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Surgery Clerkship > Hernias > Flashcards

Hernias Flashcards

1
Q

Direct and indirect inguinal hernias

A
  • Direct: directly through the posterior wall of the inguinal canal. Medial to inferior epigastric vessels.
  • Indirect: into the inguinal canal through the deep inguinal ring. Lateral to inferior epigastric vessels.
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1
Q

Perineal hernias

A
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2
Q

Obturator hernias

A
  • Most common in women, particularly those with a history of recent weight loss
  • Palpable in mid-thigh when the hip is flexed, externally rotated, and abducted (lithotomy position)
  • Howship-Romberg sign: Positive in 50% of cases of obturator hernias. Pain along the inner thigh produced by the above movement (hip flexion, abduction, external rotation). Effective obturator neuralgia produced by nerve entrapment.
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3
Q

Sciatic hernias

A
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4
Q

Lumbar hernias

A
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5
Q

Spigelian hernia

A
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6
Q

Epigastric hernia

A
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14
Q

__ is indicated for all patients with acutely complicated inguinal hernia

A

Open surgical repair is indicated for all patients with acutely complicated inguinal hernia

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15
Q

The vast majority of congenital umbilical hernias . . .

A

. . . will spontaneously resolve by age 5

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16
Q

Presentation of uncomplicated vs incarcerated hernia

A
  • Uncomplicated: “Heaviness”, “discomfort” in an area chronically
  • Incarcerated: Acute occurence of pain (the incarceration event)
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17
Q

Subtle difference between inguinal and femoral hernias

A
  • The femoral hernia will appear below the inguinal ligament
  • The direct inguinal hernia will appear above the inguinal ligament
  • The indirect inguinal will appear at the scrotum or labia
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18
Q

Littre hernia

A
  • Hernia that contains a Meckel diverticulum
  • Congenital
  • Aka “persistent omphalomesenteric duct hernias”
    *
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19
Q

Amyand’s hernia

A

When an inguinal hernia contains the appendix

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20
Q

De Garengeot’s hernia

A

When a femoral hernia contains the appendix

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21
Q

Richter’s hernia

A

Herniation of the bowel through any hernia defect

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22
Q

The three triangles (Hesselbach’s, Pain, Doom)

A
23
Q

Sliding hernia

A
  • Indirect inguinal hernia which contains colon (L) or cecum (R)
  • High ligation of the sac without knowing its contents can cause ischemic injury to the intestine within the sac
24
Q

Hesselbach’s triangle

A
25
Q

Femoral canal

A
26
Q

Which type of inguinal hernia has the highest rate of incarceration/obstruction?

A

Femoral

Due to the small diameter of the femoral canal and the rigidity of its surrounding structures

That is why watchful waiting is not indicated for femoral hernias

27
Q

Inguinal hernias: Which do you watch and which do you send to the OR?

A
  • Any hernia that is incarcerated: Urgent OR
  • Any hernia that is strangulated: Emergent OR
  • Femoral hernia: Elective OR
  • Moderately symptomatic hernia: Elective OR
  • Asymptomatic or minimally symptomatic direct or indirect inguinal henria (NOT femoral): Watch and wait
28
Q

Chronic pain following hernia repiar

A
  • A significant complication of the procedure
  • More common in young adults and in women
  • Possible etiologies:
    • Hernia recurrence (1-5%)
    • Mesh-related pain (tends to be motion-related, treat w/ anti-inflammatories. If severe, remove mesh)
    • Nerve irritation (treat w/ gabapentinoids)
    • Infection
29
Q

If you are going to repair a hernia with mesh, you should also. . .

A

. . . cut the ilioinguinal nerve, to avoid the likely complication of ilioinguinal neuritis.

Or at least offer this to the patient.

30
Q

Inguinal hernias tend to occur on the __ side, because __

A

Inguinal hernias tend to occur on the right side, because

31
Q

Telling apart inguinal hernias

A

You can tell apart femoral from true inguinal, but you cannot distinguish direct from indirect inguinal on exam. Both direct and indirect inguinal can go to the groin.

32
Q

Inguinal canal nerves

A

Ilioinguinal

Iliohypogastric

Genital branch of genitofemoral

33
Q

Contraindications to inguingal hernia repair

A
  • Pregnancy
  • Infection
  • Ascites
34
Q

Nerves in the triangle of pain

A

Lateral femoral cutaneous nerve (on psoas muscle)

Genital branch of genitofemoral

35
Q

Structures in triangle of doom

A

Iliac vessels

36
Q

Tension free repair

A

New paradigm for hernia repair

If tension is left, it will just tear again!

37
Q

Below the arcuate line, there is no. . .

A

. . . posterior sheath

38
Q

Transverse section of abdominal wall

A

Surgery Clerkship (42 decks)

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