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D3 > Hernias > Flashcards

Hernias Flashcards

1
Q

Hernia

A

Protrusion of a viscus or part of a viscus through the walls of its containing cavity into an abnormal position.

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2
Q

Reducible

A

Sac can return to the abdominal cavity either spontaneously or w manipulation.

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3
Q

Irreducible

A

Sac cannot be reduced despite pressure or manipulation

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4
Q

Strangulated

A

Blood supply of contents is compromised due to pressure at the neck of the hernia.

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5
Q

Sliding hernia

A

Part of the sac is formed by bowel (e.g. caecum or sigmoid): take care when excising the sac.

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6
Q

Maydl’s

A

Herniating double loop of bowel. Strangulated portion may reside as a single loop inside the abdomen

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7
Q

Littre’s Hernia

A

Hernial Sac containing strangulated Meckel’s Diverticulum

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8
Q

Amyand’s hernia

A

Inguinal hernia containing stangulated appendix

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9
Q

Richter’s hernia

A

only part of circumference of bowel is within sac - commonly seen w femoral hernias
can stangulate w/o obstructing

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10
Q

pantaloon

A

simultaneous direct + indirect hernia

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11
Q

Herniotomy

A

excision of hernial sac

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12
Q

herniorrhaphy

A

suture repair or hernial defect

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13
Q

hernioplasty

A

mesh repair of hernial defect

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14
Q

Inguinal Hernia

A

M>F 50s
More common on R (?post-appendicectomy)
8-15% present as emergency - strangulation/ obstruction

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15
Q

Inguinal hernia Aetiology

A

Congenital patent processur vaginalis
- processus vaginalis should obliterate after descent of testes
- if stays patent - may fill with: fluid > hydrocele
> bowel/omentum > indirect hernia

Acquired - mainly  ^IAP
 Chronic cough: COPD, asthma
 Prostatism
 Constipation
 Severe muscular effort: e.g. heavy lifting
 Previous incision/repair
 Ascites / obesity
 Appendicectomy
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16
Q

Inguinal Hernia Classification

A

Indirect - 80% younger

  • congenital patnet processus vaginalis
  • emerge through deep ring
  • same 3 coverings as cord and descned into scrotum
  • can strangulate

Direct - 20% elderly

  • acquired
  • emergen through Hesselbach’s triangle
  • can acquire internal + external spermatic fascia
  • rarely descend into scrotum
  • rarely strangulate

Ix
- US if in doubt

17
Q

Clinical Features of inguinal hernia

A

Children - lump in groin which may descend into scrotum

  • exacerbated by crying
  • commonly obstruct

Adults - lump in groin exacerbated by straining/coughing

  • may be clear ppting event - heavy lifting
  • dragging pain radiating to groin
  • may present w obstruction _ strangulation

Questions
 Reducible?
 Ever episodes of obstruction / strangulation?
 Predisposing factors: cough, straining, lifting?
 Occupation and social circumstances?

18
Q

Inguinal Hernia Mx

A

Non-surgical
- Rx RFs - coughs, constipation
- wt loss
Truss

Surgical
- Tension free mesh (lichtenstein repair) better than suture repair (shuoldice)
> 2% recurrence vs 10%

open approach can be done under LA or GA
Lap approach allows bilateral repair > improved cosmesis
- preferred for recurrent hernias

Primary unilateral repairs should be open (NICE)

Children only require Sac excision (herniotomy)

19
Q

Inguinal Hernia Complications

A 
Early
 Haematoma / seroma formation: 10%
 Intra-abdominal injury (lap)
 Infection: 1%
 Urinary retention

Late
 Recurrence (<2%)
 Ischaemic orchitis: 0.5%
 Chronic groin pain / paraesthesia: 5%

20
Q

Femoral Hernia

definition, EP, Aetiology

A

Protrusion of viscus through femoral canal

F>M middle aged + elderly

Acquired - ^IAP. Femoral canal larger in females due to shape of pelvis + changes in configuration due to birth

21
Q

Femoral Hernia Clinical Features

A

Painless groin lump

  • neck inferior + lateral to pubic tubercle
  • cough impulse
  • often irreducible (tight borders)

Commonly w obstruction or strangulation

  • tender, red and hot
  • abdo pain, distension, vomiting, constipation
22
Q

Femoral Hernia Mx

A

 50% risk of strangulation w/i 1mo
 Urgent surgery

Elective: Lockwood Approach
 Low incision over hernia c¯ herniotomy and herniorrhaphy (suture ing. ligt. to pectineal ligt.)

Emergency: McEvedy Approach
 High approach in inguinal region to allow inspection and resection of non-viable bowel.
 Then herniotomy and herniorrhaphy

23
Q

Incisional Hernia

A

Hernia arising through previously acquired defect

6% of incisions

RF
Pre-operative
 ↑ age
 Obesity or malnutrition
 Comorbidities: DM, renal failure, malignancy
 Drugs: steroids, chemo, radio
Intra-operative
 Surgical technique/skill (major factor)
 Too small suture bites
 Inappropriate suture material
 Incision type (e.g. midline)
 Placing drains through wounds

Post-operative
 ↑ IAP: chronic cough, straining, post-op ileus
 Infection
 Haematoma

24
Q

Incisional Hernia Mx

A

Surgery is not appropriate for all patients.
 risk of operation and recurrence w risk of obstruction/strangulation and pt. choice.
 Usually broad-necked > low risk of strangulation

Conservative
 Manage RFs: e.g. constipation, cough
 Weight loss
 Elasticated corset or truss

Surgical
Pre-Op
 Optimise cardiorespiratory function
 Encourage wt. loss
Nylon mesh repair: open or lap
25
Q

Umbilical Hernia

A

Features - Congenital, 3% of LBs, defect in umbilical scar

RF - afrocaribbean, Down’s, Congen hypothyroidism

Mx

  • usually resolves 2-3 years
  • Mesh repair if no closure
  • can recur in adults - pregn or gross ascites
26
Q

Paraumbilical Hernia

A

Features

  • acquired - middle aged obese men
  • defect through linea alba (just above/below umbilicus)
  • small defect > strangulation (often omentum)

RF - chronic cough
- straining

Mx -

  • Mayo (double breasted liena alba sutures)
  • mesh repair
27
Q

Epigastric Hernia

A

Features M>F

  • pea-sized swelling caused by defect in linea alba above the umbilicus
  • usually contains omentum - can strangulate

Mx - mesh repair

28
Q

Spigelian Hernia

A

Hernia through linea semilunaris
Hernia lies between layers of abdo wall
Palpable mass more likely to be colon Ca

29
Q

Obturator Hernia

A

F>M old age
Sac protrudes through obturator foramen
PAin on inner aspect of thigh or knee
Frequently present obstructed/strangualted

30
Q

Lumbar hernia

A

Middle aged M>F
typically following loin incisions
Hernias through sup/inf lumbar triangles

31
Q

Sciatic hernia

A

hernia through lesser sciatic foramen

usually presents as small bowel obstruction + gluteal mass

32
Q

Gluteal Hernia

A

Hernia through greater sciatic foramen

Usually persents SBO + gluteal mass

D3 (14 decks)

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