Hernias Flashcards

1
Q

What are the most common Hernias ?

A

Inguinal, Incisional, Umbilical, and hiatus.

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2
Q

What is reducible hernia ?

A

In reducible hernia contents re-enter the abdomen with manipulation or spontaneously.

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3
Q

What is Irreducible or Incarcerated hernia ?

A

These are Hernias that persist despite trying to manipulate which can lead to obstruction and increases risk of strangulation.

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4
Q

What is strangulated hernia ?

A

These are hernias at an increased risk of ischemai and necrosis.

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5
Q

What are inguinal hernias ?

A

It is most common in men as the descent of the testis through the abdominal wall predisposes men to inguinal hernias. It Usually occur in association with congenitally patent processus vaginalis. 70% are direct and 30% are indirect.

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6
Q

What is the cause of indirect inguinal hernia ?

A

Weakness of posterior abdominal wall.

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7
Q

What is the presentation of inguinal hernia ?

A

It presents as lump in the groin and may be palpable on coughing as a lump on superficial inguinal ring. It usually reduces when the patient lay down. Severe complications strangulation which is a surgical emergency and is rare.

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8
Q

What are the three vessels in the inguinal canal ?

A

– Testicular A&V
– A&V to the Vas
– Cremasteric A&V

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9
Q

What are the three nerves in the inguinal canal ?

A

– Genital branch of genitofemoral
– Cremasteric
– illioinguinal
– (+ sympathetics)

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10
Q

What are the three fasciae in the inguinal canal ?

A

– External spermatic
– Internal spermatic
– Cremasteric

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11
Q

What are the 3 non vascular, non neural structures of the inguinal canal ?

A

– Spermatic cord
– Vas Deferens
– Lymphatics

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12
Q

What is the management of inguinal hernia ?

A
  • Conservative: Lifestyle modifications and Hernia belts/truss.
  • Surgical: Laparoscopic Mesh Repair,
    *TAPP: TransAbdominal Pre-Peritoneal
  • TEP: Totally Extra-Peritoneal
    – Open surgery: Patch of non-absorbable mesh strengthens posterior wall of inguinal canal.
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13
Q

What are incisional hernias ?

A

These are herniation of abdominal content through the vertical surgical incisions. The patients often presents with pain and lumps that comes and goes during coughing or straining.

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14
Q

What is the management of incisional hernia ?

A
  • Conservative– Abdominal binder
  • Open repair + mesh
  • Laparoscopic repair + mesh
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15
Q

What is the 2nd most common hernia ?

A

Umbalical hernia 90% acquired and 10% congenital. Common in females.

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16
Q

risk factors for umbalical hernia ?

A

Obese, multiparous women, and ascites.

17
Q

What is the management of umbalical hernia ?

A

– Suture repair
– Open/Laparoscopic mesh repair

18
Q

What is the presentation of femoral hernia ?

A

They present within the femoral triangle and are common in woman. It is often a surgical emergency due to it getting strangulated within the narrow neck of the femoral canal.

19
Q

What is the location of inguinal hernia ?

A

Above and medial to public tubercle.

20
Q

What is the location of femoral hernia ?

A

Below and lateral to pubic tubercle.

21
Q

What is the deep ring test utility in reducible inguinal hernia ?

A

Occlude deep ring with 2 fingers while hernia reduced and ask the patient to cough. If the hernia reappears it is a direct hernia and if it does not reappear, it is an indirect hernia.