General Surgery - Hernias, Bariatric Surgery + Stomas Flashcards
what is a hernia?
abnormal protrusion of an organ/fatty tissue through a weakness in its containing wall
what 3 bad things can happen to hernias?
incarcerated
obstructed
strangulated
difference between direct and indirect inguinal hernias?
direct - medial to inferior epigastric artery
indirect - lateral to inferior epigastric artery
where are inguinal hernias related to the pubic tubercle?
superior and medial
which type of hernia is at higher risk of strangulation? why?
indirect
narrow neck
where are femoral hernias in relation to the pubic tubercle? femoral pulse?
inferior and lateral
medial to femoral pulse
what are femoral hernias at high risk of? why?
strangulation
bony structures nearby
what types of ventral hernias exist? what are these?
umbilical
paraumbilical
epigastric
bulge through muscles of the abdomen
what types of congenital hernias exits?
inguinal due to persistant process vaginalis
umbilical
features of an incarcerated hernia?
irreducible
features of an obstructed hernia?
distended
constipated
colicky
features of a strangulated hernia?
tense
tender
irreducible
how can examination help distinguish hernia type?
femoral - upper thigh
occlusion of internal ring controls indirect
Tx for an inguinal hernia?
patient choice
mesh repair
Tx for a femoral hernia?
always repair
Tx for ventral hernias?
only if symptomatic or high risk of strangulation
hernia repair complications?
infection
reoccurance
bleeding
chronic groin pain
what is the criteria for bariatric surgery?
BMI >35 with co morbidities that would improve with weight loss
trying to lose for >6months
what gastric surgery is slower with less weight loss?
gastric band
what gastric surgery is better with more weight loss?
roux en Y
what happens in a roux en Y bypass?
jejunum attached to stomach pouch
contents bypass straight through this
duodenum attaches to jejunum
complications of a gastric band?
pouch enlargement
erosion
band slip
vomiting
complications of a roux en Y?
vitamin deficiencies hernias dumping syndrome stricture cholelithiasis
what is dumping syndrome?
fainting and sweating after eating food with high osmotic potential
what type of stoma is commonly on the RHS?
ileostomy
what type of stoma is commonly on the LHS?
colostomy
what are ileostomies and colostomies made form?
ileo - mid to distal small bowel
colostomy - large. bowel
what are jejunostomies often used for?
feeding
have tube access
what are urostomies made from?
ileum with the ureters within
what is ileostomy output like?
thick green/brown porridge
what is colostomy output like?
similar to faeces
how does stoma output vary?
more proximal the more liquid output
