Hernia Flashcards
- What is an external hernia?
Answer: An external hernia is an abnormal protrusion of intraabdominal tissue through a fascial defect in the abdominal wall.
- Where do most hernias occur, and what are the proportions of different types?
Answer: Most hernias (75%) occur in the groin. Incisional hernias account for an increasing proportion (15-20%), while umbilical and other ventral hernias make up the remainder.
- What are the components of a hernial mass?
Answer: A hernial mass is composed of covering tissues (such as skin and subcutaneous tissues), a peritoneal sac, and any contained viscera.
- What happens if the neck of a hernia sac is narrow?
Answer: If the neck of the sac is narrow where it emerges from the abdomen, bowel protruding into the hernia may become obstructed or strangulated.
- Why might operative repair of a hernia become more complicated over time?
Answer: If a hernia is not repaired early, the fascial defect may enlarge, making operative repair more complicated.
- What is the definitive treatment for a hernia?
Answer: The definitive treatment of a hernia is operative repair.
- What is a reducible hernia?
Answer: A reducible hernia is one in which the contents of the sac return to the abdomen spontaneously or with manual pressure when the patient is lying down (recumbent).
- What defines an irreducible or incarcerated hernia?
Answer: An irreducible (incarcerated) hernia is one whose contents cannot be returned to the abdomen, usually because they are trapped by a narrow neck.
- Does incarceration of a hernia always mean obstruction or strangulation?
Answer: No, incarceration does not imply obstruction, inflammation, or ischemia, though it is necessary for obstruction or strangulation to occur.
- What is a strangulated hernia?
Answer: A strangulated hernia occurs when the blood supply to the contents of the sac (e.g., omentum or intestine) is compromised, resulting in gangrene of the contents.
- Which type of groin hernia has a higher incidence of strangulation?
Answer: The incidence of strangulation is higher in femoral hernias than in inguinal hernias, though strangulation can occur in any hernia.
- What is a Richter hernia, and why is it dangerous?
Answer: A Richter hernia occurs when only part of the circumference of the bowel becomes incarcerated or strangulated in the fascial defect. It is dangerous because a strangulated Richter hernia may spontaneously reduce, leaving a gangrenous piece of intestine overlooked during surgery, which could later perforate and cause peritonitis.
- What is the myopectineal orifice of Fruchaud, and why is it significant?
Answer: The myopectineal orifice of Fruchaud is a weakness or defect in the transversalis fascia through which all groin hernias protrude. It is significant because it is the common anatomic pathway for groin hernias.
- What causes an indirect inguinal hernia?
Answer: An indirect inguinal hernia results when the processus vaginalis (a peritoneal extension accompanying the testis during its descent) fails to obliterate, allowing a hernia sac to pass through the internal inguinal ring and potentially into the scrotum.
- What is a complete hernia?
Answer: A complete hernia is an indirect inguinal hernia that passes fully into the scrotum.
- What is the Hesselbach triangle, and how is it related to direct inguinal hernias?
Answer: The Hesselbach triangle is bounded by the inguinal ligament, the inferior epigastric vessels, and the lateral border of the rectus muscle. A weakness or defect in the transversalis fascia forming the floor of this triangle results in a direct inguinal hernia.
- What distinguishes a femoral hernia anatomically?
Answer: A femoral hernia passes beneath the iliopubic tract and inguinal ligament into the upper thigh through the femoral canal, a small empty space between the lacunar ligament and the femoral vein.
- Why are femoral hernias at high risk of incarceration and strangulation?
Answer: Femoral hernias have a high risk of incarceration and strangulation because the borders of the femoral canal are distinct and unyielding, particularly the lacunar ligament, which can act as a tight noose.
