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Gastrointestinal > Hernias > Flashcards

Hernias Flashcards

1
Q

What is a hernia?

A

A protrusion of a viscus or part of a viscus through a weakness in its containing cavity into somewhere it shouldn’t be

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2
Q

What is meant by an irreducible hernia?

A

When the hernia can’t be pushed back to where it should be

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3
Q

Where in the body are hernia’s most common?

A

Abdomen

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4
Q

What is an inguinal hernia?

A

A protrusion of abdominal cavity contents through the inguinal canal

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5
Q

What is the inguinal canal?

A

A passage that goes through the anterior abdominal wall

Conveys the spermatic cord in men and the round ligament in women

There is one either side of the midline

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6
Q

What 2 types of inguinal hernia are there?

A

Direct

Indirect

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7
Q

Describe a direct inguinal hernia?

A

When the abdominal contents come through into the inguinal canal through a defect in its posterior wall

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8
Q

Describe an indirect inguinal hernia?

A

The abdominal contents come through the deep inguinal ring (the entrance to the inguinal canal)

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9
Q

In which type of inguinal hernia is there a risk of strangulation of the bowel that has come through?

A

Indirect

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10
Q

What causes an indirect inguinal hernia?

A

The deep inguinal ring never closed properly during embryonic development.

It should do this after the testicle passes through it

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11
Q

Clinical features of inguinal hernia?

A

Bulges in the groin area that become more prominent when coughing and straining

Rarely painful, if so suspect strangulated bowel

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12
Q

What should you do if you find you’re unable to reduce the bulge back into the abdomen?

A

The hernia is likely incarcerated

Emergency surgery!

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13
Q

What is meant by an incarcerated hernia?

A

The contents of the hernia are stuck inside it by adhesions

They must be moved back by prompt surgery

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14
Q

How do you manage inguinal hernia?

A

Watchful waiting if they are asymptomatic

If not, elective surgery to move bowel back into right place and strengthen the weakness

If suspected incarcerated or strangulated hernia emergency surgery

Advise weight loss and avoid heavy lifting/exercise

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15
Q

Which is more common, indirect or direct inguinal hernias?

A

Indirect

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16
Q

Which sex gets inguinal hernias more?

A

Men

17
Q

What is a femoral hernia?

A

When abdominal contents go down the femoral canal

18
Q

What/where is the femoral canal?

A

AKA the femoral sheath

A canal containing femoral artery, vein and nerve that goes from the lower abdomen area down along the femur

19
Q

Which sex gets femoral hernias more?

A

Females

FEMoral - FEMale

20
Q

How do femoral hernias present?

A

A mass in the upper thigh

21
Q

How do you distinguish femoral hernias from inguinal hernias?

A

The direction they point in:

Inguinal: towards the groin
Femoral: away from the groin

22
Q

Femoral hernias are unlikely to be irreducible or to become strangulated.
True or false?

A

False!

Most femoral hernias do just that, they need surgical intervention

23
Q

What is an incisional hernia?

A

Hernias that occur along lines of previous surgical incisions

The incision creates a weakness in the muscle

24
Q

What is an epigastric hernia?

A

When the abdominal contents pass through the linea alba above the umbilicus

25
Q

What is a hiatus hernia?

A

When part of the stomach herniates through the oesophageal hiatus in the diaphragm

26
Q

What are the 2 types of hiatus hernia?

A

Sliding

Rolling (para-oesophageal)

27
Q

What is a sliding hiatus hernia?

A

The gastro-oesophageal junction slides through the hiatus into the area above the diaphragm

28
Q

What are the symptoms of a sliding hiatus hernia?

Why do these occur?

A

Acid reflux, because the gastro-oesophageal sphincter becomes incompetent

29
Q

What is a rolling hiatus hernia?

A

The gastric fundus rolls up through the hiatus so it is alongside the oesophagus

The gastro-oesophageal junction remains below the diaphragm

30
Q

What are the symptoms + complications of a rolling hiatus hernia?

A

Gastric volvulus: rotating and strangulation of the fundus of the stomach

Also, bleeding, obstruction and even respiratory problems

31
Q

Investigations of hiatus hernia?

A

Endoscopy

Barium swallow is the best test

32
Q

Treatment of hiatus hernia?

A

Advise weight loss

Treat reflux symptoms in sliding hiatus hernia

Surgery is advised in rolling hiatus hernia, even if asymptomatic to prevent it getting strangulated in the future

Surgery in sliding hiatus hernia if symptoms become uncontrollable

Gastrointestinal (20 decks)

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