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Hernias Flashcards

1
Q

What causes visceral pain?

A

Visceral stretching
Visceral inflammation
Visceral ischaemia

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2
Q

Describe visceral pain
What often accompanies it?

A
  • vague/poorly defined
  • often midline
  • nausea, vomiting + sweating
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3
Q

Where is foregut visceral pain often localised to?
What dermatomes?
What nerve is it associated with?

A
  • epigastric area
  • T5-T9
  • greater splanchnic nerve
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4
Q

Where is midgut visceral pain often localised to?
What dermatomes?
What nerve is associated with it?

A
  • peri umbilical
  • T10-T11
  • lesser splanchnic nerve
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5
Q

Where is hindgut visceral pain often localised to?
What dermatomes?
What nerve is it associated with?

A
  • Supra-pubic
  • T12-L1/2
  • least splanchnic nerve
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6
Q

What is a hernia?

A

A protrusion of a part of the abdominal contents beyond the normal confines of the abdominal wall

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7
Q

Signs and symptoms of hernias that are not stuck

A
  • fullness or swelling
  • gets larger when intra abdominal pressure increases
  • aches
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8
Q

Signs and symptoms of hernias that are stuck

A
  • pain
  • cannot be moved
  • nausea + vomiting
  • systemic problems if bowels become ischaemic
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9
Q

Causes of a hernia

A

Weakness in the containing cavity:
- congenitally related
- post surgery with inadequately healed wounds
- normal points of weakness

Anything that increases intra-abdominal pressure:
- obesity
- weightlifting
- chronic constipation or coughing

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10
Q

What are the three parts of a hernia?

A
  • the sac
  • contents of the sac
  • coverings of the sac
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11
Q

Complications of hernias

A
  • obstruction
  • incarceration
  • strangulation
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12
Q

What is an incarcerated hernia?

A
  • when a hernia is irreducible (bowel is trapped in herniated position)
  • can cause strangulation + obstruction
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13
Q

What is a strangulated hernia?

A

when a hernia is non-reducible + the base of the hernia becomes so tight it cuts of blood supply > ischaemia

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14
Q

Types of hernias

A
  • inguinal
  • femoral
  • umbilical
  • para umbilical
  • hiatus
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15
Q

General options of abdominal wall hernias

A
  • conservative management
  • tension free repair (surgery)
  • tension repair (surgery)
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16
Q

Conservative management of hernias

A
  • leaving hernia alone
  • most appropriate when hernia has a wide neck or pt is inappropriate for surgery
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17
Q

Options for surgical repair of hernias

A

tension free repair
tension repar

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18
Q

Outline tension free hernia repair

A
  • placing a mesh over defect in abdominal wall
  • mesh is sutured to muscle on either side of defect
  • this prevents herniation
  • overtime tissues grow into the mesh + provide extra support
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19
Q

Outline tension repair of hernias

A
  • surgical operation to suture the muscles + tissue on either side of the defect back together
  • less commonly done
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20
Q

What type of hernia surgery has a lower recurrence rate + is done more frequently?

A

tension free repair

21
Q

What is the inguinal canal?

A

Oblique passage through lower part of the abdominal wall

22
Q

What happens if processus vaginalis doesn’t obliterate?

A
  • inguinal hernia if partial obliteration
  • scrotal hernias if no obliteration
23
Q

What makes an inguinal hernia in the scrotum more likely?

A

If the processus vaginalis doesnt obliterate

24
Q

What are the borders of the inguinal canal?

A
  • anterior wall: aponeurosis of external oblique
  • posterior wall: transversalis fascia (+conjoint tendon medially)
  • floor: inguinal ligament (+lacunar ligament medially)
  • roof: internal oblique + transverse abdominus
25
Borders of Hesselbachs triangle
- **lateral**: inferior epigastric vessels - **medial**: lateral border of rectus abdominis - **inferior**: inguinal ligament
26
Where are indirect and direct inguinal hernias in relation to the inferior epigastric vessels?
- **indirect**: lateral to IEV - **direct**: medial to IEV (through hesselbach’s triangle)
27
How does an indirect hernia exit?
Passes through inguinal canal Through deep + superficial ring
28
Where does a direct inguinal hernia exit?
- through Hesselbach's triangle (directly through abdominal wall) - medial to inferior epigastric vessels
29
How can you differentiate between direct + indirect inguinal hernia?
- when an indirect hernia is reduced + pressure is appled to deep inguinal ring, the hernia will remain reduced - pressure over deep inguinal ring with NOT stop herniation in direct
30
First line imaging of inguinal hernia
USS scan
31
Where do femoral hernias exit?
Herniation through superior border of femoral canal - the femoral ring
32
Borders of femoral canal
FLIP - lateral: **F**emoral vein - medial: **L**acunar ligament - anterior: **I**nguinal ligament - posterior: **P**ectineal ligament
33
Risk factors of femoral hernia
- female - pregnancy - raised intra-abdominal pressure *e.g. weight lifting, chronic constipation* - increasing age
34
Why are femoral hernias often unlikely to reduce?
the femoral ring is very tight
35
Why do all femoral hernias require surgical intervention
high risk of strangulation due to tightness of femoral ring
36
Are femoral hernias more common in men or women? Why?
Women Pelvis is larger
37
What are incisional hernias?
- occur at site of incision from previous surgery - due to weakness in muscles + tissues
38
Who are umbilical hernias most common in?
Infants
39
What is the most common type of abdominal wall hernias?
Inguinal hernias
40
Describe a para umbilical hernia
Goes through linea alba in region of umbilicus
41
Describe a epigastric hernia
herniation through upper midline fibres of linea alba
42
Describe Littre's hernia
- rare form of abdominal hernia - herniation of meckel's diverticulum -most commonly in inguinal canal
43
What is a hiatus hernia?
herniation of stomach up through diaphragm
44
Types of hiatus hernias
- **type 1**: sliding - **type 2**: rolling - **type 3**: combination of sliding + rolling - **type 4**: large opening with additional abdominal organs entering thorax
45
what is a sliding hiatus hernia?
- type 1 - stomach slides up through diaphragm with the gastro-oesophageal junction passing up too
46
what is a rolling hiatus hernia?
- type 2 - a separate portion of the stomach (*e.g. fundus*), folds around + enters through the diaphragm opening, alongside the oesophagus
47
risk factors of hiatus hernia
increasing age obesity pregnancy
48
Presentation of hiatus hernia
- dyspepsia - heart burn - acid reflux - food reflux - burping - bad breath
49
management of hiatus hernia
- PPIs - **laparoscopic fundoplication**: wrapping fundus of stomach around lower oesophagus to narrow the lower oesophageal sphincter

Gastrointestinal (30 decks)

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