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Hernias Flashcards

1
Q

What is a hernia?

A

A protrusion of a viscus or part of a viscus through the wall which is designed to contain it

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2
Q

What is a viscus?

A

Internal organ of the body

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3
Q

What do hernias consist of?

A

Sac, coverings of the sac, contents

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4
Q

What does the hernia sac consist of?

A

Peritoneum

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5
Q

What are coverings of the hernia sac?

A

Skin, fat and fascia

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6
Q

What are common contents of a hernia?

A

Small bowel or omentum

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7
Q

What are the two most common hernias?

A

Femoral and inguinal

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8
Q

What is an inguinal hernia?

A

Bulge through the inguinal canal

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9
Q

What is a femoral hernia?

A

Bulge through the femoral canal

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10
Q

What is the most common groin hernia?

A

Inguinal

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11
Q

Why are inguinal hernias more common in men?

A

Passage of the testes through the inguinal canal during development makes it wider and more susceptible

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12
Q

Who are femoral hernias more common in?

A

Women with lots of children

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13
Q

Which type of hernia is more commonly an emergency presentation?

A

Femoral

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14
Q

What is the purpose of the inguinal canal?

A

None in females but allows the passage of the testes in males

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15
Q

What allows the passage of the spermatic cord through the inguinal canal?

A

Oblique intermuscular slit

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16
Q

What forms the roof of the inguinal canal?

A

Transversalis fascia, internal oblique, transversus abdominus

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17
Q

What makes up the posterior wall of the inguinal canal?

A

Transversalis fascia

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18
Q

What makes up the floor of the inguinal canal?

A

Inguinal ligament, lacunar ligament

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19
Q

What makes up the anterior wall of the inguinal canal?

A

Aponeurosis of the external oblique, internal oblique

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20
Q

Where does the inferior epigastric artery arise from?

A

External iliac artery

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21
Q

What supplies the muscles of the abdominal wall?

A

Inferior epigastric artery

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22
Q

Where does the inguinal ligament run from?

A

ASIS to pubic tubercle

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23
Q

What does the deep inguinal ring do?

A

Allows entry of the vas deferens, arteries, veins and nerves

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24
Q

Where is the deep inguinal ligament found?

A

2cm up from the midpoint of the inguinal ligament

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25
Q

What does the superficial ring do?

A

Allows exit of its contents into the scrotum

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26
Q

What is the rule associated with the spermatic cord?

A

3 arteries, 3 nerves, 3 other things

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27
Q

What are the 3 arteries of the spermatic cord?

A

Testicular artery, artery to vas deferens, (deferential artery), cremasteric artery (to cremasteric artery)

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28
Q

What are the 3 nerves of the spermatic cord?

A

Nerve to cremaster (genital branch of genitofemoral nerve), testicular nerve (sympathetic), ilioinguinal nerve (technically outside cord)

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29
Q

What are the 3 other things on the spermatic cord?

A

Vas (ductus) deferens, pampiniform plexus, lymphatic vessels

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30
Q

What are the risk factors for an inguinal hernia?

A

Male, increased age, obesity, chronic cough, previous hernia, heavy lifting, constipation, pregnancy

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31
Q

When is the peak incidence of inguinal hernias?

A

6th decade

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32
Q

Which side and type of inguinal hernias are more common?

A

Right side, indirect

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33
Q

Where are direct hernias in relation to the inferior epigastric vessels?

A

Medial

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34
Q

What happens in a direct hernia?

A

Abdominal contents herniate through a weak spot in the fascia of the posterior wall of the inguinal canal

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35
Q

Which type of hernia is more common in older men?

A

Direct

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36
Q

Where are indirect hernias in relation to the inferior epigastric vessels?

A

Lateral

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37
Q

What happens in an indirect hernia?

A

Abdominal contents protrude through the deep inguinal ring

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38
Q

What can be a cause of an indirect hernia?

