Hernias Flashcards
(L. rupture) Protrusion of a peritoneal sac through a musculoaponeurotic barrier
Hernia
Incidence of Hernia
5-10% lifetime
50% indirect inguinal
25% direct inguinal
=5% are femoral
Precipitating factors of hernias
Increased intraabdominal pressure
straining at defecation or urination
COPD
Why should hernias be repaired?
To avoid complications of INCARCERATIONS/Strangulation, bowel necrosis, SBO, pain
What is more dangrerous: a large or small hernia defect?
SMALL: tight defect is more likely to strangulate if incarcerated
Ability to return the displaced organ or tissue/hernia contents to their usual anatomic site
Reducible
Swollen or fixed within the hernial sac
Incarceated
Strangulated
Incarcerated with resulting ischemia
Hernia sac and its contents protrude all the way through the defect
Complete
Defect present without sac
Incomplete
Hernia sac partially formed by the wall of a viscus
Sliding hernia
Hernia involving a Mecke’s diverticulum
Littre’s henria
Thing alphabetically = LM
Hernia through the linea semilunaris
Spigelian
Hernia into or involving intraabdominal structure
Internal Hernia
after bariatric gastric bypass
Peterson’s hernia
Petit’s hernia or Grynfeltt’s hernia
Lumbar hernia
Both a direct and indirect
Pantaloon hernia
Incisional hernia in the ventral abdominal wall
Ventral
Hernia adjacent to an ostomy
Paratomal hernia
Only one sidewall of the bowel involved
Richter’s hernia
Abdominal contents migrate between the layers of the abdominal wall
Intraparietal hernia
Hernia MEDIAL to femoral vessels
Femoral hernia
Hernia UNDER the inguinal LIGAMENT, LATERAL to femoral vessels
Hesselbach’s hernia
Hernia THROUGH the femoral canal tracking into the scrotum or labia majus
COPPER’s
Hernia LATERAL to the Hesselbach’s triangle
Indirect inguinal
Inguinial Hernia WITHING the HESSELBACH’ triangle
Direct
hernia containing a ruptured appendix
Amyand’s
The bounderies of the HESSELBACH’s triangle
Inferior epigastric levels
Inguinal ligament (Pourparts)
Lateral border of the rectus sheath
What are the LAYERS of the abdominal wall?
Skin Subcutaneous fat Scarpa's Fascia External oblique Internal oblique Transversus abdominis Transversalis fascia Peritoneal fat Peritoneum
Hernia within the floor of HESSELBACH’s triangle
Direct inguinal
Cause of direct inguinal hernia
Anatomical breakfown over the years
Hernia through the internal ring of the inguinal canal, traveling down toward the external ring
Indirect inguinal hernia
What is the cause of INDIRECT inguinal hernia
Patent processus vaginalis
How do you diagnose indirect inguinal herna
Hx and PE
examination with index finger invaginated into the external ring and palpation of hernia
Treatment for Indirect inguinal hernia
Emergent herniorrhaphy - Strangulated
Hernia traveling BENEATH the inguinal ligamant down the femoral canal medial to the femoral vessels
Femoral Hernia
Factors associated with femoral hernias
women
pregnancy
exertion
% of all femoral hernias
5%
% of all female femoral hernas
85%!
Complications of femoral hernia
1/3 incarcerate
Most common hernia in women
indirect inguinal hernia
What is the repair of a femoral hernia
McVay (cooper’s ligament repair)
Mesh plug repair
Which comes first?
Elective TURP or Elective hernioraphy?
TURP
What must you do before leaving the OR after and inguinal hernia repair?
Pull the testicle back down the scrotum
