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Surgery > Herniae > Flashcards

Herniae Flashcards

1
Q

What is a herniae?

A

The protrusion of an organ/part of an organ through a defect in the wall of the cavity containing it, into an abnormal position

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2
Q

Define reducible

A

The contents of the hernia can be completely replaced into the cavity

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3
Q

Define irreducible

A

The contents of the hernia cannot be completely replaced into the cavity

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4
Q

Define obstructed

A

Bowel contents cannot pass through the herniated bowel

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5
Q

Define strangulated

A

There is ischaemic of the contents of the hernia, which unless relieved will lead to gangrene and perforation

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6
Q

Define incarcerated

A

The contents of the hernia sac are stuck inside by adhesions

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7
Q

What is a direct inguinal hernia?

A

1/3 inguinal hernia
Acquired
Contents pass through a weakness of the anterior abdominal wall in the inguinal triangle

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8
Q

What is an indirect inguinal hernia?

A

2/3 inguinal hernia
Congenital
Contents pass through the inguinal canal due to a patent processus vaginalis

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9
Q

Where do indirect inguinal hernias exit the superficial ring?

A

Inside the cord - often pass into scrotum/labia majorus

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10
Q

Where do direct inguinal hernias exit the superficial ring?

A

Lateral to the cord

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11
Q

What factors predispose to the development of inguinal hernias?

A 
Patent processus vaginalis (indirect)
Chronic cough
Straining at micturition/defecation
Heavy lifting
Smoking
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12
Q

What are the signs of bowel obstruction in a hernia?

A

Tinkling bowel sounds
Constipation
Build up of faecal matter

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13
Q

Which inguinal herniae are more likely to strangulate?

A

Indirect inguinal herniae

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14
Q

Which inguinal herniae are covered by the spermatic fascia?

A

Indirect inguinal herniae

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15
Q

What is a femoral herniae?

A

Herniation of viscus through the femoral canal

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16
Q

What are the symptoms of a femoral herniae?

A

50% present as a surgical emergency - obstruction
50% present as a globular lump inferolateral to the pubic tubercle
Cough impulse often absent

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17
Q

What is an umbilical herniae?

A

Hernia present at the umbilicus

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18
Q

What are the two main types of umbilical herniae?

A

True umbilical herniae

Paraumbilical herniae

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19
Q

Describe a true umbilical herniae

A 
Occur in 3% of live births
Result of a defect in the transversalis fascia at the umbilical ring - incomplete closure of the umbilical cicatrix
Covered by skin
Generally asymptomatic
90% retract by 2 yrs
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20
Q

Describe a paraumbilical herniae

A

Acquired herniae above/below umbilicus
Caused by raised IAP
Managed early w/ Mayo’s operation

21
Q

What are the symptoms of a true umbilical herniae?

A

Generally asymptomatic

Rarely strangulate/obstruct

22
Q

What are the symptoms of a paraumbilical herniae?

A 
Localised dragging pain
Enlarging herniae over time
Tender w/ colic from intermittent obstruction
Often reducible
Commonly strangulate/obstruct
23
Q

What are the signs of strangulation?

A 
Nausea/vomiting
Fever
Sudden pain
Change in colour of hernia
Inability to pass stool/gas
24
Q

What are incisional herniae?

A

Herniae arising due to a weakness in the abdominal wall post surgery

25
Q

How common are incisional herniae?

A

10% of herniae

1% of abdominal incisions followed up by a herniae

26
Q

What are the pre-op risk factors for incisional herniae?

A 
Age
Poor nutrition
Sepsis
Uraemia
Jaundice
Obesity
Steroids
27
Q

What are the operative risk factors for incisional herniae?

A

Vertical incisions
Knots too lose/tight
Presence of drains

28
Q

What are the post-op risk factors for incisional herniae?

A

Post op ileus
Coughing
Obesity
Wound infection

29
Q

What are the Sx of an incisional herniae?

A

Bulge/local discomfort
Subacute bowel obstruction
Adhesions often develop –> irreducible –> obstruction/strangulation

30
Q

What is an epigastric herniae?

A

Small protrusions through the linea alba superior to the umbilicus, usually only containing extra peritoneal fat

31
Q

What are the Sx of an epigastric herniae?

A

75% asymptomatic
Occasionally painful (worse on exertion/after meals)
-indicates some degree of strangulation

32
Q

What is a divarification of the rectus muscle?

A

Rectus muscles do not met in the midline at the linea alba
Muscles split apart when the patient flexes the abdominal muscles
NO SURGICAL INDICATION

33
Q

What are the management principles for pts with hernias?

A

Reduce hernia to prevent obstruction/strangulation
If irreducible then elective surgery considered
-lichtenstein repair mesh technique
If obstructed/strangulated
-emergency Hartmann’s
If congenital inguinal hernias
-herniotomy
-ligation of processus vaginalis at 1yr

34
Q

In which pts are inguinal herniae more common?

A

Males

-indirect affect a young population

35
Q

In which pts are femoral herniae more common?

A

Women

36
Q

What is the most common type of hernia in women?

A

Indirect inguinal hernia

37
Q

What is Richter’s hernia?

A

Hernia involving only one sidewall of the bowel and not the lumen

  • results in strangulation/perforation w/o warning signs
  • likely in femoral sac
38
Q

How is the inguinal canal formed?

A

Relocation of testes during foetal development

39
Q

Where is the inguinal canal?

A

Parallel & medial to inguinal ligament

40
Q

What does the inguinal canal contain?

A 
3 arteries
   -testicular/ovarian
   -artery to vas def
   -cremasteric artery
3 nerves
   -genital branch of genitofemoral
   -ilioinguinal
   -sympathetic
3 structures
   -vas def/round ligament of uterus
   -pampiniform plexus
   -testicular lymphatics
41
Q

What are the three fascial coverings of the inguinal canal?

A 
Internal spermatic fascia (from transversalis)
Cremasteric fascia (from IO)
External spermatic (from EO)
42
Q

What is the deep inguinal ring?

A

Entrance to inguinal canal

-just above mid point of inguinal ligament (ASIS-PT)

43
Q

What is the superficial inguinal ring?

A

Exit of inguinal canal

-just superolaterla to PT

44
Q

What are the boundaries of the inguinal canal (MALT)?

A 
Sup wall = 2 MUSCLES
   -IO
   -transversalis abdominus
Ant wall = 2 APONEUROSES
   -EO
   -IO
Inf wall = 2 LIGAMENTS
   -inguinal
   -lacunar
Post wall = 2 T's
   -transversalis fascia
   -conjoint tendon
45
Q

What structures form the femoral triangle?

A 
Sup
   -inguinal ligament
Lat
   -medial border of sartorius
Med
   -lateral border of adductor longus
46
Q

What structures does the femoral triangle contain?

A

Femoral nerve
Femoral artery
Femoral vein

47
Q

What is the femoral sheath?

A

Inferior prolongation of transversalis/iliopsoas fascia

  • passes deep to inguinal ligament
  • allows passage of femoral aa/vv into femoral triangle
48
Q

What is the femoral canal?

A

Lies at medial extremity of femoral sheath

Site of femoral hernia

49
Q

Where does the bowel exit the abdominal cavity?

A

Through the femoral ring

Surgery (9 decks)

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