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Clinical > Hernias > Flashcards

Hernias Flashcards

1
Q

Definition of hernias?

A

An abnormal protrusion of a viscous outwith its normal body cavity

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2
Q

4 of the most common hernias?

A

Inguinal
Umbilical
Incisional
Femoral

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3
Q

Causes of abdominal wall hernias?

A

May arise from natural openings OR weak areas, caused by stretching or surgical incisions

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4
Q

5 natural abdominal wall hernias?

A 
Inguinal
Femoral
Umbilical
Oesophageal hiatus hernia
Obturator
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5
Q

4 weak area hernias?

A

Incisional
Parastomal (around a stoma)
Epigastric
Paraumbilical

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6
Q

6 factors that predispose to abdominal hernias?

A 
Increase in intra-abdominal pressure:
Heavy lifting
Coughing
Constipation	
Prostatism
Pregnancy
Obesity
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7
Q

Classification of hernias?

A

Reducible

Irreducible:
Obstructed (can progress to strangulation)
Incarcerated

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8
Q

What does strangulation mean, in relation to hernias?

A

Compromise of blood supply of the contents of the hernia; strangulation increases morbidity and mortality

Initially, the low pressure venous system is occluded and then the arterial supply; this leads to ischaemia and then gangrene (coagulative necrosis)

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9
Q

What are incisional hernias?

A

Incompletely-healed surgical wound can cause a hernia

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10
Q

Aetiology of incisional hernias?

A

Age and general debility, e.g: malignancy
Steroids
Obesity

Post-operative wound infection or haematoma

Raised intra-abdominal pressure, e.g: ileus

Type of incision; vertical incisions have greater incidence of hernia than transverse

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11
Q

Prevention of incisional hernia?

A

In predisposed patients, use tension sutures + “mass closure” of the linea alba

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12
Q

What is a para-umbilical hernia?

A

Around the umbilicus and occur in ADULTS, usually in obese individuals

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13
Q

Causes of epigastric hernias?

A

Arise from a CONGENITAL weakness of the linea alba, between the umbilicus and xiphisternum

They usually contain extra-peritoneal fat

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14
Q

Occurrence of epigastric hernias?

A

More common in males, usually in late teens or early adulthood

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15
Q

Symptoms of epigastric hernia?

A

Usually asymptomatic or there are local symptoms

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16
Q

Treatment of epigastric hernia?

A

Repair with sutures or mesh

17
Q

Cause of umbilical hernias?

A

Congenital problem; occurs in CHILDREN, within 1st year of life or when they are born

They can occur alongside pediatric inguinal hernias

18
Q

Treatment of umbilical hernias?

A

Usually resolve by the age of 3; if >3 years of age, operate

19
Q

What is the processus vaginalis?

A

Tunica vaginalis is the embryological remnant of the processus vaginalis; in males, the processus vaginalis proceeds down the gubernaculum and forms a small pouch next to the testes and the neck closes off, called fusion, to form the tunica vaginalis

20
Q

What problems can occur with fusion?

A

If fusion does not occur completely and the neck remains open, a scrotal or inguinal hernia can form

Also, hydroceles can form, as fluid enters the processus vaginalis from the peritoneal cavity

21
Q

Occurrence of pediatric inguinal hernia?

A

30% present before the age of 1; they are far more common in males and also in premature and low birth weight infants

Right-sided hernias are more common and there is a risk of developing a contralateral hernia

22
Q

When does the risk of strangulation, with a pediatric inguinal hernial, occur?

A

Increased risk of strangulation if aged less than 1; urgent surgery required

23
Q

What are femoral hernias?

A

Form due to a defect in the femoral canal

24
Q

Boundaries of the inguinal canal?

A

Anterior - inguinal ligament
Medial - lacunar ligament
Lateral - femoral vein
Posterior - pectinate ligament

25
Q

Location and features of femoral hernias?

A

Below and lateral to the PUBIC TUBERCLE and usually flatten/cause a loss of the groin crease; they are 10 x more common in females, particular in thin, elderly females with no previous surgery

Half present as a surgical emergency and, of those, 50% require small bowel resection

26
Q

Location and features of inguinal hernias?

A

Above pubic tubercle and increase the groin crease

27
Q

How to examine scrotal swellings?

A

Can you get above it? - if yes, it is likely a scrotal swelling and perhaps a hydrocele; if not, it is likely an inguino-scrotal hernia

Can you feel the testes separate? - if you can separate from the testes, it is an epididymal cyst

28
Q

Causes of scrotal swellings?

A

Inguino-scrotal hernia (indirect)

Hydrocele

Epididymal cyst

Testicular swelling in young males; be wary of testicular cancer

29
Q

Signs of inguinal hernia?

A

Hernia to scrotum, probably an indirect hernia

Find the pubic tubercle:
If above and medial - inguinal
If below and lateral - femoral

Ask patient to cough

30
Q

How to clinically differentiate between direct or indirect hernias?

A

Not clinically useful:
Reduce hernia and place pressure over the deep inguinal ring and get patient to cough

Place little finger in the canal (behind the cord)

It is best to differentiate at surgery:
If medial to inferior epigastric vessels - direct
If lateral to inferior epigastric vessels - indirect

31
Q

Types of inguinal hernias?

A

Indirect inguinal hernias are lateral to the inferior epigastric vessels and with the cord; they may reach the scrotum and are more common in males
All congenital hernias are indirect

Direct inguinal hernia - posterior bulge through transversalis fascia and they are medial to the inferior epigastric vessels; they are often bilateral

32
Q

What is Hesselbach’s triangle?

A

Inguinal ligament inferiorly

Inferior epigastric vessels laterally

Lateral border of the rectus sheath medially

33
Q

When to operate on hernias?

A

Hernia at risk of complications even if no symptoms, e.g: femoral

Hernia with previous symptoms of obstruction

Hernia interfering with lifestyle

34
Q

Complications of inguinal hernias?

A

Haematoma (wound or scrotum)

Acute urinary retention

Wound infection

Chronic neurogenic pain

Hernia Recurrence

Testicular pain and atrophy

Clinical (54 decks)

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