Hernias Flashcards
Most common type of hernia after age 50
Direct
External hernia
Sac protrudes completely through abdominal wall
Intraparietal hernia
Sac is contained within the abdominal wall
Internal hernia
Sac is within the visceral cavity (ex. diaphragmatic hernia)
Protruding viscus can be returned to abdomen
Reducible hernia
Strangulated hernia
Vascularity of the viscus is compromised. Surgical emergency!
Anterior wall of inguinal canal
External oblique aponeurosis
Posterior wall of inguinal canal
Transverse abdominal muscle aponeurosis
Innervates cremaster muscle, skin of the side of the scrotum and labia
Genital nerve (L1-L2)
Site of direct inguinal hernia
Hesselbach’s triangle
Why are females more predisposed to femoral hernias than men?
Increased diameter of true pelvis…proportionally widens the femoral canal
DDX for inguinal hernia
Abdominal wall mass Desmoids Neoplasm Adenopathy Rectus sheath hematoma
Bassini’s repair
Suturing of conjoint tendon to the incurved part of the inguinal ligament
Benefits of laparoscopic repair
Decreased post-op pain
Decreased wound infection
How do you handle a hernia in a patient with ascites?
Repair the hernia AFTER the ascites is controlled
Complications of hernia surgery
Ischemic orchitis with testicular atrophy
Residual neuralgia
Recurrence is more common with which type of hernia?
Direct
Hernia more common in smokers
Direct: due to weakened connective tissue
Where is pain referred in a direct inguinal hernia?
Testis
Congenital indirect hernia is associated with a patent what?
Processus vaginalis
Which side is a hernia more common on in the first decade of life? Why?
Right: because of the late descent of right testis
Symptoms of obstructed femoral hernia?
vomiting, constipation
DDX femoral hernia
Inguinal hernia Saphenous varix Enlarged femoral lymph node Lipoma Femoral artery aneurysm Psoas abscess
Associated factors with umbilical hernias?
Ascites
Pregnancy
Obesity
Cause of pediatric umbilical hernia
Failure of timely closure of umbilical ring…central defect in linea alba
Type I esophageal hiatal hernia
Sliding type: cardia of stomach upwardly dislocates in the posterior mediastinum
*Most common type
Type II hiatal hernia
Upward dislocation of the gastric fundus alongside a normally positioned cardia
*No disruption of GE junction
Type III hiatal hernia
Upward dislocation of both the cardia and the gastric fundus
Sliding hiatal hernia predisposes patient to what?
Barretts esophagus
Which type of hiatal hernia warrants prompt surgical correction?
Type II (paraesophageal)–high frequency of complications (obstruction, strangulation, hemorrhage)
Richter’s hernia
Only part of the intestinal wall circumfrence is in the hernia. May strangulate without obstruction.
Littre’s hernia
Hernial sac containes Meckel’s diverticulum
Garengoff’s hernia
Hernial sac has the appendix
Pantaloon hernia
combo of direct and indirect inguinal hernia
Cooper’s hernia
Hernia that involves the femoral canal and tracts to the labia majora in females and to the scrotum in males
Hernias associated with obesity
Direct inguinal
Paraumbilical
Hiatal hernia
Incisional hernia
Result as surgical complication: associated with obesity, diabetes, and infection
