Chapter 84: Hernias Flashcards
A hernia that is firm, often painful, and nonreducible by direct manual pressure
Incarcerated
A consequence of incarceration and implies impairment of blood flow (arterial, venous, or both)
Strangulation
Seventy-five percent of all hernias occur in the ____, making it the most common form of hernia
Seventy-five percent of all hernias occur in the inguinal region, making it the most common form of hernia
The most common hernias in women
Inguinal hernia
Hesselbach triangle is constructed with
Lateral border of the inferior epigastric arteries, a medial border with the rectus sheath, and an inferior border of the inguinal ligament
Hernia that passes directly through a weakness in the transversalis fascia in the Hesselbach triangle
Direct inguinal hernia
Hernia that passes from the internal to the external inguinal ring through the patent process vagina- lis, and then to the scrotum
Indirect inguinal hernia
Hernia the result of a defect in the anterior abdominal wall and can be either spontaneous or acquired
Ventral hernias
Hernia that account for up to 20% of all abdominal wall hernias. They are often the result of excess wall tension or inadequate wound healing
Incisional hernias
Patient with chronic ascites are at risk for this kind of hernia
Umbilical hernia - strangulation is unusual
True or False
The femoral hernia is particularly prone to complications, such as incarceration and strangulation
True
The femoral hernia is particularly prone to complications, such as incarceration and strangulation
True or False
Femoral hernias are more common in men, with a 10 to 1 male predilection
False
Femoral hernias are more common in women, with a 10 to 1 female predilection
Also known as a lateral ventral hernia, arises at the lateral edge of the rectus muscle and the arcuate (semilunar) line
Spigelian hernia
The classic presentation of spigelian hernia is
The classic presentation is abdominal pain associated with an anterior lateral abdominal wall mass or bulge
The best imaging for diagnosis of hernia
CT scan
The typical patient of this hernia is an elderly frail female with signs and symptoms of intestinal obstruction
Obturator hernia
Sign Calle for a pain in medial portion of the thigh due to obturator nerve compression
Howship-Romberg sign
Involves only the antimesenteric border of the intestine and involves only a portion of the wall circumference
Richter hernia
True or False
Doppler US can detect the arterial flow to the loop of bowel, but is usually not sensitive enough to detect venous flow and cannot detect lymphatic flow. Thus, Doppler US can be insensitive for strangulation
True
Doppler US can detect the arterial flow to the loop of bowel, but is usually not sensitive enough to detect venous flow and cannot detect lymphatic flow. Thus, Doppler US can be insensitive for strangulation
Most useful for diagnosis in children and pregnant women given its lack of ionizing radiation
Ultrasound
Steps for hernia reduction
- NPO status in case reduction attempts are unsuccessful.
- Adequate IV narcotic analgesia.
- Apply cold packs to the hernia site to reduce swelling and make reduction attempts easier.
- Grasp and elongate the hernia neck with one hand, and with the other hand, apply firm, steady pressure to the proximal part of the hernia at the neck at the site of the fascial defect. US can aid in the identification of the fascial defect if it is not clinically obvious. Applying pressure on the most distal part of the hernia can cause bulging (or ballooning) at the hernia neck and prevent reduction.
- Consult surgery if the reduction is unsuccessful after one or two attempts.
