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General Surgery - Phase II > Hernias > Flashcards

Hernias Flashcards

1
Q

What is the most common type of Hiatus hernia?

A

Sliding - Gastro-oesophageal junction slides up into the chest. Often associated with GORD

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2
Q

What is the less common type of Hiatus hernia?

A

Rolling - Gastro-oesophageal junction remains in the abdomen, but a bulge of stomach rolls into the chest with the oesophagus. LOS intact so GORD uncommon

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3
Q

Which type of Hiatus hernia is more at risk of strangulation?

A

Rolling

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4
Q

What investigations can be done for a patient with suspected Hiatus hernia?

A

CXR - Gas bubble and fluid level in chest
Barium swallow
OGD - Assess for oesophagitis
Manometry (Pressure sensing tube placed in oesophagus) to rule out Achalasia or Dysmotility

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5
Q

What is the treatment of a Hiatus hernia?

A

Lifestyle adjustments - Lose weight
Treat any reflux - PPIs
Surgery if doesn’t respond to treatment or rolling as strangulation can occur

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6
Q

What is the aetiology of Inguinal hernias?

A

More common in males (due to descent of the testes)

Tends to be in older patients for acquired and younger patients for congenital

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7
Q

What are the two main causes of Inguinal hernias?

A

Congenital - Patent processus vaginalis (Should go after birth). Can fill with fluid (Hydrocele) or bowel (Indirect hernia)
Acquired - Mainly due to increased abdominal pressure eg chronic cough, constipation, severe muscular effort, obesity, ascites, appendectomy. Weakening of the muscle wall

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8
Q

What is the pathology of a congenital Inguinal hernia?

A 
Indirect
Patent processus vaginalis
Emerge through deep inguinal ring
Has the same 3 covering as the spermatic cord (Internal spermatic fascia, Cremasteric muscle, External spermatic fascia)
Descends into the scrotum
*Can strangulate*
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9
Q

What is the pathology of an acquired Inguinal hernia?

A

Direct
Emerge through weakened area called Hesselbach’s triangle - medial to the inferior epigastric vessels
Rarely descent into scrotum
Rarely strangulate!

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10
Q

What are the boundaries of Hesselbach’s triangle?

A

Superio-lateral - Inferior epigastric vessels
Medial - Linea semilunaris (lateral margin of the rectus sheath)
Inferior - Inguinal ligament

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11
Q

What investigations can be done in a patient with suspected Inguinal hernia?

A

USS

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12
Q

What are some of the clinical features of an Inguinal hernia in children?

A

Lump in groin which may descend into the scrotum
Exacerbated by crying or coughing
Commonly obstruct

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13
Q

What are some of the clinical features of an Inguinal hernia in adults?

A

Lump in groin
Exacerbated by straining or coughing
May be a clear event that caused it in Hx
Dragging type pain that radiates to the groin
may present with strangulation or obstruction

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14
Q

What questions are important to ask in a patient with a suspected hernia?

A

Is it reducible?
Is it painful?
Has there been any episodes of obstruction or strangulation?
Are there any predisposing factors? eg Straining, lifting, coughing
Occupation, lifestyle

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15
Q

What are some of the non surgical treatments for an Inguinal hernia?

A

Manage any risk factors eg cough, constipation
Lifestyle adjustments eg weight loss
Truss (similar to support brace, support the area effected and keep it in the correct position)

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16
Q

What are some of the surgical treatments for an Inguinal hernia?

A

Tension free mesh and suture repair
Open repair
Laparoscopic repair - better for recurrent hernias
Children may have herniotomy - sac excision

17
Q

What are some of the early complications of an Inguinal hernia repair?

A

Haematoma/Seroma
Intra-abdominal injury (Laparoscopic)
Infection
Urinary retention

18
Q

What are some of the late complications of an Inguinal hernia repair?

A

Recurrence
Chronic groin pain
Groin paraesthesia
Ischaemic orchitis (inflammation of testicles)

19
Q

What are the borders of the Inguinal canal?

A

Anterior wall - Aponeurosis of external oblique
Posterior wall - Transversalis fascia
Roof - Transversalis fasica, Internal oblique, Transversus abdominis
Floor - Inguinal ligament, lacunar ligament medially

20
Q

What are the borders of the Femoral canal

A

Anterior - Inguinal ligament
Posterior - Pectineal ligament, Pectineus muscle, Superior rami of the pubi
Medial - Lacunar ligament
Lateral - Femoral vein

21
Q

What are the borders of the Femoral triangle

A

Superior - Inguinal ligament
Lateral - Medial border of the Sartorius muscle
Medial - Medial border of the Adductor longus muscle (Also forms floor of the triangle)

22
Q

What is found at the mid inguinal point

A

Half way between ASIS and pubis symphysis

Femoral artery is found here

23
Q

What is found at the mid point of the inguinal ligament

A

Half way along the inguinal ligament which runs from ASIS to pubic tubercle
Deep inguinal ring is found here

24
Q

What are some of the risk factors for a Femoral hernia?

A

Female - due to wider shape of pelvis and changes during childbirth
Increasing age
Increased intra abdominal pressure

25
Q

What are some of the clinical features of a Femoral hernia?

A

Painless lump in the groin that has a cough impulse and often cannot be reduced
Commonly presents with strangulation/obstruction

26
Q

What are the symptoms of strangulation or obstruction of a hernia?

A 
Tender
Erythematous
Hot
Abdominal pain
Distension
Vomiting 
Constipation
27
Q

What is the management of a Femoral hernia?

A

Urgent surgical repair as highly likely to strangulate

28
Q

Define Incisional hernia

A

Hernia arises through a previously acquired defect

29
Q

What are some of the pre operative risk factors for an Incisional hernia?

A 
Increasing age
Obesity
Malnutrition
Co morbidities eg DM, malignacy
Drugs eg steroids, chemotherapy
30
Q

What are some of the intra operative risk factors for an Incisional hernia?

A

Srugical technique/skill - too small sutures or wrong material used
Incision type/position eg midline
Drain placement through wounds

31
Q

What are some of the post operative risk factors for an Incisional hernia?

A

Increased intra abdominal pressure eg cough, straining, post op ileus
Infection
Haematoma

32
Q

What is the management for an Incisional hernia?

A 
Mange risk factors eg cough
Weight loss
Truss/Corset
Surgery if appropriate (Nylon mesh repair)
*Low chance of strangulation*
33
Q

What is the managment of Umbilical hernias?

A

Usually congenital

Tends to resolve when 2-3 y/o can recur in pregnancy or ascites

34
Q

What are some of the features of a Periumbilical hernia?

A

Middle aged obese men
Defect through linea alba
Chronic cough/straining are risk factors
Mesh repair needed

35
Q

What causes an Epigastric hernia?

A

Defect in linea alba, small pea sized hernia
Usually contains omentum
Mesh repair

36
Q

What is a Spigelian hernia?

A

Hernia through linea semilunaris, lies between the layers of the abdominal wall
High risk of strangulation
Mesh repair

37
Q

What can cause a persistent midline bulge when patients lie down/raise head?

A

Divarication of the abdominal wall (Diastasis recti)
Happens in obese or pregnant patients
Not a true hernia, weakening of the abdominal wall muscles

General Surgery - Phase II (9 decks)

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