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G.I. > Hernias > Flashcards

Hernias Flashcards

1
Q

A hernia consists of 3 layers

A 
1. A sac (of peritoneum)
   o The bulge people get 
   o	Skin, fat and fascia
   o	More interested in the hole, the defect allowing the hernia to happen 
   o	Omentum, small bowel, or just fat
  1. Coverings of the sac
  2. Contents
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2
Q

Common adult hernias

A 
> Inguinal
> Femoral
> Para-umbilical
> Epigastric
> Incisional
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3
Q

Inguinal hernias

A

> Very common in men
can be “direct” or “indirect”

> right commoner than left

Indirect is more common.

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4
Q

Spermatic Cord consists of?

A

> 3 arteries
3 nerves
3 other things

arteries//

  • testicular artery, deferential artery, cremasteric muscle artery

Nerves//

  • genital branch of the genitofemoral, cremasteric nerve, sympathetic nerve fibers

3 other things//

  • ductus deferens, pampiniform plexus, lymphatic vessels
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5
Q

Femoral hernias

A

commoner in females - elderly, several children

emergency procedure

easily missed

40% present acutely

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6
Q

Risk factors for groin hernias

A 
> Male
> age
> Obesity
> Chronic cough
> Prev hernia
> Collagen disorder
> AAA
> Appendicectomy
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7
Q

Indirect hernia?

A

Bulges straight through the deep inguinal ring.

Traverses inguinal canal

Lateral to inferior epigastric vessels

Can go into scrotum.

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8
Q

Direct hernia?

A

Bulge through weakened transversals fascia

directly behind superficial inguinal ring

medial to inferior epigastric vessels

NEVER/rarely go into the scrotum

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9
Q

Where is there transversals fascia?

A

Roof of the inguinal canal

Posterior wall

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10
Q

Repair of inguinal hernias

A

> Watchful waiting - elderly and frail with asymptomatic hernia

> Beware of groin pain hernia

> OPERATION

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11
Q

Incarcerated hernia

A

Something (like the small bowel) has become trapped within the hernia and is losing blood supply due to strangulation.

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12
Q

Open Hernia surgery

A

Lichtenstein method

  • Mesh repair
  • does not put tension on muscles
  • lowers rate of recurrence
  • uses glue
  • patients are able to walk only a few hours after surgery
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13
Q

Laparoscopic surgery

A
  • less pain and faster recovery
  • needs general anaesthetic
  • longer learning curve
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14
Q

Post-surgery complciations

A 
> Recurrence
> Urinary retention
> Bleeding/haematoma
> Chronic pain
> numbness
> Testicular atrophy
> Wound infection
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15
Q

Hernias - emergency presentation

A

> Irreducible
Strangulate
Obstruct

  • if reducible, push it back in under anaesthetic
  • If not –> operative repair after rests
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16
Q

Femoral canal (structures)

A

NAV Y fronts

Nerve –> Artery –> Vein (laterally to medially)

17
Q

Femoral or inguinal - which is more prone to incarceration?

A

Femoral - lots of tight, firm tissue.

18
Q

Groin lump assessment

What should you ask the patient to do?

A

> Hernia is usually a clinical diagnosis
Assess standing and sitting

> Ask patient to COUGH
Is the lump reducible?

Position

19
Q

What is meant by reducible?

A

Can the hernia be pushed back inside

20
Q

Where does neck of inguinal hernia originate?

A

Above and medial to pubic tubercle

21
Q

Where do femoral hernias originate?

A

Below and lateral to the pubic tubercle

22
Q

Which hernias are more urgent?

A

Femoral hernias

23
Q

Epigastric Hernia

A

> Defect in the linea alba between the xiphisternumand umbilicus

Congenital

More common in females
obesity and pregnancy

24
Q

Paraumbilical Hernias

A

Defect around the umbilicus
Obesity, pregnancy, ascites

Almost always repaired
suture
open mesh
laparoscopic

25
Q

Incisional Hernia

A

> Hernia at site of prev abode incision

Occur in 10-15% of abode incisions

Risk factors//

obesity
smoking
age
surgical site infection
post chest infection

Whole wound might give way
Often quite large

26
Q

Paediatric hernias

A

Common
usually resolve by age 4

If they persist - repair them.

27
Q

Paediatric inguinal hernia

  • presentation
  • more common in
  • specific sign (soft material)
A

3-5% of Boys at term
Almost always INDIRECT.
Commoner in prem babies

Groin swelling on crying
Maybe difficult to elicit on exam

“SILK” sign - when palpating child’s groin, you can feel the hernial sac which feels like rubbing silk together.

ALWAYS REPAIRED

28
Q

Obturator hernia (rare)

A
  • Cause of small bowel obstruction in elderly females
  • Medial thigh pain - obturator nerve compression
  • small bowel passes through obturator canal

more common females

G.I. (20 decks)

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