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Surgery.(General 1).Hernia > 4. Oblique (Indirect) inguinal hernia > Flashcards

4. Oblique (Indirect) inguinal hernia Flashcards

1
Q

ETIOLOGY & TYPES of Oblique inguinal hernia

A

1 - Congenital hernia :

2- Infantile hernia (operative finding only)

3-Adult (acquired) oblique inguinal hernia

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2
Q

Congenital hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

A
  • Pathogenesis
  • Clinical picture
  • Age of presentation
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3
Q

Pathogenesis of Congenital hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

A

persistent patency of the whole processus vaginalis.

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4
Q

Clinical picture of Congenital hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

A

It reaches down the scrotum from the start.

The testis is inseparate from the hernial sac and its contents.

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5
Q

Age of presentation of Congenital hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

A

Although congenital, it may appear in adult life

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6
Q

Infantile hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

A

Pathogenesis

Its problem

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7
Q

Pathogenesis of Infantile hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

A

Combined inguinal hernial sac + infantile hydrocele (2 sacs).

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8
Q

problem of Infantile hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

A

At operation, the tunica is liable to be opened in mistake for the true sac.

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9
Q

Adult (acquired) oblique inguinal hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

A

Pathogenesis

Types

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10
Q

Pathogenesis of Adult (acquired) oblique inguinal hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

A
  • Raised intra abdominal pressure

* Weak abdominal wall.

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11
Q

Types of Adult (acquired) oblique inguinal hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

A

a) Bubonocele
b) Funicular
c) Complete (scrotal) hernia

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12
Q

Pathogenesis of Bubonocele Type of Adult (acquired) oblique inguinal hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

A

The hernial sac is limited to the inguinal canal and is seen as a bulge or swelling in the inguinal region and does not come out through the external ring.

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13
Q

Pathogenesis of Funicular Type of Adult (acquired) oblique inguinal hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

A

The hernia passes out through the external ring and starts to descend into the scrotum, reaching only its neck.

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14
Q

Pathogenesis of Complete (scrotal) hernia Type of Adult (acquired) oblique inguinal hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

A
  • The hernia descends to the bottom of the scrotum, as a continuation of funicular type.
  • The testis is separate from the hernial sac and its contents
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15
Q

Difference between Adult Scrotal hernia and Congenital hernia by

A

History

Examination

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16
Q

History of Adult Scrotal hernia

A

The hernia descends to the bottom of the scrotum, as a continuation of funicular type.

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17
Q

History of Congenital hernia

A

It reaches down the scrotum from the start.

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18
Q

Examination of Adult Scrotal hernia

A

The testis is separate from the hernial sac and its contents

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19
Q

Examination of Congenital hernia

A

The testis is inseparate from the hernial sac and its contents.

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20
Q

PATHOLOGY of Oblique inguinal hernia

A
  1. The defect :
  2. The sac :
  3. The contents :
  4. The coverings :
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21
Q

Pathogenesis of The defect in PATHOLOGY of Oblique inguinal hernia

A

Stretched deep inguinal ring.

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22
Q

Pathogenesis of The sac in PATHOLOGY of Oblique inguinal hernia

A

Congenital sac

acquired sac

23
Q

in Pathogenesis of The sac in PATHOLOGY of Oblique inguinal hernia, Congenital sac present within

A

The spermatic cord contents

24
Q

in Pathogenesis of The sac in PATHOLOGY of Oblique inguinal hernia, acquired sac present within

A

The spermatic cord coverings antero-lateral to the vas and vessels.

25
Q

The contents in PATHOLOGY of Oblique inguinal hernia

A

Small intestine, omentum or both.

26
Q

The coverings in PATHOLOGY of Oblique inguinal hernia

A

a) In the inguinal region

b) In the scrotum

27
Q

The coverings of a hernia In the inguinal region in PATHOLOGY of Oblique inguinal hernia

A

Skin

superficial fascia

external oblique aponeurosis

cremasteric muscle and fascia

internal spermatic fascia

28
Q

The coverings of a hernia In the scrotum in PATHOLOGY of Oblique inguinal hernia

A

Skin,

Dartos muscle

Colles’ fascia

The three cord coverings

29
Q

CLINICAL PICTURE of Oblique inguinal hernia

A

History

Examination

30
Q

History in CLINICAL PICTURE of Oblique inguinal hernia

A
  • Painless inguinal or inguinoscrotal swelling (unless complicated).
  • Before appearance of the hernia, the patient may complain of stitching pain (Pre eruptive pain)
31
Q

Pre eruptive pain in History in CLINICAL PICTURE of Oblique inguinal hernia

A

stitching pain before appearance of the hernia

32
Q

Examination in CLINICAL PICTURE of Oblique inguinal hernia

A

General examination

Local examination

33
Q

General examination in CLINICAL PICTURE of Oblique inguinal hernia

A
  • Other features of weak mesenchyme
  • Chest examination
  • P/R
34
Q

Other features of weak mesenchyme in General examination in CLINICAL PICTURE of Oblique inguinal hernia

A

varicose veins, varicocele, flat foot

35
Q

Chest examination in General examination in CLINICAL PICTURE of Oblique inguinal hernia

36
Q

P/R in General examination in CLINICAL PICTURE of Oblique inguinal hernia

A

For Benign prostatic hyperplasia “BPH”

37
Q

Local examination in CLINICAL PICTURE of Oblique inguinal hernia

A
  1. Site
  2. Size
  3. Shape
  4. Surface
  5. Special character
  6. Special tests :
  7. Edge: well defined.
  8. Consistency: Soft or doughy.
  9. Descent: Downwards, forwards and medially.
  10. Reduction :
38
Q

site in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

A

Inguinal or inguino-scrotal (by scrotal neck test).

39
Q

Size in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

A

Variable and decrease on lying flat & increase on straining

40
Q

Shape in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

A

Usually oblong.

41
Q

Surface in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

A

Usually smooth

42
Q

Special character in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

A
  • Reducible (unless complicated)

* gives expansile impulse on cough

43
Q

Special tests in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

A

Internal and external ring tests

44
Q

Edge in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

A

well defined.

45
Q

Consistency in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

A

Soft or doughy

46
Q

Descent in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

A

Downwards, forwards and medially

47
Q

Reduction in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

A

upwards, Backwards and laterally

48
Q

Differential Diagnosis of Oblique inguinal hernia

A

Inguino-scrotal swellings especially direct and femoral hernia

49
Q

Investigations of Oblique inguinal hernia

A

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

50
Q

Investigations to detect underlying cause of increased abdominal pressure in Investigations of Oblique inguinal hernia

A

a. Chest x-ray & pulmonary function test.
b. Abdominal U.S.
c. Trans-rectal U.S

51
Q

Abdominal U.S in Investigations to detect underlying cause of increased abdominal pressure in Investigations of Oblique inguinal hernia

A

may show

  • Ascites
  • splenomegaly
52
Q

Trans-rectal U.S in Investigations to detect underlying cause of increased abdominal pressure in Investigations of Oblique inguinal hernia

A

to detect B.P.H.

53
Q

Routine preoperative investigations in Investigations of Oblique inguinal hernia

A

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

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

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