Hernias Flashcards
What is a hernia?
Protrusion of an organ or part of an organ through connective tissue or wall of a cavity in which it is normally enclosed
Can be congenital or acquired through weakening/disruption of abdominal wall fascia, or failed healing of surgical incision.
What does ‘reducible’ mean in the context of hernias?
Herniated contents can be manually placed back into anatomic position spontaneously or with gentle pressure.
What is an incarcerated hernia?
Hernia cannot be reduced back to anatomic position, increasing risk for bowel obstruction.
Define a strangulated hernia.
Blood supply to incarcerated hernia is compromised, leading to ischemia and necrosis of tissue.
What are the common symptoms of a strangulated hernia?
Steadily increasing pain, nausea, vomiting.
What physical exam finding is associated with hernias?
Hernia may only appear with increased intra-abdominal pressure; evaluate in standing and recumbent positions.
What percentage of hernias occur in the groin?
75%.
What is the most common type of hernia?
Inguinal hernia.
What is the lifetime risk for men and women to develop inguinal hernias?
Men: 27%, Women: 3%.
List the types of groin hernias.
- Indirect inguinal hernia
- Direct inguinal hernia
- Femoral hernia.
What are the types of abdominal hernias?
- Umbilical hernia
- Epigastric hernia
- Spigelian hernia
- Incisional hernia.
What anatomical layers are involved in abdominal hernias?
- Skin
- Subcutaneous tissue
- Superficial fascia
- External oblique
- Internal oblique
- Transversus abdominus
- Transversalis fascia
- Preperitoneal adipose tissue
- Peritoneum.
What is a Spigelian hernia?
Rare hernia occurring along arcuate line due to weakness from lack of posterior rectus sheath below line.
What risk factors are associated with incisional hernias?
- Diabetes
- Immunosuppressant use
- Smoking
- Obesity
- Malnutrition
- Connective tissue disorders.
What are the contents of the inguinal canal in males?
- Spermatic cord
- Vas deferens.
What forms the deep (internal) inguinal ring?
Hiatus in transversalis fascia.
What are the boundaries of Hesselbach’s triangle?
- Superolaterally: Inferior epigastric vessels
- Medially: Lateral edge of rectus sheath
- Inferior: Inguinal ligament.
True or False: Inguinal hernias are 5 times more common than femoral hernias.
True.
What is the indication for surgical repair of umbilical hernias?
Symptomatic, incarceration, failure to close spontaneously after 5 years.
Fill in the blank: Hernias can develop at the site of a previous _______.
[abdominal incision].
What is the risk of incarceration in Spigelian hernias?
Up to 20%.
What is the anterior layer of the rectus sheath composed of?
- External oblique
- Internal oblique
- Transversus abdominus fascia.
What is the role of the arcuate line in hernia anatomy?
Demarcates transition between posterior wall of rectus sheath covering superior ¾ of rectus abdominus and transversalis fascia covering inferior ¼.
What does the femoral triangle contain?
Femoral artery, vein, and nerve
The femoral triangle is an important anatomical landmark in the groin region.
What does the femoral sheath contain?
Femoral artery, vein, canal (with deep inguinal nodes), but NO nerve
The femoral sheath is crucial for understanding femoral hernias.
Which nerves are involved in the innervation of the groin?
- Iliohypogastric n.
- Ilioinguinal n.
- Genitofemoral n. (Genital and Femoral branches)
- Lateral Femoral Cutaneous n.
These nerves originate from the lumbar plexus.
What guides the descent of the testes into the scrotum?
Gubernaculum
The gubernaculum is a fibrous cord that helps in the descent of the testes.
What is the processus vaginalis?
An evagination that protrudes through the inguinal canal and is involved in the descent of the testes
Failure of closure of the processus vaginalis can lead to hernias.
What happens if the processus vaginalis persists?
Predisposed to indirect inguinal hernia and hydrocele
Hydrocele is the accumulation of fluid in the tunica vaginalis.
What characterizes an indirect inguinal hernia?
Herniated contents enter through deep inguinal ring, lateral to inferior epigastric vessels
It is the most common type of inguinal hernia.
When do indirect inguinal hernias typically form?
In the first year of life, but may not become symptomatic until adulthood
This hernia type is common in both genders.
What is the path of a direct inguinal hernia?
Enters through parietal peritoneum, medial to inferior epigastric vessels, and lateral to rectus abdominus
Direct inguinal hernias are less common and usually occur in older men.
What is a femoral hernia?
Passes beneath inguinal ligament through femoral canal into the upper thigh
Femoral hernias are more common in females due to pelvic anatomy.
What is the risk associated with femoral hernias?
Increased risk of incarceration/strangulation due to rigid boundaries of femoral ring
The femoral ring is bordered by the femoral vein and lacunar ligament.
What imaging techniques are used to diagnose hernias?
- US
- CT
- MRI
MRI is the most sensitive and specific for hernia diagnosis.
What is the current standard for hernia repair?
Synthetic tension-free mesh
This method has shown to decrease recurrence rates.
What is the recurrence rate after hernia repair?
Ranges from 0.5% to 15%
Recurrence rates can vary based on the type of hernia and repair method.
What is a clinical sign of a hernia?
Nonreducible bulging mass, tender to palpation
This sign is often accompanied by pain and may indicate incarceration.
True or False: Femoral hernias are less common than inguinal hernias.
True
However, they are more common in females.
Fill in the blank: The __________ is used to provide external compression over a hernia defect.
truss
Non-surgical repair methods may be temporary solutions.
