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GI Pathology > Hernia Management > Flashcards

Hernia Management Flashcards

1
Q

What is a hernia?

A

Anytime fatty tissue pushes through the abdominal wall

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2
Q

Waht are the possible complications of Hernias?

A

Progression to bowel or small/med organ herniation, ischemia, necrosis, death, etc

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3
Q

Who is more likely to develop a hernia?

A

Males are more succeptible to hernias due to their anatomy.

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4
Q

What are the layers of the inguinal canal?

A

Transversallis Fascia-floor
Transverse Abdominis-floor
Internal Oblique-floor
External Oblique-shelving edge

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5
Q

What is a Direct inguinal Hernia?

A

Passes through the weakess of Hasselbach’s triangle
(Rectus abdominis, med to inferior epigastric vessels
Superior to inguinal ligament)
Med to inferior epigastrics
lies within inguinal canal
adjacent to spermatic cord

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6
Q

What is a Femoral Hernia?

A 
Passes through femoral space
(inguinal ligament above, cooper's lig below, lacunar lig, fem vessels laterally)
Passes through the femoral space 
below the inguinal ligament
maintain index of suspicion
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7
Q

Different types of Inguinal Hernia Repair?

A

Bassini
Shouldice
McVay
Don’t use prosthetic reinforcement!

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8
Q

Why would we do a tissue repair?

A

No mesh available

Infected field and risk of infection

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9
Q

What is the Lichtenstein Mesh Repair

A 
Mesh reconstruction of inguinal floor
Tension free
Lowest incidence of recurrence
Risk of prosthetic mesh infection
(Standard hernia repair)
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10
Q

What is the Pre-Peritoneal Mesh Repair?

A

Mechanically more sound repair
Eliminates need to reconstruct internal ring
Theoretically more durable
Open vs laparoscopic

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11
Q

Pro/Cons of Labparoscopic repair?

A

Low pain
Low infection and hematoma
Rapid recovery

Comparable recovery vs open mesh

Technically difficult
Longer operation
Higher Hospital cost

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12
Q

What is the TransAbdominal Preperitoneal Lap. Ing. Hernia Repair

A 
Lap Entry
Incision of Peritoneum
Dissection of Pre-Peritoneal space
Placement of mesh
Closure of peritoneal flap
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13
Q

What is the total Extraperitoneal Preperitoneal Lap. Ing. Hernia Repair

A

Entry into rectus sheath
Dissection of pre-peritoneal space
Placement of mesh
Avoid Peritoneal entry/injury

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14
Q

What are the indications for Laparoscopic Repair?

A

Bilateral Ing. Hernia
Comorbid UImbilical Hernia
Earlier Return to work

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15
Q

When is watchful waitign a satisfactory alternative to surgery?

A

Pt is unfit for surgery

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16
Q

What are the different Abdominal Hernia Types?

A

Umbilical, Incisional, Epigastric, Spigelian

17
Q

What is an umbilical hernia?

A 
Occurs at the umbilical stalk, 
Congenital in infants (regress)
Acquired in Adults (Progress and enlarge)
Primary repair if 1-2cm
Mesh reinforcement for    1-2+cm defects
18
Q

What is an Inciisional hernia?

A

Failure of Fascia Healing

20-30% incidence in laparotomy incision

19
Q

Risk factors for incisional hernia?

A 
Wound infection
Lifting and straining
Obesity
Age
Male
Sleep apnea
Emphysema
20
Q

What is an eigastric hernia?

A

Occur between umbilicus and rib cage
Small but painful
Difficult to ID when asleep
Repaired to alleviate pain

21
Q

What is an Spigelian hernia?

A

Vascular perforations of inferior semilunar line

22
Q

What are ways of repairing abdominal wall hernias?

A

Primary Repair
Mesh Reinforced repair
Component Separation

23
Q

What is primary repair of abdominal wall hernias?

A 
Suture repair of defect
Re-approximated transeversely
Small defects 
Ok with contaminated fields
high recurrence
24
Q

What is mesh reinforced repair of abdominal wall hernias?

A

Contra-indicated in infected fields.
lower recurrence rate
variety of types of mesh available
Need explanation for infection

25
Q

What is the most robust, gold standard placement of mesh?

A

Retrorectus (dissect into back of muscle belly)

26
Q

What is the most common mesh placement in laparoscopic techniques?

A

Underlay

27
Q

What is the clinical presentation of hernias?

A

Palpate + Valsalva
Can you reduce it?
Note prior incisions
Can present with bowel obstruction.

28
Q

What is the difference between Reducible and Incarcerated hernias?

A

Reducible can be returned to the abdominal cavity

Incarcerated hernias cannot be returned.

29
Q

What are signs of a Strangulated hernia?

A

Compromised blood flow
tissue death
Redness, Warmth, etc

30
Q

What is the Bassini repair of Inguinal hernias?

A

single layer reconstruction of the inguinal floor

31
Q

What is the Shouldice repair of Inguinal hernias?

A

4 layer reconstruction of the inguinal floor

32
Q

What is the McVay repair of Inguinal hernias?

A

Inguinal floor brought to Cooper’s ligament

GI Pathology (12 decks)

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