Hernias

Question 1

3 types of hernias (not locations)

Answer 1

reducible- can be returned to original body cavity
incarcerated- can’t be returned
strangulated- contain tsu w compromised vascular supply; esp dangerous, can lead to tsu necrosis –> perf, sepsis, death.

Question 2

Types of hernias by location

Answer 2

Indirect inguinal (50%)
Direct inguinal (25%)
Incisional
Ventral
Femoral (F>M)
Umbilical
Obdurator (rare)
Overall, 5:1 M:F

Question 3

What are the 3 fasical layers that keep abd contents intraperitoneal?

Answer 3

Innermost- transversalis
Middle- internal oblique
Outer- external oblique

Question 4

What is the border of the internal ring?

Answer 4

Transversalis and internal oblique
plus the pubic tubercle
Superior aspect is formed by arch of the transversalis

Question 5

Describe testicular descention during devt

Answer 5

Testes start intraperitoneally
Descend thru internal ring, taking a layer of periotneum with them, forming a hollow tube- this is the processus vaginalis.
Processus vaginalis collapses from a tube into a cord, plus transversalis maintains integrity of ring- so this is how hernias don’t occur.

Question 6

What is the cause of an indirect inguinal hernia?

Answer 6

When the processus vaginalis doesn’t obliterate into a cord (it stays a tube, where bowel can come through) from the intraperitoneum

Question 7

What is the cause of a direct inguinal hernia?

Answer 7

Weakened transversalis

Abd contents hernia directly thru the fascia

Question 8

T/F the external oblique has no fn in the pathogenesis of hernias

Answer 8

True.

It inserts onto the pubic tubercle and bounds the external(!) ring.

Question 9

Px of hernia

Answer 9

Intermittent bulge in groin/scrotum (reducible)
persistent bulge w nausea/vom (incarceration)
severe pain at hernia site/in abd w naus/vom (strangulation)

Question 10

PhysEx for hernia

Answer 10

Put finger on pubic tubercle and push upward to find superficial ring- feel bulge/prs when pt coughs
Reducible hernias can be pushed back, incarcerated can’t.
Strangulated hernias are tender, can be w abd distention or peritoneal signs (rebound, guarding)

Question 11

Indications for hernia repair

Answer 11

prevent bowel obstruction d/t incarceration of intestine
prevent bowel strangulation/perf
relieve sx

Question 12

T/F reducible inguinal hernias need to be repaired urgently

Answer 12

False. Can be repaired on elective basis. Either open or laproscopic

Question 13

What are the indications for lap hernia repair?

Answer 13

Bilateral or recurrent

Question 14

T/F strangulated hernias should not be reduced

Answer 14

True
Reduction is contraindicated- reducing necrotic bowel into abd can cause perf and sepsis.
Do emergency surgery.

Question 15

T/F the incidence of umbilical hernias is higher in caucasians.

Answer 15

false. africans.

Question 16

Indications for operation of umbilical hernia

Answer 16

incarceration, strangulation, cosmetic.
most regress by age 2
but, if very large- can become incarcerated, so surgery indicated.

Question 17

Where do femoral hernias occur? ventral hernias?

Answer 17

Femoral- femoral canal

Ventral- midline

Question 18

When/where do internal hernias occur?

Answer 18

After abd operations- bowel gets trapped dt adesions or new anatomy.
Major cause of bowel obstruction

Question 19

Where do obdurator hernias occur? In what pts?

Answer 19

Thru obdurator canal, which has obdurator nerve, artery, and vein.
Most asx, but nerve compressio can cause paresthesias or Howship-Romberg sign: pain radiating down middle thigh.
Occur in thin elderly women.