A

Failure of embryonic closure of the processus vaginalis

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39
Q

What type of hernia can pass into the scrotum and how?

A

Indirect- through the inguinal canal

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40
Q

What is the process for differentiating between direct and indirect hernias?

A

Ask patient to stand up, press on hernia and cover deep ring, ask patient to cough

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41
Q

If the hernia does not bulge out on a cough, what is it?

A

Indirect

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42
Q

If a hernia does bulge out on a cough, what is it?

A

Direct

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43
Q

What is a risk of hernia (uncommon though)?

A

Incarceration (something getting stuck and causing loss of blood supply)

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44
Q

Do hernias always need to be treated?

A

No

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45
Q

What happens in terms of treatment in incarceration?

A

The hernia cannot be pushed back in manually

46
Q

What is open hernia surgery (Lichtenstein method)?

A

Inserting mesh over the site of the hernia once it has been pushed back in

47
Q

What type of anaesthetic is required for an open hernia repair?

A

Local or spinal

48
Q

What are the advantages of laparoscopic surgery?

A

Less pain, shorter recovery and less chance of infection

49
Q

What are the disadvantages of laparoscopic surgery?

A

Harder procedure to do/learn and cannot be done in emergencies

50
Q

What type of anaesthetic is needed for laparoscopic surgery?

A

General

51
Q

What is a major complication of the Lichtenstein method?

A

Damage to the ilioinguinal nerve which can cause chronic pain for a few years

52
Q

What are other complications of surgery?

A

Recurrence, urinary retention, bleeding.haematoma, numbness, testicular atrophy, wound infection

53
Q

What are types of emergency hernia?

A

Irreducible, strangulating or causing obstruction

54
Q

What is the first step to treating an emergency hernia?

A

Give patient analgesia and try to force it back in

55
Q

What is the second step (if the fist doesn’t work) in treating an emergency hernia?

A

surgery

56
Q

What type of hernias often have an acute emergency presentation?

A

Femoral

57
Q

What is the femoral canal in relation to the inguinal ligament?

A

Inferior border

58
Q

What is the anterior border of the femoral canal?

A

Inguinal ligament

59
Q

What is the posterior border of the femoral canal?

A

Pectineal line and ligament

60
Q

What is the medial border of the femoral canal?

A

Lacunar ligament

61
Q

What is the lateral border of the femoral canal?

A

Femoral vein

62
Q

Which of the four borders of the femoral canal is not firm?

A

Femoral vein

63
Q

What does the femoral canal contain?

A

Fat and lymph nodes

64
Q

What is the low/Lockwood approach to treating femoral hernias?

A

Used for elective surgery, incision below the medial portion of the inguinal ligament

65
Q

What is the high/McEvedy approach to treating femoral hernias?

A

Used for emergency surgey, incision transversely 2cm above the pubic tubercle and extending laterally

66
Q

What is done to eliminate the weak structure during surgery for femoral hernias?

A

Inguinal ligament is sutured to the pectineal ligament

67
Q

A hernia is a clinical diagnosis, but what tests can be done if need be?

A

Ultrasound or CT

68
Q

What should happen when a patient with a hernia lies down?

A

It should go away

69
Q

Where do inguinal hernias originate in relation to the pubic tubercle?

A

Above and medial

70
Q

Where do femoral hernias originate in relation to the pubic tubercle?

A

Below and lateral

71
Q

What is the difference in the urgency or treatment for inguinal and femoral hernias?

A

Inguinal- waiting list

Femoral- ASAP

72
Q

What causes an epigastric hernia?

A

A congenital defect in the linea alba between the xiphoid process of the sternum and the umbilicus

73
Q

Where are paraumbilical hernias found?

A

Usually above the umbilicus

74
Q

What are the risk factors for a paraumbilical hernia?

A

Obesity, pregnancy, ascites

75
Q

What are incisional hernias?

A

Acquired rather than congenital and usually occur in the site of a previous abdominal incision

76
Q

Who are incisional hernias more common in?

