Hernia + Miscellaneous Flashcards
What is an inguinal hernia
Bowel moved into inguinal canal
What is an indirect hernia
Bowel passes through weakness in the internal ring
How do you know it is indirect
Press down on deep ring + reduce
Won’t refill on cough impulse
What is a direct hernia
Bowel pushes through weakness in posterior wall
How do you know it is direct
Reduce the hernia Occlude the deep ring Ask patient to cough or stand Will refill on cough if direct Won't refill if indirect as blocked off Doesn't hang into scrotum
Can only truly determine at surgery
Where is the superficial (external) ring
Above and medial to pubic symphsis
Where is the femoral ring
Below and lateral to PS
This is where femoral hernia is
Where is deep ring of inguinal canal
Between ASIS and PS
What is the anatomy of inguinal canal
External oblique = infront
Inguinal ligament = floor
Rectus abdominas = medial
Transverse abdominas
WHat are the contents
Vas deferens
Testicular artery and vein
Genitofemoral nerve
Ilioinguinal nerve
What are the symptoms of inguinal hernia
Bulge Sensation of drag Increases with cough Reduces lying flat May become irreducible and painful May obstruct
What is a strangulated hernia
Blood supply cut of
Rare in inguinal
Common in femoral
What are the symptoms of strangulation
Tender red stcotum so always ask for this Red Sudden pain Fever Tachycardia
How do you examine a hernia
Stand and get to cough
Lie flat and cough while pressing
CHeck other side
What are the RF for hernia
Male Older as ring gets bigger Obesity Weight lifting Manual job Chronic cough Obstruction Constipation Past abdo surgery Ascites
What are women with hernia likely to have
Inguinal hernia
Who is most likely to have a femoral
Women
What imaging for hernia
USS
Differentiate fromLN
How do you treat hernia
Weight loss
Stop smoking
If becomes irreducible = urgent surgery as risk of strangulation
What are surgical options
MESH / open - reinforce posterior wall
Laparoscopic
What are complications of surgery
Recurrecne Chronic pain Mesh infection Testicular damage Bowel damage
What are complications of hernia
Incarcerated - can’t reduce
Strangulation - necrosis
Obstruction
WHat is SMA syndrome
Duodenum gets obstructed by aorta and SMA
What are symptoms of weak sphincter
Diarrhoea
Incontinence
Key is formed stool still leads to incontience not just diarrhoea
How do you investigate
DRE - tone
GI physiology to measure sphincter
USS
How do you Rx
Sural nerve stimulation
What do you do for loose stools
Send stool culture
If on Ax suspect C.diff
If tired / weight loss / diarrhoea
FBC Ferritin Thyroid Coaelic qFIT
If Hb low
Haematinic bloods
How can you give contrast
Oral
IV
Rectal - not routine
Double = oral and IV
Why is contrast useful
Time around body allows you to visualise
PA = 15s
Aterial = 90s
Portal venous = 3 miuntes
When do you do USS
Gall stone Intra+extra hepatic dilatation Portal vein Liver texture LIver mets Pancreatic tumour Exclude spleen / kidney / aorta pathology
WHen do you do pancreatico-biliary EUS
Small pancreatic tumour + bile duct stone
Dx of duoedenal / pancreatic cancer
Allow FNA
When is CT useful
STage malignancy
Acute pancreatitis + complication
When is MRCP used
Hepatic + pancreatic duct if not fit for ERCP / no intervention
CBD stones and biliary
No contrast or invasion
Miss small stone / PSC/ stricture
What does PTC allow
Visualisation of biliary tract
Percutaneous acess + stent
Use if ERCP fails as bigger risk
What is calprotectin
Neutrophil in inflammation release protein
Higher lower down the bowel
What is QFIT
Immunotherapy
FOB was detecting blood / Hb
How do you investigate iron anaemia
FBC Ferritin (not in inflammation) - low Transferin- low TIBC - high Colonoscopy once confirmed
What does TIBC show if iron is low
High if iron deficiency as want more binding receptors for iron to bind do
Low in haemachromatosis
What causes iron deficiency anaemia
Blood loss
Malabsorption
Mentruation
Pregnancy
How do you differentiate iron deficiency from anaemia of chronic disease
Anaemia chronic disease has low TIBC as don’t want iron available for pathogen
What is a hernia
Protrusion of viscous or part through a defect of the walls of its containing cavity
Irreducible
Cannot push back into place
Need to reduce to prevent obstruction, strangulation and necrosis
Obstructed
Content cannot pass
eg. faeces can’t pass through bowel
Strangulated
Non reducible and becomes so tight it cuts of blood supply
Significant pain and tenderness at site
Ischaemia occurs = urgent surgery
Incacerated
Contents of sac stuck inside by adhesions
