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Med Procedures > Hernias > Flashcards

Hernias Flashcards

1
Q

What is a hernia

A

condition in which part of an organ is displaced and protrudes through the wall of the cavity containing it

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2
Q

What is a reducible hernia?

A

a hernia that can be manually “reduced” or pushed back through the defect

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3
Q

what is an incarcinated hernia?

A

hernia which cannot be manually reduced (may NOT be painful) = surgery

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4
Q

What is a strangulated hernia

A

an incarcerated hernia with some degree of torsion leading to ischemic bowel
very painful
emergency surgery

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5
Q

how many sides foes the ingunial canal have?

A

Roof
Floor
Anterior wall
Posterior wall

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6
Q

Posterior wall is made of?

A

Transversalis fascia and conjoined tendon of the internal oblique and transversus abdominis muscles

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7
Q

What is the anterior muscle made of?

A

Primarily External Oblique muscle

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8
Q

What is the floor of the inguinal canal?

A

Inguinal Ligament and Lacunar ligament

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9
Q

What is the roof of the inguinal canal

A

External oblique & Transversus abdominis muscles

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10
Q

Contents of Inguinal Canal

A

Males – Ilioinguinal nerve & Spermatic Cord

Females – Ilioinguinal nerve and Round Ligament of the uterus

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11
Q

What does hesslebach’s triangle consist of?

A

Medial border – Rectus abdominis (sheath of muscle)
Lateral border – Inferior epigastric vessels
Inferior border – Inguinal ligament

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12
Q

What is the entrance and exit for hesslebachs triangle

A

Deep inguinal ring – entrance to the inguinal canal

Superficial inguinal ring – exit of the inguinal canal

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13
Q

What are 7 types of hernias?

A 
inguinal
Femoral
Umbilical
Spigelian
Hiatal Hernia
Incisional / Ventral
Sports Hernia
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14
Q

Epidemiology for hernias

A

Occur in 5% of all men at some point in their lifetime
Men > Women
75 – 80% of all hernias are groin (inguinal or femoral) hernias
2 – 20% are incisional / ventral
3 – 10% are umbilical

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15
Q

What are the risk factors for Hernias

A 
Increased intra-abdominal pressure
Coughing
Heavy lifting
Constipation or straining at stool
Pregnancy / ascites  
Obesity
Advancing age 
Smoking
Steroid use
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16
Q

What is a direct hernia

A

Usually acquired, herniation through defect in the posterior inguinal wall (through Hesselbach’s triangle) – occurs most commonly in older males

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17
Q

What is an indirect hernia

A

Usually congenital, through deep inguinal ring, lies within the spermatic cord, and the hernia sac is covered by the cremaster muscle – occurs most commonly in younger males and may be in scrotum

18
Q

Clinical Presentation of hernias

A

unilateral groin pain especially w/exertion

Report of intermittent bulge in groin

19
Q

What is the gold standard for hernias?

A

surgical repair – herniorraphy

20
Q

what are 4 different techniques for hernias

A

Open
Laparoscopic
Mesh vs No mesh
Local anesthesia w/sedation / vs GA

21
Q

What are some complications of hernias?

A

incarceration
strangulated hernia
pediatric hernias

22
Q

Epidemiology of femoral hernias?

A

84% of femoral hernias occur in women
25% of femoral hernias become incarcerated or strangulated
Hernia protrudes through the femoral canal – so sac is seen or palpated in the upper thigh

23
Q

Clinical Presentation of femoral hernias

A

May complain of intermittent groin mass/bulge or pain
Presenting feature may be small bowel obstruction due to incarceration / strangulation
Elderly pts may be asymptomatic EVEN in the face of incarceration
Bulge just BELOW the inguinal ligament
Tenderness if incarcerated

24
Q

Treatment for femoral hernias?

A

Surgery

25
Q

Umbilical hernia epidemiology?

A

Congenital defects
African Americans > Caucasians
Most newborn umbilical hernias close spontaneously by age 2
Patients w/ascites have a higher incidence of umbilical hernias
Have a generally low rate of incarceration

26
Q

Clinical Presentation for umbilical hernias

A

Painless bulge around umbilicus
May present with gastric symptoms (pain)
In children under 2 – wait for spontaneous closure unless LARGE
In adults often associated w/obesity
Visible and palpable umbilical defect
Often easily reducible by just pushing on defect

27
Q

Spigelian Hernias facts

A

Protrude through the Spigelian fascia – this structure is near the terminus of the transversus abdominis muscle along the lateral edge of rectus abdominis

28
Q

Clinical presentation for spigelian hernias

A

Often pts present with obscure abdominal pain and no apparent cause
no bulge seen or palpated because it is obscured by abdominal wall

29
Q

Diagnostic imaging for spigelian hernias

A

Ultrasound
CT scan
Diagnostic laparoscopy

30
Q

Treatment for spigelian hernias

A

Surgical referral

Probable surgical intervention

31
Q

Hiatal Hernia

A

Reflux barrier composed of two components working together prevent reflux
Lower esophageal sphincter
Crural diaphragm
Stomach can herniate up through diaphragm into thoracic compartment

32
Q

What is the clinical presenation for hiatal hernia

A

May have some epigastric tenderness but physical findings may be lacking
Present w/symptoms similar to GERD – dyspepsia, reflux
Some types of HH can present w/postprandial pain, bloating, early satiety, SOB w/meals, dysphagia

33
Q

How to make a diagnosis of hiatal hernia

A

Chest X-ray (CXR) – look for air fluid levels in mediastinum on lateral x-ray
Barium swallow – can confirm Dx also looks for strictures, ulcers, (this is the gold standard for Dx)
Esophagogastroduodenoscopy (EGD) – can help if pt has Barrett’s esophagus
Esophageal manometry

34
Q

How to treat hiatal hernia

A

asymptomatic – no further Tx is indicated
If pt is symptomatic – trial of medical management – similar to Rxing GERD
Surgical management is a major surgical procedure

35
Q

5 causes of Incisional or Ventral Hernia

A 
Infection
Malnutrition
Obesity 
Flawed wound closure
Conditions that increase abdominal pressure on a wound
36
Q

Clinical Presentation of Incisional or Ventral Hernia

A

Presence of bulge at incision site
Reproducing intermittent bulge with Valsalva maneuver and that disappears with exhalation
Edge of fascial defect is usually palpable on exam
Prior Hx of surgical procedure
Presence of previously noted pre-disposing factors
Complaints of intermittent or persistent bulge at incision site

37
Q

Treatment for incisional or ventral hernia

A

Definitive treatment is surgical repair

38
Q

Sports hernia

A

Can often go unrecognized
Also called Athletic Pubalgia
Seen most frequently in high performance athletes
Painful musculotendinous injury to the medial inguinal floor

39
Q

Clinical presentation for sports hernia

A

Tenderness over the pubic ramus
Usually high performance athlete with history of groin or lower abdominal pain aggravated by physical activity and relieved by rest

40
Q

Treatment for sports hernia

A

Conservative Tx – activity modification, PT

If not helping consider surgical intervention

Med Procedures (5 decks)

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