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General Surgery > Hernia > Flashcards

Hernia Flashcards

1
Q

What is a hernia?

A

Protusion of a viscus into an abnormal space

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2
Q

What are the most common types of abdominal hernia?

A

Inguinal
Femoral
Incisional
Hiatus

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3
Q

What is an inguinal hernia?

A

Abdominal cavity contents enter into the inguinal canal

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4
Q

Difference between direct and indirect inguinal hernias

A

Direct

  • bowel enters inguinal canal through weakness in posterior abdominal wall
  • enters through Hesselbach’s triangle
  • medial to inferior epigastric vessels

Indirect

  • bowel enters inguinal canal bia deep inguinal ring
  • lateral to inferior epigastric vessels
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5
Q

What are the borders of the inguinal canal?

A

Anterior wall - aponeurosis of the external oblique

Posterior wall - transversalis fascia

Roof - transversalis fascia, internal oblique, transverus abdominis

Floor - inguinal ligament

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6
Q

What are the borders of Hesselbach’s triangle?

A

Medial - lateral border of rectus abdominis

Lateral - inferior epigastric vessels

Inferior - inguinal ligament

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7
Q

Risk factors of inguinal hernias

A

Male
Increasing age
Raised intra-abdominal pressure
Obesity

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8
Q

Clinical features of inguinal hernia

A

Lump in groin

  • cough impulse
  • reducible
  • superomedial to pubic tubercle
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9
Q

Differentiate clinically between direct and indirect inguinal hernias

A

Locate deep inguinal ring
Reduce hernia
Apply pressure over deep inguinal ring
Ask patient to cough

Reappears = direct

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10
Q

Management of inguinal hernias

A

Symptomatic hernia

  • surgical intervention
  • open/laparoscopic repair
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11
Q

Complications of inguinal hernias

A

Incarceration
Strangulation
Obstruction

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12
Q

What is a femoral hernia?

A

Abdominal contents passes through femoral ring and into femoral canal

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13
Q

What are the borders of the femoral canal?

A

Medial - lacunar ligament

Lateral - femoral vein

Anterior - inguinal ligament

Posterior - pectineal ligament, superior ramus of pubis, pectineus muscle

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14
Q

Risk factors for femoral hernias

A

Female
Pregnancy
Raised intra-abdominal pressure
Increasing age

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15
Q

Clinical features of femoral hernias

A

Small lump in the groin

  • inferolateral to pubic tubercle
  • usually irreducible
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16
Q

Investigations for suspected femoral hernia

A

Surgical intervention

Ultrasound

17
Q

Management of femoral hernia

A

Managed surgically due to high risk of strangulation

18
Q

What is an incicsional hernia?

A

Protusion of the contents of a cavity through a previously made incision in the compartments wall

19
Q

Causes of incisional hernias

A

Weakness in wall due to incision

Raised intra-abdominal pressure, contents are forced through the weakness

20
Q

Risk factors of incisional hernia

A

Emergency surgery
Wound type
Obesity
Wound infection

21
Q

Clinical features of incisional hernias

A

Non-pulsatile, soft, reducible and non-tender swelling at the site of a previous surgical wound

22
Q

Investigations for a suspected incisional hernia

A

Diagnosis made on a clinical basis

23
Q

Management of incisional hernias

A

Managed conservatively if asymptomatic

Repaired surgically if indicated

24
Q

What is a hiatus hernia?

A

Protrusion of an organ from the abdominal cavity into the thorax through the oesophageal hiatus

25
Q

What are the classifications of hiatus hernias?

A

Sliding hiatus hernia (80%)
- gastro-oesophageal junction, abdominal oesphagus and cardia of the stomach moves up through diaphragmatic hiatus

Rolling/para-oesophageal hernia (20%)

  • upwards movement of gastric fundus
  • lies alongside normally position GOJ
  • creates a ‘bubble’ of stomach in thorax
26
Q

Risk factors of hiatus hernia

A

Age
Pregnancy
Obesity
Ascites

27
Q

Clinical features of hiatus hernias

A

Majority = asymptomatic

Gastroesophageal reflux symptoms - made worse by lying flat
Hiccups

28
Q

Investigations for suspected hiatus hernia

A

OGD - shows upwards displacement of GOJ

29
Q

Management of hiatus hernias

A

Conservative

  • PPIs
  • weight loss
  • smoking cessation

Surgical (indicated if remains symptomatic or nutrional failure)
- Cruroplasty (hernia reduced)

General Surgery (15 decks)

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