Hernias Flashcards
Strangulation define
Strangulation develops as a consequence of incarceration and implies impairment of blood flow (arterial, venous, or both).
A strangulated hernia presents as severe, exquisite pain at the hernia site, often with signs and symptoms of intestinal obstruction, toxic appearance, and, possibly, skin changes overlying the hernia sac.
A strangulated hernia is an acute surgical emergency.
hernia is called reducible when
the hernia sac itself is soft and easy to replace back through the hernia neck defect.
hernia is incarcerated
when it is firm, often painful, and nonreducible by direct manual pressure.
most common form of hernia
INGUINALHERNIA
most common hernias in women
inguinal hernias
True or false
100% sensitivity and 100% specificity of bedside emergency US for the diagnosis of groin hernia
True
Hesselbach triangle
Lateral border : inferior epigastric arteries
Medial border : rectus sheath
Inferior border : inguinal ligament
direct inguinal hernia
passes directly through a weakness in the transversalis fascia in the Hesselbach triangle
indirect inguinal hernia
passes from the internal to the external inguinal ring through the patent process vagina- lis, and then to the scrotum
develop as a result of a defect in the anterior abdominal wall and can be either spontaneous or acquired. They are typically characterized by their anatomic location as epigastric, umbilical, incisional, or hypogastric
Ventral hernias
account for up to 20% of all abdominal wall hernias. They are often the result of excess wall tension or inadequate wound healing. They are also associated with surgical wound infections.
Incisional hernias
hernia sac protrudes through the femoral canal and produces a mass that is typically below the inguinal ring
Femoral hernia
Arises at the lateral edge of the rectus muscle and the arcuate (semilunar) line.
Nearly always acquired conditions due to comorbidities that increase intra-abdominal pressure
Spigelian hernia also known as a lateral ventral hernia
classic presentation is abdominal pain associated with an anterior lateral abdominal wall mass or bulge
Spigelian hernia, also known as a lateral ventral hernia
True or false
CT scan remains the best imaging for diagnosis
True
bowel herniation through the obturator canal and nearly always presents as either a partial or complete bowel obstruction
Obturator hernia
typical patient is an elderly frail female with signs and symptoms of intestinal obstruction
Obturator hernia
pain in medial portion of the thigh due to obturator nerve compression
Howship-Romberg sign
involves only the antimesenteric border of the intestine and involves only a portion of the wall circumference
Richter hernia
presents differentially from a traditional incarcerated/strangulated hernia
presents without vomiting or intestinal obstruction due to the incomplete involvement of the circumference of the intestine
leads to strangulation and gangrene than other more standard hernias. Surgical repair is indicated
Richter hernia
reduction en mass
incarcerated hernia is reduced back into the peritoneal cavity but a loop of bowel remains inside the hernia sac even after reduction, so that the retained bowel remains incarcerated
