Hernia's Flashcards

1
Q

What is visceral pain?

A

Pain that results from stretching, inflammation and ischaemia.

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2
Q

What are the symptoms of visceral pain?

A

The pain is diffuse, poorly defined and often in the midline.
It is often accompanied by nausea, vomiting or sweating,

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3
Q

What is a hernia?

A

A protrusion of part of the abdominal contents beyond the normal confines of the abdominal wall.
(But can occur outside of abdomen)

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4
Q

What are the parts of a hernia?

A

Sac - pouch of peritoneum
Sac contents - any structure found within the abdominal cavity. Commonly: loops of bowel or omentum
Sac covering - layers of the abdominal wall through which the hernia has passed

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5
Q

What are the most common abdominal hernias?

A

Inguinal hernia’s

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6
Q

What is the inguinal canal?

A

Oblique passage through the lower part of the abdominal wall.
In males the structures pass through from abdomen-testes
In females round ligament goes from uterus-labia majus

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7
Q

On what side to inguinal hernias most commonly occur?

A

The right

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8
Q

How do we describe the location of the hernia?

A

Where it leaves the abdominal cavity.

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9
Q

Where are indirect hernia found?

A

Lateral to epigastric vessels.
They pass through the deep inguinal ring into the inguinal canal and out of the superficial inguinal ring.
50% of all hernias are indirect inguinal hernias (mostly men).

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10
Q

Where are direct hernias found?

A

Medial to epigastric vessels. Bulge through Hesselbachs triangle and generally in vicinity of superficial inguinal ring.

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11
Q

What are the borders of Hesselbacks triangle?

A

Medial - Inferior border of rectus abdominis
Inferior - Inguinal ligament
Lateral - Inferior epigastric vessels

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12
Q

In who are femoral hernias more common? Why?

A

Females (although rarer then inguinal hernia’s)
because of wider pelvis (as children).
These hernias can easily get stuck (incarcerated)

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13
Q

What is omphalocele?

A

Failure of the midgut to return to the abdomen during development.

Viscera persists outside the abdominal cavity within the umbilical ring.
The abdominal cavity may not grow to correct size to accommodate viscera.
Viscera are covered in peritoneum so the gut has a chance to develop relatively normally and feeding can commence.
BUT, often associated with other genetic problems so high mortality rate.

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14
Q

What is gastroschisis?

A

A defect in ventral abdominal wall.
Abdominal viscera are not covered in peritoneum -exposed to amniotic fluid. This means that there tends to be problems with gut development and around feeding.
BUT, better mortality than omphalocele as less genetic complications. This defect can often be closed at birth.

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15
Q

What is an umbilical hernia?

A

Hernia (bulge) at site of umbilicus - not usually painful and usually left alone as they often (80-90%) result themselves by age 3

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16
Q

How would foregut pain be felt?

A

Foregut is innervated by the greater splanchnic nerve (T5-9). This means pain is felt in the T5-9 dermatomes so, it comes out as epigastric pain.

17
Q

How would midgut pain be felt?

A

Midgut is innervated by the lesser splanchnic nerve (T10-11). This means pain is felt in the T10-11 dermatomes, which it felt as peri-umbilical pain.

18
Q

How would hindgut pain be felt?

A

Hindgut is innervated by the least splanchnic nerve (T12). This means pain is felt in the T12 dermatome which comes out as suprapubic pain.

19
Q

What is a caecal volvulus?

A

This is distended small bowel.
general visceral afferents are activated
Afferent impulse fo back to superior mesenteric ganglia (prevertebral) into the dorsal horn of the spine.
This then converges with the somatic afferents at that spinal level (T9&10).
Brain interprets visceral afferents to be coming from T9&10 dermatomes.
So peri-umbilical pain.

20
Q

What are the signs and symptoms of a hernia that is not stuck?

A
  • Fullness or swelling
  • Gets larger when intra-abdominal pressure increases
  • Aches
21
Q

What are the signs and symptoms of a hernia that is stuck (incarcerated)?

A
  • Pain
  • Cannot be moved
  • Nausea and vomiting (and other signs of bowel obstruction)
  • Systemic problems if bowel becomes ischaemic (e.g. sepsis)
22
Q

What are the causes of hernias?

A

Weakness in the containing cavity:

  • Congenitally related (descent of testes)
  • Post surgery where wounds are not healed properly (incisional hernias)
  • Normal points of weakness

Increases in abdominal pressure:

  • Obesity
  • Weightlifting
  • Chronic constipation / coughing
23
Q

What are the borders of the inguinal canal?

A

Floor: Inguinal ligament and macular ligament (medially)
Roof: Internal oblique, transverse abdominis
Anterior: Aponeurosis of external oblique
Posterior: Transversalis fascia and conjoint ligament (medially)

24
Q

What is a paraumbilical hernia?

A

Acquired as an adult
Goes through lines alba region of umbilicus.
More common in females than males,
Obesity (anything that increases intra-abdominal pressure) is a risk factor.
Risk of strangulation as small defect.

25
Q

What is an incarcerated hernia?

A

Means it is ‘stuck’ and irreducible

26
Q

What is a strangulated hernia?

A

This is when blood supply is disrupted so can often lead to tissue necrosis.