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Gastrointestinal Conditions (JBR) > Hernias > Flashcards

Hernias Flashcards

1
Q

Where do hiatus hernias occur?

A

At the gastro-oesophageal junction (part of the gastric cardia) above the diaphragm

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2
Q

What causes hiatus hernias?

A

Diaphragmatic weakness an increased intra-abdominal pressure

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3
Q

What is the major risk factor for hiatus hernias?

A

obestiy

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4
Q

What happens during a hiatus hernia?

A

Proximal stomach perforates through the diaphragm

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5
Q

What are the two types of hiatus hernias?

A

Sliding

Rolling (para-oesophageal)

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6
Q

What is the difference between a sliding and rolling hiatus hernia?

A

Sliding - LOS moves superiorly

Rolling - LOS stays in same position

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7
Q

How do hiatus hernias present?

A

Reflux, reflux oesophagitis

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8
Q

How can you investigate a possible hiatus hernia?

A

CXR
Barium swallow
Endoscopy

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9
Q

How do you manage a hiatus hernia?

A 
Avoid triggers 
Elevate head of bed to reduce reflux at night 
Weight loss
Smaller peals
PPIs
Surgery for specific patients
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10
Q

What is a hernia?

A

Abnormal protrusion of a viscus (internal body organ) outwit its normal body cavity (very common)

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11
Q

What does a hernia consist of?

A

A sac (peritoneum)
Cover of the sac
Contents (bowel, momentum, fat)

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12
Q

What are natural abdominal wall hernias?

A 
Inguinal
Femoral
Umbilical
Oesophageal Hiatus
Obturator
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13
Q

What are weak areas where hernias develop?

A

Incisional
Para-stomal
Epigastric
Para-umbilical

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14
Q

What is the main risk factor for hernias?

A

Increased intra-abdominal pressure

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15
Q

What are sources of increased intra-abdominal pressure?

A 
Heavy lifting
Coughing
Constipation
Prostation (BPH)
Pregnancy
Obesity
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16
Q

What happens during a hernia?

A

Section of bowel passes through a weak point

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17
Q

What are the two types of hernias?

A

Reducible

iressducible

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18
Q

Irreducible hernias can become obstructed leading to?

A

Strangulation or incarceration

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19
Q

What is strangulation?

A

Compromise of blood supply; venous then arterial –> gangrene

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20
Q

What are risk factors for incisional hernias?

A 
Age
Obesity
Debility
Post-op wound infection or haematoma
Increased abdominal pressure 
Steroids
Type of infeciton
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21
Q

What are predisposing factors for epigastric hernias?

A

Congenital weakness in linea alba

Male > female (usually late teens/early adult)

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22
Q

What are symptoms/features of epigastric hernias?

A

Usually asymptomatic or local symptoms

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23
Q

How do you treat epigastric hernias?

A

Suture/mesh

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24
Q

Congenital umbilical hernias are meant to resolve before the age of _____ otherwise operate

A

3-4

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25
Q

Paediatric hernias are more common in?

A

Males, preterm/LBW infants

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26
Q

Paediatric hernias occur most common on the _____ side

A

right

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27
Q

Paediatric hernias are almost alway _____

A

indirect

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28
Q

How do paediatric hernias typically present

A

Groin swelling on crying - may be difficult to elicit on examination

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29
Q

What is the silk sign of paediatric hernias?

A

Rubbing two layers against each other feels like 2 pieces of silk

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30
Q

How do you treat paediatric hernias?

A

Urgent surgical repair - increased strangulation risk < 1 year old

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31
Q

What is the anterior border of the femoral canal?

A

Inguinal ligament

32
Q

What is the posterior border of the femoral canal?

A

Pectinate ligament

33
Q

What is the lateral border of the femoral canal?

A

Femoral vein

34
Q

What is the medial border of the femoral canal?

A

Lancunar ligament

35
Q

Where are femoral hernias usually located?

A

Below and lateral to the pubic tubercle

36
Q

What usually happens to the groin crease when there is a femoral hernia?

A

Usually fall tens

37
Q

Femoral hernias occur more in?

A

Women

38
Q

What % of femoral hernias are surgical emergencies?

