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1st Year Medicine > Hernias > Flashcards

Hernias Flashcards

1
Q

What are the most common surgeries for hernias, from the most common to least?

A

Inguinal
Umbilical
Incisional
Femoral

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2
Q

What are natural openings in the body that can herniate?

A

Inguinal, femoral, umbilicus, oesophageal hiatus and obturator.

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3
Q

What are some natural areas that may stretch and herniate?

A

Epigastric and paraumbilical.

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4
Q

What are two surgically induced hernias?

A

Incisional and parastomal.

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5
Q

What can predispose people to hernias?

A

Heavy lifting, coughing, constipation, prostatism (enlarged prostate), pregnancy and obesity.

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6
Q

What two categories do we divide hernias into?

A

Reducible and irreducible.

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7
Q

What are the two different types of irreducible hernia?

A

Obstructed and incarcerated.

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8
Q

What can happen to an obstructed hernia?

A

Strangulated.

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9
Q

What is strangulation of a hernia?

A

Is due to compromise of blood supply of the contents. The low pressure venous system is occluded first and then the arterial supply becomes occluded, with the development of gangrene.

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10
Q

What are the hernias of the abdominal wall?

A

Incisional, paraumbilical, epigastric paediatric umbilical, paediatric inguinal hernia, femoral and inguinal.

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11
Q

What factors can contribute to the development of an incisional hernia?

A

Age, obesity and general debility e.g. Malignancy.

Post operative wound infection or haematoma, suturing technique and type of incision (vertical more than transverse).

Raised intra-abdominal pressure and steroids.

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12
Q

What can we do to avoid an incisional hernia in predisposed patients?

A

Use tension sutures and mass close the linea alba.

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13
Q

What three types of hydrocele hernias do we have?

A

Hydrocele of the cord, communicating hydrocele and hydrocele of the tunica vaginalis.

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14
Q

What is a hydrocele?

A

A collection of fluid in the scrotum.

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15
Q

What is an epigastric hernia?

Who most commonly gets them?

A

Arise from a congenital weakness of the linea alba, usually containing extra peritoneal fat.
Male 3:1 female.

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16
Q

What are the symptoms of epigastric hernias and how do we repair them?

A

Usually Asymptomatic or local symptoms.

Repair with sutures or mesh.

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17
Q

What is the treatment for congenital umbilical hernias?

A

Monitored to see if they resolve by the age of three, if aged over three then they will operate.

18
Q

What paediatric patients are more prone to having an inguinal hernia?

A

30% under the age of a year.
Male:female ratio is 9:1
More common in preterm and LBW infants.

19
Q

On What side are paediatric inguinal hernias more common?

A

Right sided more common.

20
Q

What are the complications of paediatric inguinal hernias?

A

20% chance of developing a contralateral hernia.

Increased risk of strangulation under the age of 1 and so they are urgently operated on.

21
Q

What kind of patients should we consider having a femoral hernia?

A

Thin elderly females. Look for a loss of groin crease.

22
Q

How much more common are femoral hernias in females than males?

A

10x

23
Q

What is the most common type of hernia?

A

Inguinal.

24
Q

What must we exclude when examining for an inguinal hernia?

A

Exclude scrotal swelling.

25
Q

How do we differentiate between an inguinal and femoral hernia on examination?

A

Examine upright.
Find the pubic tubercle, if above and medial it is inguinal.
If it below and lateral its femoral.

26
Q

How do we differentiate between direct and indirect inguinal hernias on examination?

A

Put pressure over the deep inguinal ring and ask the patient to cough.
Place a little finger in the canal behind the cord and ask the patient to cough.
If there is a palpable bulge this means there is an indirect hernia.

27
Q

How do we differentiate between an indirect and direct hernia in surgery?

A

Direct is medial to inferior epigastric vessels.

Indirect is lateral to inferior epigastric vessels.

28
Q

If a hernia reaches into the scrotum what type is it most likely to be?

A

Indirect.

29
Q

What type of inguinal hernias are congenital?

A

Indirect.

30
Q

Which inguinal hernias are often bilateral?

A

Direct.

31
Q

Where are the deep and superficial rings found in relation to the patients surface anatomy?

A

Deep - mid inguinal point.

Superficial - above and medial to the pubic tubercle.

32
Q

What is hesselbachs triangle?

A

Inguinal ligament inferiorly.
Inferior epigastric vessels laterally.
Lateral border of rectus sheath medially.

33
Q

What inguinal hernia is more common in younger men?

A

Indirect

34
Q

What inguinal hernia is more common in older men?

A

Direct

35
Q

When will we operate on an inguinal hernia?

A

Risk of complication even if Asymptomatic.
Hernias with previous symptoms of obstruction.
Hernia interfering with lifestyle.

36
Q

What are the complications of inguinal hernia?

A 
Haematoma (wound or scrotum)
Acute urinary retention.
Wound infection.
Chronic neurogenic pain
Hernia recurrence
Testicular pain and atrophy.
37
Q

What types of operations are done on inguinal hernias?

A

Suture e.g. Bassini.
Open mesh e.g. Lichtenstein.
Laparoscopic TAPS or TEPS (intraperitoneal or extraperitoneal).

38
Q

What are the post operative instructions after inguinal hernia operation?

A

No driving for a week and no heavy lifting for a month (1hand lift only)

39
Q

What is a herniotomy?

A

Excision of the peritoneal sac.

Done for congenital inguinal hernias.

40
Q

What is a herniorraphy?

A

Repair of the defect of the wall.

41
Q

What is a hernia?

A

An abnormal protrusion of viscous outwith it’s normal body cavity.

1st Year Medicine (64 decks)

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