Hernia + Miscellaneous Flashcards
Two types of inguinal hernia
Direct and indirect
Difference between indirect and direct hernia [4]
Direct hernias project through Hesselbach’s triangle, exits thru superficial inguinal ring - which is medial to inferior epigastric artery
Indirect hernias project from the deep inguinal ring through the superficial inguinal ring
How do you know it is indirect
Press down on deep ring + reduce
Won’t refill on cough impulse
How do you know it is direct
Will refill on cough
Doesn;t hang into sctroum
Where is the 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
Where is superfiical (external) ring
Superior and medial to pubic tubercle
What is the anatomy of inguinal canal
External oblique = infront
Inguinal ligament = floor
Transverse abdominis
What are the contents of inguinal canal [4]
Vas deferens
Testicular artery and vein
Genitofemoral nerve
Ilioinguinal nerve
What are the symptoms of inguinal hernia [5]
Bulge Increases with cough Reduces lying flat May become irreducible and painful May obstruct
What is a strangulated hernia
In which hernias is this a rare complication
In which hernias is this a common complication
Blood supply cut of
Rare in inguinal
Common in femoral
What are the symptoms of strangulation [5]
Tender scrotum so always ask for this Red Sudden pain Fever Tachycardia
How do you examine a hernia [3]
Stand and get to cough
Lie flat and cough while pressing
Compare bilaterally
What are the RF for hernia
Male, Obesity Older as ring gets bigger Weight lifting, Manual job Chronic cough and constipation Obstruction 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 [2]
USS
Differentiate from LN
How do you treat hernia [3]
Lifestyle modifications
Better to treat surgically as likely to become symptomatic
Surgical
What are surgical options for first time hernia [3]
What conditions warrant laparoscopic? [3]
Name 2 lifestyle modifications
First time hernia:
- Open inguinal hernia repair with opening of inguinal canal
- Reduction of hernia and repair of defect
- Prosthetic mesh as adjunct to reinforce repair
Recurrence/female/risk of chronic pain:
- Laparoscopic repair via intra or retroperitoneal route of repair with mesh posterior to deep ring
Lifestyle mods
Weight loss
Stop smoking
What are complications of hernia [3]
Incarcerated - can’t reduce
Strangulation - necrosis
Obstruction
WHat is SMA syndrome
Duodenum gets obstructed by aorta and SMA
What are symptoms of weak sphincter [3]
Diarrhoea
Incontinence
Key is formed stool still leading to incontience not just diarrhoea
How do you investigate [2]
DRE - tone
USS
How do you Rx
Sural nerve stimulation
What do you do for loose stools
Send blood culture
If suspect C.diff
What is important in colonoscopy
Can you scope past?
Is tissue friable or irregular?
If tired / weight loss / diarrhoea - what investigations [5]
Hb Iron Thyroid Coaelic qFIT- tests for occult blood in stool
If Hb low
Haematinic bloods
What is common cause of liver abscess [2]
S.aures children
E.coli adult
What do you do for abscess [2]
Drainage
Ax - amox + cipro + met + gent
How can you give contrast [3]
Oral
IV
Rectal - not routine
Double = oral and IV
When do you do USS [6]
Gall stone Portal vein Intra+extra hepatic dilatation Liver texture, LIver mets Pancreatic tumour Exclude spleen / kidney / aorta pathology
When do you do pancreatico-biliary EUS [3]
Small pancreatic tumour + bile duct stone
Dx of duoedenal / pancreatic cancer
Allow FNA
When is CT useful [2]
Stage malignancy
Acute pancreatitis + complication
When is MRCP used [4]
Magnetic Resonance Cholangiopancreatography
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 [3]
Percutaneous Transhepatic Cholangiogram (PTC)
Visualisation of biliary tract
Percutaneous acess + stent
Use if ERCP fails as bigger risk
What is calprotectin [2]
It is released into the feces when neutrophils gather at the site of any GI tract inflammation.
Higher lower down the bowel
What is QFIT
The faecal immunochemical test (FIT Test) can detect human haemoglobin in stool.
How do you investigate iron anaemia [5]
FBC Ferritin (not in inflammation) Transferin TIBC 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
What causes iron deficiency anaemia [4]
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
