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General Surgery > Hernia > Flashcards

Hernia Flashcards

1
Q

Hernia is the commonest condition encountered in surgical practice, T/F?

A

True

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2
Q

Hernia may account for up to 75% of cases of intestinal obstruction in developing countries, T/F?/

A

True

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3
Q

All hernia protrudes through the abdominal wall, T/F?

A

False.

Only External hernia.

Internal hernia do not.

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4
Q

Mention the 10 types of hernia you should know (excluding diaphragmatic hernia)

A
  1. Inguinal
  2. Femoral
  3. Umbilical
  4. Paraumbilical
  5. Epigastric
  6. Incisional
  7. Spigelian (lines semilunaris)
  8. Lumbar
  9. Obturator
  10. Sciatic
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5
Q

What are the 2 main factors in the causation of a hernia?

A
  1. A defect or weakness in the wall of the abdominal cavity (predisposes)
  2. Repeated increase intra-abdominal pressure (precipitates)
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6
Q

A gridiron incision can be complicated by an inguinal herb is, T/F?

A

True.

If there is an injury to the nerve of the muscle during a gridiron incision

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7
Q

All hernia has a sac, T/F?

A

False.
All except in some cases of incisional and epigastric hernia

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8
Q

List the possible content of a hernial sac

A
  1. Usually Omentum, small intestine, parts of the colon
  2. Appendix
  3. Occasionally uterine adnexa and part of the bladder
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9
Q

If the content of a hernia does not return completely to the abdominal cavity, it is called _____ hernia

A

Irreducible hernia

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10
Q

A hernia in which the viscus forms part of the sac is called

A

Sliding hernia

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11
Q

Causes of irreducible hernia

(Hint: 3)

A
  1. Adhesion (b/w the sac and the content )
  2. Content distension to form a mass too bulky to return
  3. Sliding hernia
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12
Q

The strangulation of a part of the circumference of the wall of the bowel is called _____ type of strangulation

A

Richter type of strangulation

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13
Q

Complications of hernia

(Hint: 4)

A
  1. Irreducibility
  2. Strangulation
  3. Fistula formation
  4. Rupture of hernial sac
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14
Q

Content of the inguinal canal canal in male

A

A spermatic cord with testicular vessels, ilioinguinal nerve, and the genital branch of the genito-femoral nerve

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15
Q

Embryologically, the inguinal canal is formed by the passage of _______

A

Gubernaculum testis and Processus vaginalis

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16
Q

The length of the inguinal canal in adult

A

About 4cm

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17
Q

The opening of the internal inguinal ring is directed upwards and inwards? T/F?

A

False.

Upwards and outwards

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18
Q

Describe the natural mechanism that occurs during an increase in intra-abdominal pressure to close the internal inguinal ring and prevent peritoneal herniation

A

Via the lateral and upward contraction of the transverse, which pulls the attached internal ring upwards and outwards behind the transverse, thus, closing the ring around the cord

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19
Q

In the repair of an indirect inguinal hernia, narrowing and tightening of the internal ring are not important, T/F?

A

False.
It is important, b/c without narrowing & tightening, it becomes a weak site and recurrence is then high

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20
Q

Location of the internal inguinal ring

A

Lies about 1.25cm above and perpendicular to the mid-inguinal point

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21
Q

The external inguinal ring, situated above and lateral to the public tubercle, is an opening in the ______

A

External oblique aponeurosis

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22
Q

The anterior wall of the inguinal canal is formed by

A

External oblique aponeurosis and additionally in the lateral part by the muscular fibers of the internal oblique

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23
Q

The posterior wall of the inguinal canal is formed by

A

The transversalis fascia, reinforced superficially by the aponeurotic fibers from the transverse abdominis and buttressed in the medial half by the conjoint tendon

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24
Q

Boundaries of Hesselbach’s triangle

A

Laterally: Inferior epigastric artery
Medially: lateral border of the rectus sheath
Inferior my: inguinal ligament

25
Q

The Hesselbach’s triangle is part of the posterior surface of the inguinal canal. Why is it a weak area?

