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General Surgery > Hernias > Flashcards

Hernias Flashcards

1
Q

What are the typical features of an abdominal wall hernia?

A

Soft lump protruding

Reducible lump

Lump protrudes on raised intra-abdominal pressure

Aching, pulling or dragging sensation

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2
Q

What is incarceration of a hernia?

A

Hernia cannot be reduced back into proper position

Bowel is trapped in herniated position

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3
Q

What is obstruction of a hernia?

A

Hernia causes a blockage in the passage of faeces through the bowel

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4
Q

What is strangulation of a hernia?

A

Non-reducible hernia, blood supply is cut off causing ischaemia

Bowel will die quickly- emergency

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5
Q

What is a Richter’s hernia?

A

Can occur in any abdominal hernia

Only part of the bowel wall and lumen herniate through defect

Other side of bowel remains in peritoneal cavity

Can become strangulated

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6
Q

Why do you operate immediately on a Richter’s hernia?

A

Can progress very rapidly to ischaemia and necrosis

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7
Q

What is a Maydl’s hernia?

A

Two different loops of bowel contained in the same hernia

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8
Q

What are the general management options of abdominal wall hernias?

A

Conservative management
Leaving hernia alone, most appropriate with wide neck hernia

Tension-free repair
Mesh over defect in abdominal wall, mesh sutured to muscles and tissues on either side

Tension repair
Operation to suture muscles and tissue on either side of defect back together

High recurrence rate

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9
Q

What are the differential diagnoses for a lump in the inguinal region?

A

Femoral hernia
Lymph node
Saphena varix (dilation of saphenous vein at junction with femoral vein in groin)
Femoral pseudoaneurysm- not a true aneurysm
Abscess
Undescended testes
Kidney transplant

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10
Q

What happens in an indirect inguinal hernia?

A

Bowel herniates through inguinal canal

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11
Q

What specific finding will help you differentiate an indirect inguinal hernia from a direct?

A

Indirect hernia is reduced and pressure is applied to the deep inguinal ring the hernia remains reduced

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12
Q

What happens in a direct inguinal hernia?

A

Passes through Hesselbach’s triangle

Lateral rectus abdominis

Inferior epigastric vessels

Inguinal ligament

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13
Q

What is a femoral hernia?

A

Herniation of abdominal contents through the femoral canal

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14
Q

What is the opening between the peritoneal cavity and femoral canal called?

A

Femoral ring

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15
Q

What are the borders of the femoral canal?

A

Femoral vein
-laterally

Lacunar ligament
-medially

Inguinal ligament
-anteriorly

Pectineal ligament
-posteriorly

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16
Q

What is an incisional hernia?

A

Site of incision from previous surgery due to weakness of muscles and tissues closed after surgery

Bigger the incision, the higher the risk of a hernia forming

17
Q

What is a spigelian hernia?

A

Occurs between the lateral border of the rectus abdominis and the linea semilunaris

This is the site of the spigelian fascia (an aponeurosis between the muscles of the abdominal wall)

Narrower base, higher risk of strangulation

18
Q

What is a diastasis recti?

A

Widening of the linea alba forming a larger gap between rectus muscles

Most prominent when patient lies on their back and lifts their head

Protruding bulge along middle of abdomen

19
Q

What is an obturator hernia?

A

Abdominal or pelvic contents herniate through the obturator foramen

More common in
- Women
- Older age
- Multiparity and vaginal delivery

Can irritate the obturator nerve

20
Q

What is a Howship-Romberg sign?

A

Pain extending the inner thigh to the knee when the hip is internally rotated due to obturator nerve compression

21
Q

What is a hiatus hernia?

A

Herniation of the stomach through the hiatus of the diaphragm

22
Q

What are the 4 types of hiatus hernia?

A

Type 1
Sliding

Type 2
Rolling

Type 3
Combination of sliding and rolling

Type 4
Large opening with additional abdominal contents entering thorax

23
Q

What is a sliding hiatus hernia?

A

Stomach slides up through diaphragm into thorax

24
Q

What is a rolling hiatus hernia?

A

Separate portion of stomach e.g. fundus folds around enters hiatus alongside oesophagus

25
Q

What is a type 4 hiatus hernia?

A

Large hernia that lets other organs through e.g. pancreas or omentum

26
Q

What are the key risk factors of hiatus hernias?

A

Increasing age

Obesity

Pregnancy

27
Q

What symptoms do patients with hiatus hernias present with?

A

Heartburn
Reflux
Food reflux
Burping
Bloating
Halitosis

28
Q

What may hiatus hernias be seen on?

A

CXR
CT scans
GI endoscopy
Barium swallow testing

29
Q

What is the surgical management of hiatus hernias?

A

Fundoplication

General Surgery (18 decks)

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