Hernia Flashcards
1
Q
What is a hernia and what is the most common site?
A
- Abnormal protrusion or organ or tissue through defect in surrounding walls
- Most common - abdominal wall hernia
2
Q
How can hernias be described?
A
- External
- Interparietal
- Internal
- Reducible
- Non-reducible (aka incarcerated)
- Strangulated
3
Q
What are some types of abdominal wall hernias?
A
- Richter’s hernia
- Littre’s hernia
- Pantaloon
- Sliding
- Amyand
- Maydl (W)
4
Q
Give some examples of locations where hernias can form.
A
- Groin
- Umbilicus
- Linea alba (epigastric)
- Surgical incisions
- Semi-lunar line
- Diaphragm
- Lumbar triangles
- Pelvis
5
Q
Compare and contrast direct and indirect inguinal hernias.
A
- INDIRECT - more common in younger people. DIRECT - more common in old age
- INDIRECT - can descend into scrotum. DIRECT - cannot
- INDIRECT - linked to lateral to inferior epigastric vessels. DIRECT - linked to medial to inferior
- INDIRECT - passes through inguinal canal. DIRECT - bulge from posterior wall of canal
5
Q
What are the 3 types of groin hernias?
A
INDIRECT INGUINAL
DIRECT INGUINAL
FEMORAL
6
Q
Describe femoral hernias.
A
- Inferior to inguinal ligament
- Greater incidence in women than men
- Cloquet’s node
- Usually on medial aspect of femoral sheath
7
Q
How can groin hernias be diagnosed?
A
- Groin swelling that resolves with supine position
- Precipitating factors: Increased intra-abdominal pressure, defects in collagen synthesis, smoking
- Examine erect and supine
- Does not transilluminate
8
Q
What are some differential diagnosis for groin hernia?
A
- Hydrocele
- Varicocele
- Torsion of testis
- Undescended testis
- Ectopic testis
- Testicular tumor
- Femoral artery aneurysm
- Lymphadenopathy
9
Q
How can groin hernias be treated?
A
- Surgical repair with or without mesh
- Approaches can be open, laparoscopic, robotic (TEP and TAPP)
10
Q
What are some complications of groin hernias?
A
- Recurrence
- Neuralgia - Ilioinguinal, iliohypogastric, genitofemoral, lateral cutaneous
- Injury to vas deferens
- Wound infection
- Bleeding
11
Q
Describe umbilical hernias.
A
- Greater incidence in women than men
- Risk factors are obesity and pregnancy
- May rupture with ascites
- Can be repaired e.g with mesh
- Common in infants
- Close spontaneously if <1.5 cm
- Repair if > 2 cm or if persists at age 3-4 years
12
Q
A
12
Q
Define epigastric hernia.
A
- Incidence 1-5%
- Greater incidence in men than women
- Pre-peritoneal fat protrusion through decussating fibers at linea alba
- Between xiphoid and umbilicus
- Repair primarily
13
Q
Describe incisional hernia.
A
- Risk factors - wound infections, smoking, hypoxia/ischemia, tension, obesity and malnutrition
- Repaired both open or laparoscopically
14
Q
Describe parastomal hernia.
A
- Variant of incisional hernia
- Low rate if through rectus muscle
- Traditionally relocate stoma, repair defect
- Concern for mesh erosion
- Laparoscopic repair
15
Q
Describe spigelian hernia.
A
- Rare
- Hernia through subumbilical portion of semi-lunar line
- Difficult to diagnose - Clinical suspicion (location) and CT scan
- Repair primarily or usually with mesh
16
Q
Describe areas that lumbar hernia can affect.
A
- Grynfeltt’s triangle - 12th rib, internal oblique and sacrospinalis muscle - Covered by latissimus dorsi
- Petit’s triangle - Latissimus dorsi, external oblique and iliac crest - Covered by superficial fascia
17
Q
What are the types of pelvic hernia?
A
- Obturator hernia - Most commonly in women
- Sciatic hernia
- Perineal hernia
