more common and why

A

Females - due to wider pelvis

57
Q

In which gender are inguinal hernias more common

A

Males

58
Q

What are 3 risk factors for femoral hernia

A
  1. Raised intra-abdominal pressure: obesity, pregnancy, heavy lifting, chronic cough
  2. Female
  3. Age
59
Q

How do femoral hernias present clinically

A

Small non-reducible lump in the groin

60
Q

What % of femoral hernias strangulate

A

30

61
Q

What is the anatomical relation of femoral hernias to the pubic tubercle

A

Inferior-lateral

62
Q

What is the anatomical location of inguinal hernias to the pubic tubercle

A

Superior-medial

63
Q

How are femoral hernias investigated

A
  1. USS
  2. Surgical exploration

As all femoral hernias are operated on - objective investigations should be performed.

64
Q

Why are all femoral hernias surgically operated

A

Due to high risk of strangulation - due to narrow neck

65
Q

What is the time frame to operate on femoral hernias

A

2-4W

66
Q

What are the two surgical approaches for managing femoral hernia

A

High approach

Low approach

67
Q

What is the low approach

A

Approach from under the inguinal ligament

68
Q

What is the advantage of low approach

A

Inguinal structures are intact - but limits space for returning bowel

69
Q

What is the high approach

A

Approach from above inguinal ligament

70
Q

When is a high approach preferred

A

In an emergency - due to more space to return bowel

Gastroentrology (18 decks)

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