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Surgery > Hernia > Flashcards

Hernia Flashcards

1
Q

definition of hernia?

A

Protrusion of a viscus or part of a viscus through the walls of its containing cavity into an abnormal position.

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2
Q

definition of reducible hernia?

A

Sac can return to the abdominal cavity either spontaneously or w manipulation.

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3
Q

definition of irreducible hernia?

A

Sac cannot be reduced despite pressure or manipulation

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4
Q

definition of strangulated hernia?

A

Blood supply of contents is compromised due to pressure at the neck of the hernia.

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5
Q

Maydl’s hernia?

A

Herniating double loop of bowel. Strangulated portion may reside as a single loop inside the abdomen.

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6
Q

what is Littre’s hernia?

A

any Hernial sac containing strangulated Meckel’s diverticulum.

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7
Q

what is Amyand’s hernia?

A

Inguinal hernia containing strangulated Appendix

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8
Q

what is a pantaloon hernia?

A

type of inguinal (related to the groin) hernia that involves a direct and indirect hernia on the same side of the groin.

(simultaneous direct and indirect hernia)

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9
Q

herniotomy?

A

Excision of hernial sac

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10
Q

what is a herniorrhaphy?

A

Suture repair of hernial defect

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11
Q

what is a hernioplasty?

A

Mesh repair of hernial defect

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12
Q

pathophysiology of congenital hernia?

A

patent processus vaginalis

  • should obliterate following descent of the testes
  • if it stays,, may fill with fluid -> hydrocele or bowel / omentum -> indirect hernia
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13
Q

causes of acquired hernia?

A

things that increase intra abdominal pressure

Chronic cough: COPD, asthma

 Prostatism

 Constipation

 Severe muscular effort: e.g. heavy lifting

 Previous incision/repair

 Ascites / obesity

 Appendicectomy

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14
Q

what is an indirect hernia?

A

80% of hernias: commoner in young

Congenital patent processus vaginalis

Emerge through deep ring

Same 3 coverings as cord and descend into the scrotum

Can strangulate

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15
Q

what is a direct hernia?

A

20%: commoner in elderly

acquired

emerge through hesselbachs triangle

rarely descend into scrotum/ strangulate

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16
Q

ix of hernia if type is uncertain?

A

US

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17
Q

features of hernia in children?

A

lump in groin which may descend into scrotum

exacerbated by crying

commonly obstruct

18
Q

features of hernia in adults?

A

lump in groin, exacerbated by straining / coughing

may be clear precipitating event e.g. heavy lifting

dragging pain radiating to groin

may present w obstruction/ strangulation

19
Q

impt features to ask about hernia?

A

reducible?

episodes of obstruction/ strangulation?

predisposing factors: cough, straining, lifting?

occupation and social circumstances?

20
Q

mx of hernia?

A

non surgical:

reduce risks: cough, constipation

lose weight

truss (hernia support belt)

surgical:

tension free mesh repair

lap if bilateral/ recurrent

open if primary unilateral

children only require sac excision (herniotomy)

21
Q

complications of hernia surgery?

A

Early:

Haematoma / seroma formation: 10%

Intra-abdominal injury (lap)
Infection: 1%
Urinary retention

Late:

Recurrence

ischaemic orchitis

chronic groin pain/ parasthesia

22
Q

definition of femoral hernia?

A

Protrusion of viscus through the femoral canal

23
Q

why are femoral hernias more common in females?

A

Femoral canal larger in females due to shape of pelvis

and changes in its configuration due to childbirth

24
Q

features of femoral hernia?

A

painless groin lump

  • neck inferior and lateral to pubic tubercle
  • cough impulse
  • often irreducible

commonly presents w obstruction/ strangulation

  • tender, red and hot

abdo pain, distension, vomiting, constipation

25
Q

mx of femoral hernia?

A

urgent surgery

50% risk of strangulation within 1 mo

elective: Lockwood approach

Emergency: McEvedy Approach

(high approach in inguinal region to allow inspection and resection of non viable bowel then herniotomy and herniorrhaphy)

26
Q

definition of incisional hernia?

A

hernia arises through a previously acquired defect

27
Q

risk factors of incisional hernia?

A

preop:

increased age, obesity, malnutrition, comorbidities, drugs: steroids, chemo, radio

intra-op:

surgical technique: too small suture bites/ inappropriate suture material

incision type e.g. midline

placing drains through wounds

post-op:

  • increased intra-abdo pressure: chronic cough/ straining, post op ileus

infection

haematoma

28
Q

mx of incisional hernia?

A

surgery not appropriate for all patients

  • must balance risk of operation and recurrence w risk of obstruction/ strangulation

usually broad necked-> low risk of strangulation

conservative:

manage risk factors e.g. constipation, cough

weight loss

elasticated corset or truss

surgical:

preop- optimise cardioresp function

nylon mesh repair: open or lap

29
Q
A

umbilical hernia

  • congenital
  • defect in umbilical scar
30
Q

risk factors of umbilical hernia?

A

afro-caribbean

trisomy 21

congenital hypothyroidism

31
Q

mx of umbilical hernia?

A

usually resolves by 2-3 yrs of age

mesh repair if no closure

may recur in adulthood: pregnancy, gross ascites

32
Q

what does paraumbilical hernia herniate through?

A

defect through linea alba just above or below umbilicus

  • acquired: usually middle aged obese men

small defect -> strangulation (often omentum)

33
Q

risk factors of paraumbilical hernia?

A

chronic cough

straining

34
Q

mx of paraumbilical hernia?

A

May (double breast linea alba w sutures)/ mesh repair

35
Q

what is a spigelian hernia?

A

hernia through linea semilunaris

hernia lies between layers of abdo wall

palpable mass more likely to be colon ca

36
Q

what is an obturator hernia?

A

old aged F>M

sac protrudes through obturator foramen

pain on inner aspect of thigh or knee

frequently present obstructed/ strangulated

37
Q

what is a lumbar hernia?

A

middle aged M> F

typically follow loin incisions

herniates through superior/ inferior lumbar triangles

38
Q

what is a sciatic hernia?

A

hernia through lesser sciatic foramen

usually presents as SBO + gluteal mass

39
Q

what is a gluteal hernia?

A

hernia through greater sciatic forament

usually presents as SBO+ gluteal mass

40
Q

inguinal vs femoral hernias?

A

Surgery (17 decks)

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