A

50

39
Q

What makes a femoral hernia a surgical emergency; if it is..?

A

Irreducible
Strangualtion
Obstruction

40
Q

How do you treat femoral hernias?

A

Gentle reduction under analgesia

Operative repair under resus (inguinal ligament is sutured to pectineal ligament)

41
Q

To find inguinal hernias you need to examine the patient..?

A

Upright

42
Q

If the hernia extends to the scrotum it is probably?

A

Indirect

43
Q

An inguinal hernia is usually above and medial to the?

A

Pubic tubercle

44
Q

An indirect inguinal hernia is a bulge straight through the?

A

Deep inguinal rign

45
Q

An indirect inguinal hernia is lateral to`

A

Inferior epigastric vessels and outwith the cord

46
Q

An indirect inguinal hernia may reach the?

A

Scrotum

47
Q

Indirect inguinal hernias are more common in?

A

Men

48
Q

What is the diagnostic feature differentiating direct and indirect inguinal hernias?

A

Indirect - can be controlled by digital pressure over inguinal ring (press and ask to cough - should stay in)
Direct - can’t

49
Q

Congenital inguinal hernias are always?

A

Indirect

50
Q

Direct inguinal hernias go straight through the?

A

Transversalis fascia in the posterior wall

51
Q

The posterior bulge through the transversals fascia is medial to the _____ and is often?

A

Inferior epigastric

Bilateral

52
Q

Direct inguinal hernias are more common in?

A

Older men

53
Q

Direct inguinal hernias never go through to the?

A

Scrotum

54
Q

What is the processus vaginalis?

A

Outpouching of peritoneum attached to testicel left behind as it descends

55
Q

If the obliteratetion of the processus vaginalis fails an _____ hernia occurs

A

Inguinal

56
Q

How do you treat a hernia?

A

Operate if risk of complications, previous symptoms of obstruction, interfering with lifestyle

57
Q

What are complications of inguinal hernias?

A 
Haematoma
Acute urinary retention
Wound infection
Chronic neurogenic pain
Recurrence
Numbness
Testicular atrophy/ischaemic orchitis
58
Q

What is a herniotomy?

A

Excise peritoneal sac - congenital hernias

59
Q

What is a herniorrhaphy?

A

Wall defect reapir

60
Q

The Liechtenstein method/open hernia repair can be done under?

A

Spinal or local

61
Q

Open hernia repairs have a higher rate of?

A

Infection

62
Q

Laprascopic hernia repairs have the advantages of? Disadvantages?

A

Less pain
Faster recovery

Needs GA
Longer learning curve for surgeons

63
Q

The inguinal canal is between the?

A

Deep and superficial ring

64
Q

The deep ring is at the?

A

Mid-inguinal point

65
Q

The superficial ring is where?

A

Above and medial to the pubic tubercle

66
Q

What is anterior to the inguinal canal?

A

External oblique aponeurosis

67
Q

What makes up the floor of the inguinal canal?

A

Inguinal and Lacunar ligament

68
Q

What makes up the roof of the inguinal ligament?

A

Conjoint tendon coming over

69
Q

What is posterior to the inguinal ligament?

A

Transversalis fascia and conjoint tendon (med)

70
Q

What makes up Hasselbach’s triangle?

A

Inguinal ligament inferiorly
Inferior epigastric vessels laterally
Lateral border of rectus sheath medially

71
Q

How do you investigate a hernia?

A

Assess standing and sitting
Ask them to cough
Is lump reducible?

72
Q

What is the position of inguinal hernias?

A

Originate above and lateral to pubic tubercle

73
Q

What is the position of a femoral hernia?

A

Originate below and lateral to the pubic tubercle

74
Q

What is incarceration of a hernia?

A

Contents of the hernia become trapped in the weak point in the abdominal wall which can obstruct the bowel leading to severe pain, nausea, vomiting, and the inability to pass bowels or gas

75
Q

An incarcerated hernia can cut off blood flow to part of the bowel; this is known as?

A

Strangulation

76
Q

How does a hernia usually present?

A

As a lump which is worst on coughing, disappears on lying down and can be pushed back in

Gastrointestinal Conditions (JBR) (33 decks)

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