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Year 3 Gastro > Hernias > Flashcards

Hernias Flashcards

1
Q

What are the 3 types of groin hernia?

A

Direct inguinal
Indirect inguinal
Femoral

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2
Q

What anatomy is involved with a direct inguinal hernia?

A

Protrudes through hesselbach’s triangle

Passes medial to the inferior epigastric artery

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3
Q

What are the borders of the Hesselbach’s triangle?

A

Medial – lateral border of the rectus abdominis muscle.
Lateral – inferior epigastric vessels.
Inferior – inguinal ligament.

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4
Q

What causes direct inguinal hernias?

A

Defect or weakness in the transversalis fascia area of the Hesselbach triangle

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5
Q

Who generally gets direct inguinal hernias?

A

Male adults

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6
Q

What anatomy is involved with a indirect inguinal hernia?

A

Protrudes through the inguinal ring

Passes lateral to the inferior epigastric artery

Above and medial to pubic tubercle

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7
Q

What causes indirect inguinal hernias?

A

Failure of the processus vaginalis to close

embryonic developmental outpouching of the parietal peritoneum

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8
Q

Who generally gets indirect inguinal hernias?

A

Infants

Males

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9
Q

What anatomy is involved in femoral hernias?

A

Protrudes below the inguinal ligament, lateral to the pubic tubercle

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10
Q

What is worrying about femoral hernias?

A

High risk of strangulation

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11
Q

Who generally gets femoral hernias?

A

Adult females

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12
Q

Define hernia

A

Protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it

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13
Q

What are risk factors for abdominal wall hernias?

A

obesity
ascites
increasing age
surgical wounds

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14
Q

What are the presenting features of abdominal wall hernias?

A

palpable lump
cough impulse
pain
obstruction: more common in femoral hernias
strangulation: may compromise the bowel blood supply leading to infarction

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15
Q

What are the different types of abdominal wall hernia?

A 
Inguinal
Femoral
Umbilical
Paraumbilical
Epigastric
Incisional
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16
Q

What is an umbilical hernia?

A

Symmetrical bulge under the umbilicus

17
Q

What is a paraumblical hernia?

A

Asymmetrical bulge - half the sac is covered by skin of the abdomen directly above or below the umbilicus

18
Q

What is a epigastric hernia?

A

Lump in the midline between umbilicus and the xiphisternum

Most common in men aged 20-30 years

19
Q

What are congenital inguinal hernias?

A

Indirect hernias resulting from a patent processus vaginalis

Occur in around 1% of term babies. More common in premature babies and boys

20
Q

What is incarceration of a hernia?

A

herniated tissue cannot be reduced

21
Q

How urgent is hernia strangulation?

A

Surgical emergency that requires urgent management

22
Q

How will strangulated hernias present?

A

tender and likely non-reducible, and may also present with a systemically unwell patient

23
Q

How can femoral hernias be repaired?

A

laparoscopically or via a laparotomy

laparotomy only option in emergency

24
Q

How are hernias diagnosed?

A

Clinically by observation/palpation

Imaging only when complex e.g. obese

25
Q

What are some differentials for a groin lump?

A 
Indirect inguinal hernia 
Direct inguinal hernia
Femoral hernia
Inguinal lymphadenopathy 
Psoas abscess 
Femoral aneurysm
26
Q

What question do you want to ask about a groin lump?

A

How long has it been there?
Is the lump always there? Does it reduce when lying down?
Painful? will be if strangulated hernia, groin abscess
Other lumps?

27
Q

What may cause hernias to increase in size?

A

Increase intra-abdo pressure e.g. Coughing, straining on loo

28
Q

How can you differentiate between hernias and lymph nodes?

A

Swollen lymph lodes are solid
Hernias, aneurysms etc. are softer and can be fluctuant
Aneurysms will be fluctuant

29
Q

What are the differences in direct and indirect hernias?

A

Direction of reducibility
Direct - reduce superiorly
Indirect - reduce inferiorly

30
Q

Why must the rest of the abdomen be examined with an hernia?

A

Check for masses, ascites, tumour, gross faecal loading

All can raise intra-abdo pressure which can predispose hernia

31
Q

What bedside test can help confirm whether a hernia is direct or indirect?

A

Reduce the hernia
Place a finger over the deep ring
Ask pt to cough

If hernia emerges whilst you are occluding the deep ring it must be direct
If only emerges once finger is removed it is indirect

32
Q

What can a strangulated hernia cause?

A

Small bowel obstruction

Colicky pain, N+V

33
Q

What are the management options for a direct inguinal hernia?

A

Nothing - advise to represent if it becomes symptomatic
Truss - prevents bowel obstruction, only if reducible
Surgery

34
Q

What are the causes inguinal lymphadenopathy?

A

Infective Systemic

  • HIV
  • TB

Infective local
- Lower limb/groin infection/STD

Neoplastic Systemic

  • Lymphoma
  • Leukaemia

Neoplastic local
- Mets

Year 3 Gastro (39 decks)

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