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Surgery M4 part 1 > Hernias > Flashcards

Hernias Flashcards

1
Q

What are the hernia classifications?

A

external and internal

EXTERNAL 
- groin 
(inguinal & femoral)
- ventral 
(umbilical & paraumbilical & incisional & epigastric) 
- rare 
(spigelian & obturator & lumbar)

INTERNAL

  • hernia-en-recesses
  • hiatal hernia
  • diaphragmatic hernia
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2
Q

How does a patient discover they have an internal hernia?

A

accidentally or a complaint due to obstruction

caused by
- defect in mesentery

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3
Q

What is the most common groin hernia?

A

Indirect inguinal hernia
- occurs through deep inguinal ring into inguinal canal then out through the superficial ring and may extend into scrotum

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4
Q

What are the relations of inguinal hernias to inferior epigastric vessels?

A
  • indirect hernia is lateral to inferior epigastric vessels

- direct hernia is medial to inferior epigastric vessels

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5
Q

Which hernia occurs through the posterior wall of the inguinal canal through Hesselbach’s triangle?

A

Direct inguinal hernia

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6
Q

Which inguinal hernia is more common in middle aged and elderly?

A

direct inguinal hernia

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7
Q

what are the 3 anatomical sites of an indirect inguinal hernia?

A
  • congenital
  • infantile
  • adult -bubonocele
    - funicular
    - complete
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8
Q

What are the borders of Hesselback’s triangle?

A

MEDIALLY
- lateral wall of rectus abdominis muscle

INFERIORLY
- inguinal ligament

LATERALLY
- inferior epigastric vessels

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9
Q

What is the clinical picture of a patient presenting with an inguinal hernia?

A
  • vague pain/discomfort preceding appearance
  • swelling
  • dragging pain
  • accidentally discovered
  • complicated hernia
  • acute inguinal hernia
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10
Q

What is the most medial structure in the femoral sheath?

A

femoral canal

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11
Q

What is the anatomical location of the femoral canal?

A

extends from femoral ring to saphenous opening containing fat and lymph node of cloquet

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12
Q

How to differentiate between and inguinal hernia and a femoral hernia?

A

bulge below inguinal crease in the middle of the thigh

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13
Q

Which hernia is more common in women and is at a higher risk for strangulation and irreducibility?

A

femoral hernia

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14
Q

What is the clinical picture of a femoral hernia?

A
  • obstructed or strangulated
  • intestinal obstruction
  • small groin swelling that is not reducible
  • no cough impulse
  • difficult to feel in obese women
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15
Q

How do u describe a pantaloon hernia?

A

both indirect and direct inguinal hernia occuring at the same time

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16
Q

Which hernia contains the anti-mesenteric portion of the bowel strangulated but does not produce obstruction?

A

Richter’s hernia

most common with femoral hernia

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17
Q

which hernia contains a W-shaped loop strangulated and the loop within the abdomen may be gangrenous? How should it be treated?

A

Maydl’s hernia

pull the whole hernia out before reducing it to make sure the loop inside the abdomen is not gangrenous

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18
Q

Which hernia contains a strangulated Meckel’s diverticulum with no intestinal obstruction?

A

Littre’s hernia

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19
Q

What is a sliding hernia? how is it treated?

A

part of the hernial sac is formed of an organ (usually urinary bladder)

widen constricting ring and reduce the hernial sac without herniotomy

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20
Q

How can you differentiate between an omentocele and an enterocele?

A

OMENTOCELE ENTEROCELE

  • doughy - soft
  • gurgling absent - gurgling present
  • late difficult reduction - 1st difficult reduction
  • dull - resonant
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21
Q

What is the inguinal canal?

A
  • oblique passage in the lower part of the anterior abdominal wall
  • extends from deep inguinal ring to superficial inguinal ring (4cm)
22
Q

What are the boundaries of the inguinal canal?

A 
ANTERIOR 
- external oblique aponeurosis & conjoined muscle laterally 
POSTERIOR 
- fascia transversalis & conjoined tendon 
SUPERIOR 
- conjoined muscle 
INFERIOR 
inguinal ligament
23
Q

What is the location of the superficial inguinal ring?

A

triangular aperature in the extenral oblique aponeurosis

1.25cm above pubic tubercle

24
Q

What is the location of the deep inguinal ring?

A

U shaped condensation of fascia transversalis

1.25cm above mid inguinal point

25
Q

What are the contents of the inguinal canal?

A
  • spermatic cord (or round ligament)
    • vas deferens
    • testicular & cremasteric arteries
    • pampiniform plexus
    • lymphatics
  • ilioinguinal nerve
  • genital branch of genitofemoral nerve
26
Q

What are the defense mechanisms of the inguinal canal?

