44 - Hernias Flashcards
What is the content of the inguinal canal? (6)
spermatic cord testicular artery ductus deference pampiniform plexus genital branch of genitofemoral nerve tunica vaginalis
Which nerves go through the inguinal canal? (3)
genital branch of genitofemoral nerve
sympathetic nerve
ilioinguinal nerve
The genital branch of genitofemoral nerve is part of the ___ ___ itself
spermatic cord
Ilioinguinal nerve does not enter through the ___ ring, but exist through the ___
deep
superficial
What are the 3 levels of hernia?
reducible
irreducible/incarcerated
strangulated
External hernia= classic, the sac moves with the ___ space
peritoneal
What kind of groin hernia do you know?
inguinal
femoral
Inguinal hernia may be indirect (___) or direct (___)
deep ring
Hesselbach triangle
Groin hernias make up to __% of all hernias
80
Groin hernia are __ times more common in ___. __ are direct.
25
men
2/3
Femoral hernias are __ times more common in ___.
10
women
Umbilical hernias are ___ times more common in women
2
Strangulated hernia may lead to bowel ___ and ___
ischemia
obstruction
Inguinal hernia require ___ only if symptomatic
surgery
Femoral hernia always require ___ due to high frequency of ___ (20%)
surgery
strangulation
If there is no reason to suspect ___, we can try and perform a ____ maneuver to restore the intestine
strangulation
manual
The typical imaging test for inguinal hernia is ___
US
The typical imaging test for ventral hernias is ___
CT
Name 5 DDs for a groin mass
hernia (inguinal/femoral) lymphadenopathy (reactive/infective/tumor) cryptorchidism abscess lymphoma
Testicular tumors metastasize to the ___ lymph nodes rather than the ___ lymph nodes
retroperitoneal
groin
Scrotum tumors (skin) metastasize to the ___ lymph nodes (superficial inguinal nodes)
gorin
Indirect hernias are the ___ common type.
most
In direct hernia, the intestine’s loop enter through the ___ __ to the ___ ___. It is a premade anatomic path.
deep
ring
inguinal
canal
Complete hernia is when the loop exists through the ___ inguinal canal, into the ___ cord
superficial
spermatic
Indirect inguinal hernia etiology is the patent ___ ___ that did not go through obliteration properly
process
vaginalis
Indirect hernia is more common on the ___ side, due to the fact that on this side the testicle migrate last.
right
Indirect hernia are more likely to cause ___.
strangulation
What does hernia includes (inside->out) (7)?
intestine loop peritoneum internal spermatic fascia cremasteric muscle and fascia external spermatic fascia superficial layer skin
The indirect hernia passes ___ to the inferior epigastric vessels
latterly
Direct inguinal hernia occurs due to ___ in the abdominal wall. Specifically of the ___ fascia.
weakness
transversals
The indirect hernia does not enter through the ___ ring, but can occasionally exist through the ___ ring
deep
superficial
Direct hernia is usually found in the ___ triangle area, medially to the ___ ___ vessels
Hesselbach
inferior epigastric
What are the borders of the Hesselbach triangle?
inferior- ___
superior lateral- ___
medially- ___
inguinal ligament
inferior epigastric vessels
semilunar line of the rectus abdominis
Femoral hernia are more common in ___, and makes up to __% of all hernias. It is more common on the ___ side.
women
3
right
Femoral hernia goes through the ___ ring, found ____ to the femoral vein, ___ to the ___ ligament
femoral
medially
superior
cooper
What is the femoral ring anatomy? superior- \_\_\_ ligament medially- \_\_\_ ligament inferior- \_\_\_ ligament latterly- \_\_\_ vein
inguinal
lacunar
cooper
femoral
Femoral hernia has the biggest chance (__%) to become ___, therefore we must perform ___, even if its ___
20
strangulated
surgery
asymptomatic
What are the most common organs to get strangulated in femoral hernia? (2)
intestine
ovary
When performing physical examination and palpating a mass ___ the inguinal ligament, ___ hernia should be highly suspected
under
femoral
What is pantaloons hernia?
a big hernia, penetrating through the inguinal ring (indirect) and the Hesselbach triangle (direct)
Triangle of doom: (3)
inguinal ligament
medial umbilical ligament
testicular vessels
Triangle of pain: (2)
genitofemoral nerve
lateral femoral cutaneous nerve
Acute incarceration/strangulation requires __ __ without trying to ___ the hernia, to avoid ___
emergency surgery
maneuver
perforation
Emergency surgery is made with an ____ approach
open
If the intestine is strangulated and requires surgical removal, we will not place ___, fearing from infection
net
Before performing emergency surgery, we should administrate: (3)
fluids
ABx
NGT
What are the 5 most common complications post hernia surgery:
SSI nerve injury- chronic pain syndrome ischemic orchitis/ testicular atrophy vas deferens/viscera injury recurrence