A

B/c the transversalis fascia here is not supported by the conjoint tendon and aponeurotic fibers of the transversus abdominis, unlike the other parts of the posterior wall

26
Q

Direct inguinal hernia is via ______

A

Hesselbach’s triangle

27
Q

The floor of the inguinal canal is formed by ____

A

Inguinal ligament

28
Q

The roof of the inguinal canal is formed by _______

A

The arched lowest muscular fibers of the internal oblique

29
Q

Boundaries of the Femoral triangle:
Superiorly-
Medially-
Laterally-
Floor-
Anterior wall (roof)-

A

Superiorly: Inguinal ligament
Medially: Adductor longus
Laterally: Sartorius
Floor: Iliopsoas (lateral) and Pectineus (medial)
Anterior wall: Skin, superficial fascia, deep fascia (fascia lata)

30
Q

Which muscle separates the content of the femoral triangle from the hip joint and obturator foramen

A

Pectineus

31
Q

Mention the contents of the femoral triangle from medial to lateral: + something else

(Hint: 4 + 1)

A

Femoral canal, femoral vein, femoral artery, femoral nerve. + Lymph nodes

32
Q

Content of the femoral canal

(Hint: 2)

A

Lymph node (node of Cloquet)
Fat

33
Q

The width of the femoral ring depends on _____

A

The extent of the insertion of the conjoint tendon to the pectineal line

34
Q

Boundaries of the Femoral ring:
Anterior:
Posterior:
Lateral:
Medial:

A

Anterior: inguinal ligament
Posteriorly: pubic bone & the fascia covering the pectineus( forming the pectineal ligament)
Laterally: Femoral vein
Medially: Fascia from iliopubic tract and lacunar ligament

35
Q

The femoral ring is a weak area in the abdominal wall, T/F?

A

True

36
Q

The testes descend into the scrotum in what month inutero?

A

9th Month

37
Q

The testis begins descending from the iliac fossa into the inguinal canal in which month, inutero?

A

7th Month

38
Q

The right testis usually descends earlier than the left, T/F?

A

False.
The right testis usually descends later than the left

39
Q

Which of the testis accounts for the higher incidence of abnormalities?

A

Right.
B/c of its later discernment into the scrotum

40
Q

What part of the processus vaginalis normally becomes obliterated at or soon after birth?

A

The part in the inguinal canal.

41
Q

Tunica vaginalis is derived from ____

A

The part of the processus vaginalis in the scrotum that remains patent

42
Q

Obliteration of the processus vaginalis ceases at ____ age

A

At 2years of age.

43
Q

The failure of obliteration of the processus vaginalis may lead to

Hint: 4

A
  1. Indirect inguinal hernia
  2. Infantile hydrocele of the cord
  3. Congenital hydrocele or Complete indirect inguinal hernia
  4. Encysted hydrocele of the cord
44
Q

The commonest hernia in both sexes is

A

Inguinal hernia

45
Q

The incidence of direct inguinal hernia increases with age, T/F?

A

True

46
Q

The indirect inguinal hernia occurs in age groups but especially from age ____ to ____

A

20yrs - 49yrs

47
Q

The direct inguinal hernia is usually seen after ___yrs of age

A

30yrs

48
Q

The main symptoms of inguinal hernia are ____ & _____

A

Swelling and Pain

49
Q

Severe pain in the swelling associated with abdominal pain indicates strangulation, T/F?

A

True

50
Q

The neck of the sac is below the inguinal ligament, T/F?

A

False.

It’s above

51
Q

An inguinal hernia that enters the scrotum or labium majus is called ____

A

Complete inguinal hernia

52
Q

A hernia limited to the inguinal canal is referred to as _____ OR ______

A

Incomplete inguinal hernia OR bubonocele

53
Q

An inguinal hernia that is out of the external inguinal ring and lies just above the pubic tubercle is called as

A

Funicular hernia

54
Q

A complete inguinal hernia is nearly always direct in type, T/F?

A

False.

Nearly always Indirect in type

55
Q

Very rarely does a direct hernia enter the scrotum, T/F?

A

True.

56
Q

The coexistence of an indirect and a direct inguinal hernia is called ____

A

Pantaloon hernia

57
Q

Spigelian hernia is also called ___

A

Lateral Ventral Hernia

58
Q

Describe the Spigelian zone

A

General Surgery (2 decks)

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