A
  • fascia transversalis
  • weak areas are covered with strong structures
  • obliquity of the canal
  • shutter mechanism due to conjoined tendon contraction
  • valvular mechanism
  • cremasteric mechanism
  • transversus abdominis effect
27
Q

What are the CLINICAL types of a hernia?

A
  • reducible
  • irreducible
  • obstructed
  • strangulated
  • inflammed
28
Q

What are the risk factors of developing a hernia?

A

INFANTS

  • prematurity (patent processus vaginalis)
  • male (spermatic cord)

ADULTS

  • obesity (weak abdominal muscle
  • constipation (straining)
  • male
  • chronic cough
  • heavy lifting
  • smoking
  • urinary obstructive symptoms
29
Q

What are the causes of a hernia?

A
  • unobliterated processus vaginalis
  • weakness of fascia transversalis
  • any condition that increases pressure of abdominal cavity
  • femoral ring may become dilated during pregnancy
  • destruction of connective tissue
30
Q

a posterior wall defect is considered which type in the NYHUS classification?

A

Type III

  • direct inguinal hernia
  • indirect inguinal hernia with dilated internal ring (massive scrotal or sliding hernia)
  • femoral hernia
31
Q

Type IV in NYHUS classification is?

A

any recurrent hernia

32
Q

an indirect inguinal hernia with a dilated internal ring but intact posterior wall is which type?

33
Q

an Indirect inguinal hernia with a normal internal ring is which type according to the NYHUS classification?

A

Type I

simple pediatric hernia

34
Q

What are the complications of a hernia?

A

IRREDUCIBILITY

  • due to adhesions
  • sliding hernia
  • tender irreducible

OBSTRUCTION

  • irreducible hernia that contains bowel due to obstruction
  • blood supply is unaffected
  • tender irreducible with obstruction

STRANGULATION

  • irreducible obstructed hernia + cut off blood supply due to edges or intrasaccular adhesions
  • NO impulse on cough

INFLAMMATION
- due to content (Meckle’s) or truss

HERNIA TAXIS COMPLICATIONS

RUPTURE

HYDROCELE OF HERNIAL SAC

35
Q

which type of hernia is more likely to affect an individual based on their age?

A

indirect hernia: children & young adults

direct hernia: old age

36
Q

What occupation will most likely lead to a hernia?

A

laborious occupations

37
Q

How can u clinically diagnose a swelling as a hernia?

A

if the swelling is insidious and intermittent and appears on standing but reduces on lying down

38
Q

When does pain occur in a hernia?

A

usually before appearance

in large & complicated hernias it appears later

39
Q

How do we know if the bowel is associated with the hernia?

A
  • chronic constipation

- acute IO with obstructed strangulated hernias

40
Q

What are the causes of urinary symptoms in a hernia?

A

sliding hernia

COULD BE prostatism predisposing to hernia

41
Q

What are the types of umbilical hernias? and how are they treated?

A
  • congenital
  • infantile
  • aquired paraumbilical

THEY RESOLVE IN 2 YEARS
TTT: do not wait if defect admits more than 2 fingers OR
if patient is older than 2 years preform herniorraphy

42
Q

What are the types of repairs in case of paraumbilical hernia?

A

Mayo’s repair & Keel repair

they are herniorraphy

43
Q

What causes a paraumbilical hernia in adults?

A
  • obesity
  • weak abdominal muscles
  • multiparity
  • tense ascites
44
Q

What type of hernia could occur postoperatively?

A

incisional hernia

45
Q

What is the cause of an epigastric hernia?

A
  • defect in linea alba between xiphoid process and umbilicus
46
Q

What are the 2 types of an epigastric hernia?

A

FATTY HERNIA TRUE EPIGASTRIC HERNIA

  • only fat - contains peritoneal sac
  • no impulse on cough - impulse on cough
47
Q

What are the clinical features of an epigastric hernia?

A
  • swelling with or without pain

- similar to peptic ulcer pain

48
Q

Which hernia occurs through the aponeurotic layer between rectus abdominis medially & semilunar line laterally?

A

Spigelian Hernia

49
Q

at what level does the spigelian hernia develop?

A

at or below arcuate line because of lack of posterior rectus sheath

AT HIGH RISK OF STRANGULATION

50
Q

What are the 2 types of the Lumbar hernias and where do they occur?

A
  • petit’s hernia: inferior lumbar triangle

- Grynfeltt’s hernia: superior lumbar triangle

51
Q

How is an obturator hernia discovered?

A

doesn’t show any bulge but acts like a bowel obstruction and causes nausea and vomiting

very rare and occurs mostly in women

Surgery M4 part 1 (47 decks)

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