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Surgery Rotation > EOR GI part 2: hernias > Flashcards

EOR GI part 2: hernias Flashcards

1
Q

What is a hernia?

A

Protrusion of a peritoneal sac through a musculoaponeurotic barrier; a fascial defect

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2
Q

What are the precipitating factors of a hernia?

A 
Increased intra-abdominal pressure
Straining at defecation or urination
Obesity
Pregnancy
Ascites
Valsalvagenic (cough) COPD
An abnormal congenital anatomic route
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3
Q

Why should hernias be repaired?

A

To avoid complications of incarceration/strangulation, bowel necrosis, SBO, pain

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4
Q

What is more dangerous: a small or large hernia defect?

A

Small defect is more dangerous because a tight defect is more likely to strangulate if incarcerated

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5
Q

Reducible hernia

A

Ability to return the displaced organ or tissue/hernia contents to their usual anatomic site

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6
Q

Incarcerated hernia

A

Swollen or fixed within the hernia sac

May cause intestinal obstruction

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7
Q

Strangulated hernia

A

Incarcerated hernia with resulting ischemia

Will result in signs and sx of ischemia and intestinal obstruction or bowel necrosis

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8
Q

Complete hernia

A

Hernia sac and its contents protrude all the way through the defect

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9
Q

Incomplete hernia

A

Defect present without sac or contents protruding completely through it

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10
Q

What is reducing a hernia en masse?

A

Reducing the hernia contents and hernia sac

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11
Q

Incisional hernia

A

Hernia through an incisional site

MCC is a wound infection

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12
Q

Femoral hernia

A

Hernia medial to femoral vessels (under inguinal ligament)

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13
Q

Indirect inguinal hernia

A

Inguinal hernia lateral to Hesselbach’s triangle

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14
Q

Direct inguinal hernia

A

Inguinal hernia within Hesselbach’s triangle

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15
Q

Hiatal hernia

A

Hernia through esophageal hiatus

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16
Q

What are the boundaries of Hesselbach’s triangle?

A
  1. Inferior epigastric vessels (lateral border)
  2. Inguinal ligament (base)
  3. Lateral border of the rectus sheath (medial border)
    Floor consists of internal oblique and the transversus abdominis muscle
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17
Q

What are the layers of the abdominal wall?

A 
Skin
Subcutaneous fat
Scarpa's fascia
External oblique
Internal oblique
Transversus abdominus
Transversalis fascia
Preperitoneal fat
Peritoneum
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18
Q

What is the DDx for a mass in a healed C-section incision?

A

Hernia

Endometrioma

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19
Q

What is the DDx of a groin mass?

A 
LAD
Hematoma
Seroma
Abscess
Hydrocele
Femoral artery aneurysm
EIC
Undescended testicle
Sarcoma
Hernias
Testicular torsion
20
Q

What is the cause of a direct hernia?

A

Acquired defect from mechanical breakdown over the yrs

21
Q

What nerve runs with the spermatic cord in the inguinal canal?

A

Ilioinguinal nerve

22
Q

What is the cause of an indirect hernia?

A

Patent processus vaginalis

23
Q

How is an inguinal hernia diagnosed?

A

Relies mainly on hx and PE with index finger invaginated into the external ring and palpation of hernia
Examine the pt standing up if dx is not obvious

24
Q

DDx of inguinal hernia

A 
LAD
Psoas abcess
Ectopic testis
Hydrocele of the cord
Saphenous varix
Lipoma
Varicocele
Testicular torsion
Femoral artery aneurysm
Abscess
25
Q

What is the risk of strangulation with inguinal hernias?

A

Higher with indirect than direct inguinal hernia, but highest in femoral hernias

26
Q

Tx for inguinal hernia

A

Emergent herniorrhaphy is indicated if strangulation is suspected or acute incarceration is present
Otherwise, elective herniorrhpahy is indicated to prevent the chance of incarceration/strangulation

27
Q

Bassini procedure

A

Sutures approximate reflection of inguinal ligament to the transversus abdominis aponeurosis/conjoint tendon

28
Q

McVay procedure

A

Cooper’s ligament sutured to transversus abdominis poneurosis/conjoint tendon

29
Q

Lichtenstein procedure

A

Tension free repair using mesh

30
Q

Plug and patch repair

A

Placing a plug of mesh in hernia defect and then overlaying a patch of mesh over inguinal floor

31
Q

High ligation procedure

A

Ligation and transection of indirect hernia sac without repair of inguinal floor (used only in children)

32
Q

TAPP procedure

A

TransAbdominal PrePeritoneal inguinal hernia repair

33
Q

TEPA procedure

A

Totally ExtraPeritoneal Approach

34
Q

What are the indications for a laparoscopic inguinal hernia repair?

A

Bilateral inguinal hernias
Recurring hernia
Need to resume full activity ASAP

35
Q

What are the boundaries of the femoral canal?

A

Cooper’s ligament posteriorly
Inguinal ligament anteriorly
Femoral vein laterally
Lacunar ligament medially

36
Q

What factors are associated with femoral hernias?

A

Women
Pregnancy
Exertion

37
Q

What are the complications of femoral hernias?

A

Approximately one third incarcerate (d/t narrow unforgiving neck)

38
Q

What is the repair of a femoral hernia?

A

McVay (Cooper’s ligament repair)

Mesh plug repair

39
Q

Sliding esophageal hiatal hernia definition

A

Both the stomach and GE junction herniate into the thorax via the esophageal hiatus
AKA type I hiatal hernia

40
Q

What is the incidence of type I hiatal hernias?

A

> 90% of all hiatal hernias

41
Q

What are the sx of a type I hiatal hernia?

A

Most pts are asymptomatic, but the condition can cause reflux, dysphagia (from inflammatory edema), esophagitis, and pulmonary problems secondary to aspiration

42
Q

How is a type I hiatal hernia diagnosed?

A

UGI series
Manometry
EGD with bx for esophagitis

43
Q

What is the tx for type I hiatal hernia?

A

85% of cases treated medically with antacids, H2 blockers/PPIs, head elevation after meals, small meals, and no food prior to sleeping
15% of cases require surgery for persistent sx despite adequate medical tx

44
Q

What is the surgical tx for type I hiatal hernia?

A

Laparoscopic Nissen fundoplication (LAP NISSEN) involves wrapping the fundus around the LES and suturing it in place

45
Q

What is a type II hiatal hernia?

A

Herniation of all or part of the stomach through the esophageal hiatus into the thorax without displacement of the GE junction; aka paraesophageal hiatal hernia

46
Q

What are the complications of a type II hiatal hernia?

A

Hemorrhage
Incarceration
Obstruction
Strangulation

47
Q

What is the tx for type II hiatal hernia?

A

Surgical, because of frequency and severity of potential complications

Surgery Rotation (19 decks)

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