Hernias Flashcards
What is a hernia.
The protrusion of a viscus or part of a viscus through a defect of the wall of its containing cavity into an abnormal position.
What is an irreducible hernia.
Hernias involving the bowel are said to be irreducible if they cannot be pushed back into their right place.
What is an incarcerated hernia.
It implies that the contents of the hernial sac are stuck inside by adhesions.
What is an obstructed hernia.
GI hernias are obstructed if bowel contents cannot pass through them.
What set of signs and symptoms do you see with an obstructed GI hernia.
The classical features of intestinal obstruction.
What is a strangulated hernia.
A hernia is strangulated if the blood supply is cut off and ischaemia occurs.
What is the best course of action when presented with a strangulated hernia.
Surgery.
What are the typical hernias that can occur. (14)
Inguinal hernias. Femoral hernias. Paraumbilical hernias. Epigastric hernias. Incisional hernias. Spigelian hernias. Lumbar hernias. Richter's hernias. Maydl's hernias. Littre's hernias. Obturator hernias. Sciatic hernias. Sliding hernias. Other...
What is the typical presentation of a femoral hernia. (2)
Bowel enters the femoral canal, presenting as a mass in the upper medial thigh or above the inguinal ligament (it points down the leg).
Who do femoral hernias occur most in. (2)
Women.
Especially middle aged and elderly.
What complication can occur with a femoral hernia. (2)
They can become strangulated.
They tend to be irreducible due to the rigidity of the canal borders.
What is the anatomy of a femoral hernia. (5)
The neck: it is felt inferior and lateral to the pubic tubercle.
The boundaries of the femoral canal are-
Anteriorly: the inguinal ligament.
Medially: the lacunar ligament (and pubic bone).
Laterally: femoral vein (and iliopsoas).
Posteriorly: the pectineal ligament and pectineus.
What is contained within the femoral canal. (2)
Fat.
Cloquet’s node.
What is the differential diagnosis for a femoral hernia. (6)
Inguinal hernia. Saphena varix. Enlarged Cloquet's node. Lipoma. Femoral aneurysm. Psoas abscess.
Where do paraumbilical hernias occur.
Just above or below the umbilicus.
What are some risk factors for paraumbilical hernias. (2)
Obesity.
Ascites.
What is within a paraumbilical hernia. (2)
Omentum or bowel.
Where do epigastric hernias occur.
They pass through the lineal alba above the umbilicus.
Where do incisional hernias occur.
They follow breakdown of muscle closure after surgery (11-20%).
What complicates an incisional hernia repair.
Obesity.
What is associated with mesh repair of incisional hernias. (2)
Lower recurrence rate.
Increased infection rate over sutures.
Where do spigelian hernias occur.
They occur through the linea semilunaris at the lateral edge of the rectus sheath, below and lateral to the umbilicus.
Where do lumbar hernias occur.
They occur through the inferior or superior lumbar triangles in the posterior abdominal wall.
What is the characteristic of Richter’s hernias.
They involve bowel wall only, not the whole lumen.
What do Maydl’s hernias involve. (2)
They involve herniating ‘double loop’ of bowel.
The strangulated portion may reside as a single loop INSIDE the abdominal cavity.
What are Littre’s hernias.
They are hernial sacs containing strangulated Meckel’s diverticulum.
Where do obturator hernias occur.
They occur through the obturator canal.
What is a typical symptom of an obturator hernia in a thin woman.
Pain along the medial side of the thigh.
What is a sciatic hernia.
They pass through the lesser sciatic foramen.
What suggests a sciatic hernia. (2)
A gluteal mass.
GI obstruction.
What do sliding hernias contain.
A partially extraperitoneal structure.
What is a characteristic of sliding hernias.
The sac does not completely surround the contents.
Name a few other causes of hernias. (4)
Slipped disc.
Arnold-Chiari hernia.
Hiatus hernia.
Tentorial hernia.
What percentage of male infants suffer from indirect inguinal hernias.
4%.
What is the cause of an indirect inguinal hernia in an infant male.
Patent procesus vaginalis.
What is a risk factor for a male infant to develop an inguinal hernia.
Prematurity.
What does it mean if you see a patent process vaginalis filled with fluid.
There is a communicating hydrocele.
What percentage of live births have true umbilical hernias.
3%.
What is the cause of a true umbilical hernia.
Persistent defect in the tranversalis fascia 9(the umbilical ring).
What are the risk factors for a true umbilical hernia. (3)
African-Caribbeans.
Trisomy 21.
Congenital hypothyroidism.
What is the route of an indirect inguinal hernia. (2)
They pass through the internal inguinal ring.
If they are large, the pass out through the external ring.
What is the route of a direct inguinal hernia.
They push their way directly forward through the posterior wall of the inguinal canal, into a defect in the abdominal wall.
What is Hesselach’s triangle. (3)
Medial to the inferior epigastric vessels.
Lateral to the rectus abdominus.
Where most direct inguinal hernias emerge.
What are some predisposing conditions to develop an inguinal hernia. (7)
Male. Chronic cough. Constipation. Urinary obstruction. Heavy lifting. Ascites. Past abdominal surgery.
What is the ratio of males:females who get inguinal hernias.
8:1.
What are the two important landmarks to identify. (2)
The deep inguinal ring.
The superficial inguinal ring.
What is the landmark for the deep inguinal ring.
The mid-point of the inguinal ligament.
What is the landmark for the superficial inguinal ring.
A split in the external aponeurosis just superior and medial to the pubic tubercle.
What is the floor of the inguinal canal. (2)
Inguinal ligament.
Medially it is the lacunar ligament.
What is the roof of the inguinal canal. (2)
Fibres of transversalis.
Internal oblique.
What is the anterior wall of the inguinal canal. (2)
External oblique aponeurosis.
Internal oblique for the lateral third.
What is the posterior wall of the inguinal canal. (2)
Laterally: transversalis fascia.
Medialy: conjoint tendon.
What side are inguinal hernias most common.
Right side.
How do you distinguish a direct from an indirect inguinal hernia on clinical exam. (5)
Reduce the hernia. Occlude the deep ring with two fingers. Ask the patient to cough or stand up. If the hernia is restrained = indirect. If the hernia appears = direct.
Where do direct inguinal hernias occur.
Medial to the inferior epigastric vessels.
Where do indirect inguinal hernias occur.
Lateral to the inferior epigastric vessels.
What are most inguinal hernias.
Indirect (80%).
What kind of inguinal hernia more commonly strangulate.
Indirect.
What two types of hernias frequently strangulate. (2)
Indirect inguinal hernias.
Femoral hernias.
