Hernias Flashcards
What is a hernia?
Protrusion of peritoneum through an opening
(usually at a site of weakness)
protrusion of peritoneum through an opening, what is it?
hernia
contents of hernia may be at risk of what? (2 things)
incarceration and strangulation
what is a sign of incarceration?
not reducible back into abdomen/pelvis
how can you check for incarceration of a hernia?
try to reduce hernia back into abdomen/pelvis
what are signs of strangulation of a hernia?
ischemia and necrosis
hernia is ischemic and necrotic. what is going on?
strangulation
how can complicated hernias present?
tenderness, erythema, fever
diaphragmatic hernia: what is this?
abdominal structures entering the thorax
abdominal structures entering the thorax: what is this?
diaphragmatic hernia
diaphragmatic hernia: what are the most common causes of in infants?
congenital defect of pleuroperitoneal membrane
diaphragmatic hernia in children: which side?
mostly left, because right is mostly protected by the liver
congenital defect of pleuroperitoneal membrane: causes what?
diaphragmatic hernia in children
diaphragmatic hernia in adults: what is the cause?
laxcity(looseness)/defect of phrenoesophageal membrane
leads to hiatal hernia (hernia of stomach through esophageal hiatus)
defect of phrenoesophageal membrane -> leads to what?
hiatus hernia (diaphragmatic hernia) in adults
what is a hiatal hernia?
herniation of stomach through esophageal hiatus
herniation of stomach through esophageal hiatus: what is this?
hiatus hernia
diaphragmatic hernia in adults
Sliding hiatal hernia: what is this?
gastroesophageal junction is displaced upward as gastric cardia slides into hiatus
what slides into hiatus in a ‘sliding hiatal hernia’?
cardia of the stomach
hourglass stomach: which type of hernia?
sliding hiatal hernia
what is the most common type of a hiatal hernia?
sliding hiatal hernia
which type of hernia is associated with GERD?
GERD = gastroesophageal reflux disease
sliding hiatal hernia
sliding hiatal hernia: associated with what?
GERD (gastroesophageal reflux disease)
what are the 2 types of a hiatal hernia?
sliding hiatal hernia
paraesophageal hiatal hernia
what is a paraesophageal hiatal hernia?
gastric fundus protrudes into thorax, gastroesophagea junction usually normal
gastric cardia protrudes into thorax. what is this?
sliding hiatal hernia
gastric fundus protrudes into thorax. what is this?
paraesophageal hiatal hernia
Indirect inguinal hernia: slides through which structures?
internal (deep) inguinal ring, external (superficial) inguinal ring, into the groin
Indirect inguinal hernia: medial or lateral of inferior epigastric vessels?
lateral
which hernia is lateral of inferior epigastric vessels?
indirect inguinal hernia
which hernia slides through internal (deep) inguinal ring, external (superficial) inguinal ring, into the groin?
indirect inguinal hernia
what causes a congenital indirect inguinal hernia?
failure of processus vaginalis to close
failure of processus vaginalis to close -> which hernia?
indirect inguinal hernia
failure of processus vaginalis to close can cause indirect hernia
what other structure can form in boys?
hydrocele
what is a hydrocele?
collection of fluid in the scrotum
collection of fluid in the scrotum,
what is this?
hydrocele
indirect inguinal hernia: more common in males or females?
males
can an indirect inguinal hernia be noticed in both infants and adults?
yes
indirect inguinal hernia: follows pathway of what?
testicular descent
indirect inguinal hernia: covered by what?
3 layers of spermatic fascia
what are the 3 layers of the spermatic fascia?
- external spermatic fascia
- cremasteric fascia
- internal spermatic fascia
(van buiten naar binnen tijdens het snijden)
external spermatic fascia: derived from what?
external oblique aponeurosis
cremasteric fascia: derived from what?
internal oblique aponeurosis
internal spermatic fascia: derived from what?
fascia transversalis
direct inguinal hernia: protrudes through what?
inguinal triangle (Hesselbach)
Hesselbach triangle: what are the 3 walls?
medial: rectus abdominis
lateral: inferior epigastic vessels
inferior: inguinal ligament
hernia through triangle of Hesselbach: which type?
direct inguinal hernia
direct inguinal hernia: goes through which (ring) structure?
external/superficial inguinal ring only
direct inguinal hernia: covered by which fascia?
external spermatic fascia
direct inguinal hernia: common in who?
older males due to acquired weakness of transversalis fascia
older males due with acquired weakness of transversalis fascia: which hernia?
direct inguinal hernia
direct inguinal hernia: bulges where?
directly through parietal peritoneum
direct inguinal hernia: medial or lateral of inferior epigastric vessels?
medial
direct inguinal hernia: medial or lateral of rectus abdominis?
lateral
mnemonic:
MD’s don’t LIe
MD: medial, direct hernia
LI: lateral, indirect hernia
MD: medial, direct hernia
LI: lateral, indirect hernia
which mnemonic?
MD’s don’t LIe
Femoral hernia: protrudes where?
below inguinal ligament, through femoral canal
femoral hernia: orientation with respect to pubic tubercle?
lateral and below
femoral hernia: more common in males or females?
females
(but overall inguinal hernias are the most common in females)
most common hernia in females?
inguinal hernia
below inguinal ligament, through femoral canal
what type of hernia?
femoral hernia
which hernia is more likely to present with incarceration or strangulation: femoral or inguinal?
femoral hernia
femoral hernia: which complications are more likely? (vs inguinal hernia)
incarceration and strangulation