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Clin Med 2 > Hernias > Flashcards

Hernias Flashcards

1
Q

Patho of Hernia

A

protrusion of an organ as part of an organ through the body wall that normally contains it

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2
Q

Most common type of hernia

A

groin

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3
Q

Most common hernia

A

inguinal

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4
Q

Types of groin hernias

A

inguinal and femoral

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5
Q

Types of ventral hernias

A

umbilical, epigastric, spigelian

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6
Q

Incisional hernias are due to? What type of hernia?

A
  • Due to open abdominal procedure and incision through the abdominal wall
  • Ventral hernia
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7
Q

Reducible Hernia

A

tissue is easily movable and can be reduced from the sac and easily pushed back in

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8
Q

Incarcerated Hernia

A

Trapping of hernia within the sac without compromise of vasculature

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9
Q

Strangulated Hernia

A

Circulation of hernia contents is compromised

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10
Q

What do we worry about with strangulated hernias?

A

ischemia–> dead bowel–> sepsis

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11
Q

2 types of inguinal hernias

A

direct and indirect

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12
Q

Direct inguinal hernia

A
  • inferior to epigastric vessels and doesn’t pass through inguinal canal
  • ACQUIRED
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13
Q

Indirect inguinal hernia

A
  • passes through the inguinal ring

- CONGENITAL

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14
Q

Femoral hernia

A

inferior to the inguinal ligament

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15
Q

Hesselbach’s triangle contains

A

inguinal ligament, epigastric vessel and rectus muscle

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16
Q

Cause of Acquired groin hernias

A

weakening or disruuption of fibromuscular tissue due to:

  • trauma
  • drugs
  • connective tissue abnormality (Marfan/ DE)
  • chronic overstretching of musculoaponeurotic structures
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17
Q

Age of groin hernias for men/women

A

Women get it later in life 60-80; men 50-70

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18
Q

Risk factor for groin hernia

A
  • HX of hernia or repair
  • old age
  • male
  • white
  • chronic constipation
  • abdominal wall injury
  • smoking
  • family history of hernias
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19
Q

Clinical Presentation/PE of groin hernia

A
  • bulge in the groin that may be tender to palpate but generally has no pain
  • heavy/discomfort in groin
  • slight pelvic pain in women
  • worst at end of day/ prolonged sitting
  • radiating twinge of pain with sitting/standing
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20
Q

Who is more likely to get groin hernias?

A

patients who work in manual/physically active professions

21
Q

Clinical presentation of reducable hernias

A
  • some pain

- asymptomatic

22
Q

Clinical presentation of incarcaerated hernias

A
  • +/- N/V, pain, block
  • tenderness, bowels may not move due to obstruction
  • fever
23
Q

Clinical presentation of strangulated hernias

A
  • painful
  • +/- N/V, pain, block
    ischemia–> pain out of proportion
24
Q

How do you examine inguinal canal?

A

use small finger to go into it and have patient cough.
If you feel bulge next to finger–> direct
If you feel bulge hit finger–> indirect

25
Q

Dx Groin Hernias

A

H/PE

Use US if occult, differentiation, determining if strangulation/incarceration

26
Q

Tx groin hernias

A 
ASx- monitor
Surgical:
- moderate to severe sx
- Urgent- incarceration
- Emergency- strangulation, bowel obstruction
- Laproscopic/open
- Mesh: durable and longevity
- Aloderm: human cadaver skin; less likely to get infected
27
Q

Tx Femoral Hernia

A

Surgery

28
Q

Pantaloon Hernia

A

both direct and indirect hernia on the same side

29
Q

How do you see an incisional hernia?

A

Have ptn lay down and sit up a little–> pop out

30
Q

Umbilical hernia is a protrusion through?

A

umbilical ring

31
Q

Who gets umbilical hernias?

A

Adults- acquired

Children- congenital; close spontaneously by 1.5yr

32
Q

RF for umbilical hernia

A

obesity
pregnant
ascites

33
Q

Where is an epigastric hernia?

A

in the epigastrium (upper/central abdomen)

34
Q

Where does the Spigelian hernia form?

A

through the spigelian fascia; ACQUIRED

35
Q

Clinical Spigelian hernia

A
  • swelling lateral to the rectus muscle

- pain is dull/ constant

36
Q

Dx Spigelian hernia

A

US

37
Q

Tx Spigelian hernia

A

surgical because very painful and complicated; trapped easily

38
Q

Patho Richter’s Hernia

A
  • Part of circumference of bowel becomes incarcerated

- little piece of bowel wall is stuck in hernia– weakening of the bowel wall, ischemia, or rupture

39
Q

Most common site of Richter’s Hernia

A

femoral canal

40
Q

Clinical Richter’s Hernia

A
  • local inflammation

- overtime ischemia, gangrene, perforation

41
Q

Tx Richter’s Hernia

A
  • surgical
42
Q

Parastomal hernia common in patients with?

A

stoma (ileostomy or colostomy)

43
Q

Tx Parastomal hernia

A

based on sx

44
Q

Clinical Parastomal hernia

A
  • bowels and intestine protrude out of stoma
  • skin is clean and normal looking
  • patient comfortable
45
Q

What is not a true hernia and why?

A

Rectus Abdominus Diastasis; not a break in the rectal wall only a seperation of the walls

46
Q

Biggest RF for Rectus Abdominus Diastasis

A

Pregnancy

47
Q

Cause Rectus Abdominus Diastasis

A
  • weak/stretched abdominal wall fascia due to pregnancy/ obesity
  • some association with aneurysmal disease
48
Q

Dx Rectus Abdominus Diastasis

A

PE- prominent ridge between two rectus abdominous while sitting

49
Q

Tx Rectus Abdominus Diastasis

A

conservative- weight loss, abdominal exercise

surgical- cosmetic/ severe sx

Clin Med 2 (25 decks)

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