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YR6: GASTRO > Hernias > Flashcards

Hernias Flashcards

1
Q

What is a femoral hernia?

A

Intra-abdominal contents herniate into the femoral canal through the femoral ring

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2
Q

List 5 risk factors for femoral hernias

A

Female (3:1)
Age
Obesity
Multiparity
Increased intra-abdominal pressure e.g. chronic constipation, cough, straining during micturition

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3
Q

Describe the epidemiology of femoral hernias

A

Much LESS common than inguinal
but more likely to get incarcerated as are situated in a tighter place
F > M
Account for 5% of abdominal hernias

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4
Q

Describe presentation of a femoral hernia

A

Globular lump in the groin
Enlarges with coughing
Clinical dx

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5
Q

Location of femoral hernias

A

INFEROLATERAL to pubic tubercle

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6
Q

What investigation may be used for femoral or inguinal hernias if there is diagnostic uncertainty?

A

US
(difficult to palpate in obese)

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7
Q

Describe the management of non-complicated femoral hernias

A

Refer due to high risk of strangulation (50% strangulate within a month)
Elective surgical repair with mesh hernioplasty

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8
Q

Describe management of complicated femoral hernias

A

Herniorrhaphy (non-mesh repair)

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9
Q

Name 4 complications of hernias

A

Pain
Incarceration
Strangulation
Bowel obstruction

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10
Q

Define hernial incarceration

A

Irreducible

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11
Q

Define hernial strangulation

A

Ischaemic necrosis of contents of hernial sac as blood supply compromised by incarceration

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12
Q

In which type of hernia is there greater risk of strangulation?

A

Femoral

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13
Q

Describe presentation of strangulated hernia

A

Tender, irreducible, warm hernia
Systemic Sx
Features of bowel obstruction
Severe pain

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14
Q

Describe management of strangulated hernias

A

DO NOT attempt to reduce
Laparotomy

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15
Q

What is the most common type of hernia?

A

Inguinal

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16
Q

How are inguinal hernias diagnosed?

A

CLINICAL DIAGNOSIS

17
Q

What is an inguinal hernia?

A

Protrusion of intra-abdominal contents through inguinal canal

18
Q

What is a direct inguinal hernia?

A

protrusion directly through the POSTERIOR WALL of the inguinal canal
ACQURIED

19
Q

What is an indirect inguinal hernia?

A

Protrusion THROUGH the DEEP inguinal RING, following the path of the inguinal canal
usually congenital

20
Q

What is the most common type of inguinal hernia?

A

Indirect

21
Q

Describe the aetiology of inguinal hernias

A

Congenital: abdo contents enter the inguinal canal through a patent processus vaginalis
Acquired: increased intra-abdo pressure + weakness of abdo muscles

22
Q

Describe the location of direct inguinal hernias

A

Within Hesselbach triangle
Medial to inferior epigastric blood vessels + lateral to the rectus

23
Q

Describe the location of indirect inguinal hernias

A

Outside Hesselbach triangle
Lateral to inferior epigastric blood vessels

24
Q

List 5 risk factors for inguinal hernias

A

Male
Prematurity
Age
Obesity
Heavy lifting

25
Q

Describe the epidemiology of inguinal hernias

A

COMMON
Peak age in adults: 55-85y
M > F

26
Q

How may inguinal hernias present?

A

Groin lump
Increases in size on coughing/ straining
Decreases when lying
Discomfort + ache (severe pain uncommon)

27
Q

How do you distinguish between direct and indirect inguinal hernias?

A

Reduce the hernia + occlude the deep internal ring with 2 fingers.
Ask patient to cough/ stand.
If hernia is restrained= indirect.
If protrudes= direct

28
Q

Describe management of uncomplicated inguinal hernias

A

Elective repair:
Hernioplasty (mesh repair)
Herniorrhaphy (non-mesh repair)

29
Q

When is emergency surgery performed for inguinal hernias?

A

If obstructed or strangulated
Laparotomy with bowel resection may be indicated if bowel is gangrenous

30
Q

What is the term used for presence of co-existing direct and indirect inguinal hernias?

A

pantaloon hernia

31
Q

How do you differentiate between inguinal and femoral hernias?

A

Inguinal: superior + medial to pubic tubercle
Femoral: inferior + lateral to pubic tubercle (+ medial to femoral pulse)

32
Q

Describe the anatomy of the inguinal ligament. What runs within the ligament?

A

Runs between ASIS + pubic tubercle.
Inguinal canal

33
Q

What passes through the inguinal canal?

A

Ilioinguinal nerve
+
Males: spermatic cord
Females: round ligament

34
Q

Describe the anatomy of the deep and superficial rings within the inguinal canal

A

Deep (entry): just above midpoint of inguinal ligament
Superficial (exit): just above + medial to pubic tubercle

35
Q

What is an irreducible hernia?

A

Can’t be pushed back into place

36
Q

What is a hernia?

A

protrusion of a viscus through a defect of the walls of its containing cavity into an abnormal space

37
Q

What is an obstructed hernia?

A

Bowel contents can’t pass through the no longer patent, compressed bowel lumen

38
Q

What is a strangulated hernia?

A

Compression around the hernia prevents blood flow into the hernial contents causing ischaemia to the tissues within

39
Q

What is a reducible hernia?

A

Contents of hernia can be manipulated back into its original position through the defect from which it emerges

YR6: GASTRO (61 decks)

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