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Senior - Surgery 2 > 7 - Hernias > Flashcards

7 - Hernias Flashcards

1
Q

Hernia

A

Protrusion of tissue through the fascial, muscle layer or other barrier designed to contain them

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2
Q

Inguinal hernia

A

Originates above the inguinal ligament (MC type)

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3
Q

Femoral hernia

A

Originates below the inguinal ligament

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4
Q

Incarcerated

A

Not reducible

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5
Q

Strangulated

A

Incarcerated AND ischemic

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6
Q

Indirect inguinal hernia

A

Congenital hernia from patent processes vaginalis

Same congenital defect that causes hydroceles

Contents travel down spermatic cord

Most common hernia in both sexes

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7
Q

Presentation of indirect inguinal hernia

A

Bulge in groin
Can be acute or chronic

May be associated c N/V and ABD distention

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8
Q

Workup of indirect inguinal hernia

A

H and P

Quickly determine if incarcerated or strangulated

KUB may show ileus or free air

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9
Q

What test confirms hernia?

A

CT

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10
Q

Disposition for hernia

A

Routine if reducible

Urgent if incarcerated or strangulated

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11
Q

Surgical repair of hernia

A

Reduce it

High ligation of the hernia sac

Reconstruct and tighten the inguinal ring with mesh

Initial - open

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12
Q

Direct inguinal hernia

A

Acquired 2/2 weakened floor of the inguinal canal

Defect medial to the epigastric vessels

Does not pass through deep inguinal ring

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13
Q

Risk factors for direct inguinal hernia

A 
Obesity	
• Pregnancy
• Heavy	lifting
• Chronic	cough
• Straining	to	void	(BPH/prostate	ca)
• Constipation
• Cirrhosis	with	ascites
• Pregnancy
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14
Q

Presentation of direct inguinal hernia

A

Bulging in the groin

May be acute or chronic

Normally doesn’t extend to the scrotum

May be associated with ABD distention, N/V

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15
Q

How to differentiate indirect from direct on PE

A

Deep palpation along spermatic cord

Pt valsalva - feel it on top of finger, indirect

Feel it medially - direct

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16
Q

Boundaries of Hasselbach’s triangle

A

Medially - lateral border of abd rectus muscle

Laterally - inferior epigastric artery

Inferiorly - inguinal ligament

17
Q

Risks of inguinal hernia repair

A

Bleeding
Injury to surrounding structures (spermatic cord)

Recurrence

Infection

18
Q

Femoral hernia

A

Passes below the inguinal ligament, medial to the femoral vein

More common in women

19
Q

Incarcerated hernias

A

Can be well-perfused or ischemic

Camping pain, distention

Must operate prior to strangulation

Bowel ischemia -> necrosis -> perforation

20
Q

Differentials for groin pain

A

Sports hernia • Lymphadenopathy • Undescended testis • Hydrocele • Epididymitis • Spermatocoele • Testicular torsion • Femoral artery aneurysm • Vericocele

21
Q

Sports hernia

A

Not actually a hernia

Micro-tearing of fascia

Conservative txt

22
Q

Hydrocele

A

Peritoneal fluid leaking into the sac

Congenital

Fluid filled sac

Usually non-tender

Transilluminates

DON’T ATTEMPT TO ASPIRATE - REFER

23
Q

Epididymitis

A

Testicular pain

Associated with prostatitis or vasectomy

May see pyuria

Young dudes - STD panel, NSAIDs, scrotal support, ABX for STI’s

Old dudes - same txt - cover gram neg rods

24
Q

Spermatocele

A

Fluid filled mass attached to epididymis

Normally nontender

Can become large

Benign finding

Confirm with US

Surgery

25
Q

Varicocele

A

Bag o’ worms

Normally on the left

Surgery in spermatic vein occluded

26
Q

Testicular CA

A

Masses are CA until proven otherwise

Urgent referral

27
Q

Testicular torsion

A 
Extreme pain
N/V
Sweating
Normally after strenuous activity 
Tenderness in inguinal canal

Workup - urgent US with Doppler and surgical evaluation

If testes viable - re-profuse and perform orchiopexy

If ischemic-necrotic - cut it out

28
Q

Epigastric hernia

A

Linea alba
Usually fat not bowel
No big deal

29
Q

Umbilical hernia

A

Newborns - kids - close on their own

If still there by age 5, fix it

Rarely incarcerates

In adult? Slowly enlarge, may incarcerate - elective surgery (mesh over defect)

30
Q

Incisional hernia

A

Previous op site

Weakening of surgical incision (inside only, outside still intact)

31
Q

Wound dehiscence

A

Yellow-pink (salmon) colored fluid

Peritoneal fluid

Must return to OR to close it ASAP

Acute can lead to evisceration - urgent consult

Delayed (incisional hernia) - routine

32
Q

Diastasis recti

A

Widening of the linea alba

Pregnancy
Obesity
Ascites
Large tumors

Not a hernia

Prominent midline bulge when patient raises head

33
Q

Pain is weakness leaving the body

A

A hernia is intestines leaving the body

Senior - Surgery 2 (9 decks)

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