A

Older and frail people

77
Q

An obturator hernia is a hernia through where?

A

Obturator foramen

78
Q

What and who is an obturator hernia common in?

A

Cause of small bowel obstruction in elderly females

79
Q

What type of pain will people with an obturator hernia experience and why?

A

Thigh pain due to obturator nerve disruption

80
Q

What are common paediatric hernias and when do they usually resolve?

A

Umbilical hernias- by the age of 4

81
Q

What happens if umbilical hernias persist past the age of 4?

A

They must be repaired

82
Q

What hernias may baby boys also get?

A

Indirect inguinal hernias

83
Q

When are indirect inguinal hernias more common in baby boys and when do they show up?

A

More common in premature baby boys and show up when they cry

84
Q

What is a test for an indirect inguinal hernia in boys and how does this work?

A

Silk test- rubbing hand over groin will make a noise like bits of silk rubbing together

85
Q

Do indirect inguinal hernias in baby boys always need repaired?

A

Yes as they have a high rate of incarceration

86
Q

What technique is used to remove an indirect inguinal hernia from babies?

A

Herniotomy- hernia sac is ligated without any repair of the inguinal canal and no mesh is required

87
Q

Where is the superficial ring in relation to the pubic tubercle?

A

Above and medial

88
Q

What makes up Hesselbach’s triangle?

A
  • Inguinal ligament inferiorly
  • Inferior epigastric vessels laterally
  • Lateral border of the rectus sheath medially
89
Q

Which type of hernia is a ‘posterior bulge through the transversalis fascia’?

A

Direct inguinal

90
Q

Which type of hernia can often be bilateral?

A

Direct inguinal

91
Q

Which type of hernia is more common in younger men?

A

Indirect inguinal

92
Q

Which type of hernia is more common in older men?

A

Direct inguinal

93
Q

Which type of hernia can give scrotal swelling?

A

Indirect inguinal

94
Q

Is a hernia the only cause for scrotal swelling?

A

No

95
Q

Which type of inguinal hernia has a slightly higher risk of strangulation?

A

Indirect

96
Q

Should you treat an asymptomatic hernia, which is at risk for complications?

A

Yes

97
Q

What does strangulation of a hernia lead to?

A

Occlusion of the venous system, then the arterial system which leads to gangrene

98
Q

What 2 things should patients not do after surgery and for how long?

A

No driving for a week

No heavy lifting for a month

99
Q

Which type of hernia increases the groin crease and which loses it?

A

Inguinal- increases

Groin- loses

100
Q

A thin old lady presents with a hernia. She has 4 children. What type is it most likely to be?

A

Femoral

101
Q

What is another factor which makes a femoral hernia more likely, apart from being female with children?

A

Previous small bowel obstruction with no repair surgery

102
Q

A female presents with a hernia. What type is it most likely to be?

A

Inguinal (although it is more common for femoral hernias to occur in women, it is still more likely that a woman will have an inguinal hernia)

103
Q

What do epigastric hernias normally contain?

A

Extraperitoneal fat

104
Q

Who are epigastric hernias most common in?

A

Males, late teens or young adults

105
Q

What type of hernias are usually asymptomatic but may have local symptoms?

A

Epigastric

106
Q

How can epigastric hernias be repaired?

A

Sutures or mesh

107
Q

What is the main difference between umbilical and paraumbilical hernias?

A

Umbilical- children

Paraumbilical- adults

108
Q

Who is most likely to present with a paraumbilical hernia?

A

An obese adult (or pregnancy/ascites)

109
Q

As well as old, frail people, who is more at risk for an incisional hernia?

A

Someone who has had a wound infection post-op

110
Q

What is changed about the surgery in people at risk of incisional hernias?

A

Tension sutures are used and there is a mass closure of the linea alba

111
Q

Which side is an inguinal hernia in babies most likely to be on?

A

The right

GI (17 decks)

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