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Y4 - Surgery - General > Hernia (Inguinal and Incisional) > Flashcards

Hernia (Inguinal and Incisional) Flashcards

1
Q

ESSENCE

A

Weakness in body allows an organ (eg bowel) to pass through cavity wall

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2
Q

CLINICAL FEATURES

Typical features of abdominal wall hernias

A
  • Presentation varies depending on kind of hernia, but typical features
    • Soft lump protruding from abdominal wall
    • May be reducible (can be pushed back in)
    • May protrude on coughing
    • Aching, pulling or dragging sensation
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3
Q

COMPLICATIONS

3 key complications

A
  • Incarceration
  • Obstruction
  • Strangulation
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4
Q

What is key for risk of complication

A

Size of hernia neck, larger means less likelyhood for complication, always check neck on examination

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5
Q

What is incarceration

A

Hernia cannot be reduced back into proper position, can lead to obstruction and strangulation of hernia

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6
Q

What is strangulation

A

Hernia is non-reducible and the base is so tight that it cuts of blood suuply causing ischaemia

Surgical emergency

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7
Q

What are some examples of hernia

A
  • Richter’s hernia
  • Maydl’s hernia
  • Inguinal hernia
  • Femoral hernia
  • Incisional hernia
  • Umbilical hernia
  • Epigastric hernia
  • Spigelian hernia
  • Diastasis recti
  • Obturator hernia
  • Hiatus hernia
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8
Q

What is Richters hernia

A
  • Very specific situation that can occur in any abdominal hernia
  • Part of bowel wall and lumen herniate through defect with other side still in peritoneal cavity
  • Can become strangulated easily
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9
Q

What is Maydl’s hernia

A

Specific situation where 2 different loops of bowel are contained within hernia

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10
Q

MANAGEMENT

General options

A
  • Conservative management
  • Tension-free repair (surgery)
  • Tension repair (surgery)
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11
Q

MANAGEMENT

Conservative

A
  • Leaving hernia alone, most appropriate with wide neck hernia
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12
Q

MANAGEMENT

Tension-free repair

A
  • Mesh over defect in abdominal wall and sutured to muscles and tissues on either side of defect
  • Overtime tissues grow into mesh and provide additional support
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13
Q

MANAGEMENT

Tension repair

A
  • Surgical operation to suture muscles and tissues on either side of defect back together
  • Rarely performed, tension-free repair usually done
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14
Q

2 types of inguinal hernia

A
  • Indirect inguinal hernia
  • Direct inguinal hernia
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15
Q

What is indirect inguinal hernia

A

Bowel herniates through inguinal canal

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16
Q

ANATOMY

What is inguinal canal

A
  • Tube that runs between deep inguinal ring and superficial inguinal ring
  • In males allows spermatic cord and contents to travel from peritoneal caivity into scrotum
  • In females round ligament travels through which attaches to uterus, through canal to labia majora
17
Q

ANATOMY

Embryology of inguinal canal

A
  • Processus vaginalis is a pouch of peritoneum that extends from abdominal cavity through inguinal canal
  • Allows testes to descend from abdominal cavity into scrotum
  • Normally deep inguinal ring closes and processus vaginalis obliterated
  • Sometimes remains intract and can allow bowel to travel through in life causing indirect inguinal hernia
18
Q

Findings to differentiate indirect inguinal hernia from direct

A
  • When indirect hernia reduced and pressure applied with 2 fingertips at deep inguinal ring (halfway point from ASIS to pubic tubercle) the hernia will remain reduced
19
Q

What is direct inguinal hernia

A
  • Occur due to weakness in abdominal wall at Hasselbachs triangle (not along tract like indirect inguinal hernia)
  • Pressure over deep inguinal ring will not stop the herniation
20
Q

Boundaries of Hesselbachs triangle

A
  • Remember RIP
    • Rectus abdominal muscle - medial border
    • Inferior epigastric vessels - superior/lateral border
    • Pouparts ligament (inguinal ligament) - inferior border
21
Q

What is femoral hernia

A
  • Herniation of abdominal contents through femoral canal, occurs below inguinal ligament at top of thigh
22
Q

Risk of complications with femoral hernia

A

High due to femoral ring leaving narrow opening for femoral hernias

23
Q

Boundaries of femoral canal

A
  • Remember FLIP
    • Femoral vein - lateral
    • Lacunar ligament - medial
    • Inguinal ligament - anterior
    • Pectineal ligament - posterior
24
Q

Difference between femoral triangle and femoral ring

A

Femoral triangle is area at top of thigh that contains the femoral canal

25
Q

Boundaries of femoral triangle

A
  • Remember SAIL
    • Sartorius - lateral
    • Adductor longus - medial
    • Inguinal Ligament - superior
26
Q

Contents of femoral triangle

A
  • Remember NAVY-C for contents from lateral to medial across top of thigh
    • femoral Nerve
    • femoral Artery
    • femoral Vein
    • Y-fronts
    • femoral Canal (containing lymphatic vessels and nodes)
27
Q

What is incisional hernia

A
  • Occur at site of incision from previous surgery
  • Difficult to repair with high rates recurrence
  • Often left if are large due to wide neck and low complications
28
Q

What is umbilical hernia

A
  • Occurs around umbilicus due to defect in the muscle around imbilicus
  • Can resolve spontaneously in neonates
29
Q

What is epigastric hernia

A
  • Hernia in epigastric area (upper abdomen)
30
Q

What is Spigelian hernia

A
  • Occurs between lateral border of rectus abdominis muscle and the linea semilunaris
  • This is the site of the spigelian fascia (aponeurosis)
31
Q

What is Diastasis recti

A
  • Widening of linea alba, the connective tissue that seperates rectus abdominis muscle
  • Is not technically a hernia
32
Q

What is obturator hernia

A
  • Abdominal or pelvic contents herniates through obturator foramen at bottom pelvis
  • More common in woman, particularly older age after pregnancies
33
Q

Presentation of obturator hernia

A
  • Often asymptomatic
  • Irritation to obturator nerve causing pain in groin or medial thigh
  • Howship-Romberg sign (pain extending from inner thigh to knee when hip internally rotated due to compression of obturator nerve)
34
Q

What is hiatus hernia

A
  • Herniation of stomach up through diaphragm
35
Q

4 types of hiatus hernia

A
  • 1 - sliding
  • 2 - rolling
  • 3 - combination of sliding and rolling
  • 4 - large opening with additional abdominal organs entering thorax
36
Q

Hiatus hernia presentation

A
  • Dyspepsia (indigestion)
    • Heartburn
    • Acid reflux
    • Reflux of food
    • Burping
    • Bloating
    • Halitosis (bad breath)
37
Q

Hiatus hernia investigations

A
  • Imaging, can be seen on
    • Chest x-ray
    • CT scans
    • Endoscopy
    • Barium swallow testing
38
Q

Hiatus hernia treatment

A
  • Conservative (with medical management of GORD)
  • Surgical repair (if high risk complications or symptoms resistant to medical treatment
    • Laparoscopic fundoplication

Y4 - Surgery - General (43 decks)

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