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The Gastrointestinal System 2023 > Hernias > Flashcards

Hernias Flashcards

1
Q

What is a hernia?

A

A protrusion of a viscus or part of a viscus through the wall designed to contain it

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2
Q

What three layes is a hernia composed of?

A
  1. A sac (of peritoneum)
  2. Coverings of the sac
  3. Contents
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3
Q

What may be common contents for a hernia, especially in relation to the gastro-intestinal system?

A
  • Small bowel
  • Omentum
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4
Q

Name some regions where adult hernias may originate from

A
  • Inguinal
  • Femoral
  • Epigastric
  • Paraumbilical
  • Incisional
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5
Q

Groin hernias can be which two main types of hernia?

A
  1. Inguinal
  2. Femoral
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6
Q

Most grouin hernias are _________ hernias

A

Inguinal

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7
Q

Why are inguinal hernias more common in males?

A

The testicles must pass through the inguinal canal during development meaning this canal is wider in females and therefore susceptible to herniation

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8
Q

In which gender and age profile are femoral hernias most common?

A

Old women

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9
Q

The inguinal canal has a posterior wall, anterior wall, roof and floor, what are each of these areas composed of?

A
  • Posterior wall - Transversalis fascia
  • Floor - inguinal and lacunar ligaments
  • Anterior wall - aponeurosis of external oblique, internal oblique
  • Roof - transversalis fascia, internal oblique, transversus abdominus
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10
Q

The muscles of the abdominal wall are supplied by which artery?

A

Inferior epigastric artery

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11
Q

Where can the location of the inguinal ring be located on the surface of the skin?

A

2cm up from the mid-point of the inguinal ligament

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12
Q

What are the components of the spermatic cord?

A
  • 3 arteries - testicular artery, artery to vas deferens (deferential artery), cremasteric artery
  • 3 nerves - nerve to cremaster, testicular nerves (sympathetics), ilioinguinal nerve (technically outside cord)
  • 3 other things - vas deferens (ductus deferens), pampiniform plexus, lymphatic vessels
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13
Q

What are the risk factors for inguinal hernias?

A
  • Male
  • Obesity
  • Age (increasing)
  • Chronic cough
  • A previous hernia
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14
Q

What are the two types of inguinal hernia?

A
  1. Direct
  2. Indirect
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15
Q

What is a direct inguinal hernia?

A

Occurs medially to inferior epigastric vessels

The abdominal contents herniate through a weak spot in fascia of the posterior wall of the inguinal canal

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16
Q

Which gender and age group are likely to get a direct hernia?

A

Older men

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17
Q

What is an indirect inguinal hernia?

A

They occur laterally to the inferior epigastric vessels

They will protrude through the deep inguinal ring and into the scrotum via the inguinal canal

18
Q

Which developmental process may have failed to result in the development of an inguinal hernia?

A

Failure of embryonic closure of the processus vaginalis

19
Q

Of the two inguinal hernias, which will take the same path as the spermatic cord?

A

Indirect

20
Q

In relation to a hernia, what does the term “incarceration” mean?

A

Something becoming stuck

An incarcerated hernia cannot be put back in place with manual force alone

21
Q

Which surgical procedure will often be used for emergencies involving inguinal hernias?

A

Open hernia surgery

Lichtenstein method

The content are put back in place and mesh is insterted to prevent re-protrusion

22
Q

Which surgical procedure is more likely to be used for elective hernia repair?

A

Laparoscopic surgery

There is less short and long term pain and the rate of infection is lower than open surgery

23
Q

Which nerve may be damaged during open hernia surgery and what may be the effect of this?

A

Ilioinguinal nerve

Chronic pain which may last for up to a few years

24
Q

What other complications can result from hernia surgery?

A
  • Recurrence
  • Urinary retention (in men)
  • Bleeding/haematoma
  • Chronic pain
  • Numbness
  • Testicular atrophy
  • Wound infection
25
Q

Why would a hernia ever be the cause of bowel obstruction?

A

Some hernias can irreducible and may lead to strangulation of the bowel stopping blood supply

This will cause bowel obstruction

26
Q

Which gender and age are most likely to get femoral hernias?

A

Elderly woman

(who may have had many children)

27
Q

Of the two hernias, inguinal and femoral, which is more likely to have acute presentation?

A

Femoral

(around 40%)

28
Q

The femoral canal has 4 borders, what are these?

A
  1. Anterior - Inguinal ligament
  2. Posterior - Pectineal line and ligament
  3. Medial - Lacunar ligament
  4. Lateral - Femoral vein
29
Q

What is mainly present within the femoral canal?

A

Fat and lymph nodes

30
Q

In relation to the anatomical borders of the femoral canal, what is it that gives rise to the development of femoral hernias?

A

There are three firm structures, each creating a border

(anterior, posterior and medial borders)

There is one weak structure - the femoral vein - which means that any pressure is most directed at this weaker area

31
Q

Why is it hard to push a femoral hernia back in?

A

The three firm structure composing the rest of the femoral canal provide resistance to this

32
Q

In simple terms, how can this issure be corrected in surgery?

A

The inguinal ligament is sutured to the pectineal ligament eliminating the weak structure and forming a femoral canal with only three borders

33
Q

How can the positioning of inguina and femoral hernias be differentiated based on their locations in relation to the pubic tubercle?

A
  • Inguinal - above and lateral to the pubic tubercle
  • Femoral - below and lateral to the pubic tubercle
34
Q

What gives rise to an epigastric hernia?

A

Any defect in the linea alba between the xiphisternum and umbilicus

35
Q

A paraumbilical hernia is formed due to what?

A

The umbilicus being a point of weakness

36
Q

What are the risk factors for a paraumbilical hernia?

A
  • Obesity
  • Ascities
  • Pregnancy
37
Q

Name a type of acquired hernia

A

Incisional hernia

(other hernias may be acquired through trauma)

38
Q

What is a clinical sign of an inguinal hernia in an infant?

A

The silk sign

Whent he hernia is palpated over the cord structures the sensation is similar to that of rubbing two layers of silk together

39
Q

Why do umbilical hernias resolve in infants (usually) by the age of 4, yet this does not happen in adults?

A

Children will grow allowing the hernia to resolve itself

40
Q

Why are inguinal hernias always repaired in infants?

A

They will worsen and there will be a high rate of incarceration

41
Q

Which surgical procedure is used to repair an inguinal hernia in infants?

A

Herniotomy

There hernia sac is ligated without any repair of the inguinal canal

This means no mesh is used

42
Q

Which rare hernia is a cause of small bowel obstruction in elderly females?

A

Obturator hernia

Medial thigh pain may be experienced due to obturator nerve disruption

The Gastrointestinal System 2023 (27 decks)

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