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Year 2 > Hernias > Flashcards

Hernias Flashcards

1
Q

What is an inguinal hernia

A

Protrusion of abdominal contents through the inguinal canal

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2
Q

What arteries run through the spermatic cord

A
  1. Testicular artery
  2. Cremasteric artery
  3. Artery of Vas
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3
Q

What veins run though the spermatic cord

A
  1. Pampiniform plexus of testicular veins
  2. Cremasteric vein
  3. Vas vein
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4
Q

What does the ilii-inguinal nerve supply

A

Skin sensation to anterior 1/3 of external genitalia

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5
Q

What does the genitofemoral nerve supply

A

Cremasteric muscle

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6
Q

What does the sympathetic nerve supply

A

Vas and testicular pain

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7
Q

Role of vas deferens

A

Duct that transports sperm from the epididymis to the ejaculatory ducts

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8
Q

What is the tunica vaginalis

A

Serous membrane that covers the testes

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9
Q

Is a direct or indirect inguinal hernia more common

A

Indirect

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10
Q

What people do inguinal hernias effect

A

Men over 40

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11
Q

Risk factors for an inguinal hernia

A
  1. Male
  2. Chronic cough
  3. Constipation
  4. Urinary obstruction
  5. Heavy lifting
  6. Ascites
  7. Past abdominal surgery
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12
Q

What is the inguinal canal

A

A short passage that extends through inferior abdominal wall

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13
Q

Extent of inguinal canal

A

From deep inguinal ring to superficial ring

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14
Q

Role of the inguinal canal

A

Allows structures to pass from abdominal wall to the external genitalia

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15
Q

Where is the inguinal canal weakest

A

Aldo wall

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16
Q

Length of inguinal canal

A

5cm

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17
Q

Where does the direct hernia occur

A
  1. Where peritoneal sac enters the inguinal canal through posterior wall of the inguinal canal (medial to the inferior epigastric vessels)
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18
Q

Why are direct hernias not very common

A

Rarely strangulate

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19
Q

Where are indirect hernias located

A

Where peritoneal sac enters inguinal canal through deep inguinal ring

Lateral to inferior epigastric artery

20
Q

Clinical presentation of an inguinal hernia

A
  1. Bulges when you cough or strain
  2. Rarely painful
  3. Painful = strangulation
21
Q

Differential diagnosis of an inguinal hernia

A
  1. Femoral hernia
  2. Epididymitis
  3. Testicular torsion
  4. Groin abscess
  5. Aneurysm
  6. Hydrocele
  7. Undescended testes
22
Q

How is a inguinal hernia treated

A
  1. Use of truss to contain and prevent further progression
  2. Prosthetic mesh/open repair/ laparoscopy
  3. Pre-op: diet and stop smoking
  4. May reoccur
23
Q

What is a femoral hernia

A

Bowel comes through the femoral canal blow the inguinal ligament

24
Q

In what gender are femoral hernias common

A

FEMALES

25
Q

Pathophysiology of femoral hernias

A
  1. Bowel meters femoral canal presenting as a mass
26
Q

Where is the femoral hernia mass felt

A
  1. upper medial thigh

2. Above inguinal ligament where it points down the leg

27
Q

Where do inguinal hernias point to

A

Groin

28
Q

Characteristic of femoral hernias

A

Irreducible and easily strangulated

29
Q

Why is the femoral hernia easy to strangulate

A

Due to rigidity of the canal’s borders

30
Q

Where is the neck of the femoral hernia felt

A
  1. Inferior and lateral to pubic tubercle (inguinal hernias are superior and medial to this point)
31
Q

Differential diagnosis of femoral hernias

A
  1. Inguinal hernia
  2. Lipoma
  3. Femoral aneurysm
  4. Psoas abscess
  5. Saphena varix
32
Q

What is the saphena varies

A

Dilation of saphenous vein at junction of femoral vein in groin

33
Q

How are femoral hernias treated

A
  1. Surgical repairs
  2. Heriotomy (ligation and excision of sac)
  3. Herniorrhaphy (repair of hernial defect)
34
Q

What is ligation

A

Stopping bleeding once sac is removed

35
Q

What is an incisional hernia

A
  1. Occurs when tissue protrudes through surgical scar that is weak
36
Q

Where can incisional hernias occur

A

Anywhere there is an incision and follows breakdown of muscle closure after surgery

37
Q

What factor makes repairing an incisional hernia more difficult

A

Obesity

38
Q

Risk factors for incisional hernias

A
  1. Emergency surgery
  2. Wound infection post-op
  3. Persistent coughing and heavy lifting
  4. Poor nutrition
39
Q

Who do hiatus hernias tend to effect

A

Over 50 aged women

40
Q

What is a sliding hiatus hernia

A
  1. Where gastro-oesophageal junction part of the stomach slides up to the chest via the hiatus so that it lies above the diaphragm
41
Q

Why does acid reflux happen in hiatus hernias

A

As lower oesophageal sphincter becomes less competent in many cases

42
Q

What is a rolling or para-oesophageal hiatus

A

Where the gastro-oesophageal junction remains in the abdomen but part of the funds of the stomach prolapses through the hiatus alongside the oesophagus

43
Q

When is reflux uncommon in para-oesophageal hiatus

A

When the gastro-oesophageal junction remains intact

44
Q

Clinical feature of hiatus hernias

A

GORD (50% of patients)

45
Q

How is hiatus hernias diagonsed

A
  1. Barium swallow and Upper GI endoscopy
46
Q

Why is an upper GI endoscopy beneficial in hiatus hernias

A

Visualises the mucosa (can’t exclude hiatus hernia)

47
Q

How are hiatus hernias treated

A
  1. Lose weight
  2. Treat reflux symptoms
  3. Surgically treat to prevent strangulation

Year 2 (155 decks)

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