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YR3: Gastro LO's > Hernias > Flashcards

Hernias Flashcards

1
Q

What is a femoral hernia?

A

Abdominal contents pass through the femoral canal, presenting as a mass in the upper medial thigh.

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2
Q

List 4 risk factors for femoral hernias

A

Female
Increasing age
Pregnancy: higher in multiparous
Increased intra-abdominal pressure e.g. heavy lifting, chronic constipation

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3
Q

Describe the epidemiology of femoral hernias

A

Less common than inguinal but more likely to get incarcerated as are situated in a tighter place
F > M (esp. in middle age + elderly)
Account for 5% of abdominal hernias

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4
Q

Describe presentation of a femoral hernia

A

Lump in the groin
Usually asymptomatic at presentation
~30% present as an emergency due to obstruction or strangulation

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5
Q

Describe physical examination of femoral hernias

A

Look for lump + compare both sides
Ask pt to reduce lump, ask pt to cough
Check if BELOW + LATERAL to pubic tubercle
If no lump visible, feel for a cough impulse
Likely to be irreducible + to strangulate due to rigidity of the canal’s borders
Repeat examination with pt standing

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6
Q

What investigation may be used for femoral hernias?

A

US

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7
Q

Describe the management of femoral hernias

A

Refer due to risk of strangulation

Repair urgently, as 50% risk of strangulation within a month.

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8
Q

Give 2 surgical treatment stages of femoral hernias

A

Herniotomy: ligation + excision of the sac
Herniorrhaphy: repair of the hernial defect

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9
Q

What is the most common type of hernia?

A

Inguinal

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10
Q

How are inguinal hernias diagnosed?

A

CLINICAL DIAGNOSIS

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11
Q

What is an inguinal hernia?

A

Abnormal protrusion of a peritoneal sac through a weakness of the abdo wall in the inguinal region
Both types can emerge at the superficial inguinal ring (indirect more commonly)

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12
Q

What is a direct inguinal hernia?

A

Protrusion through a weakness in the POSTERIOR WALL of the inguinal canal
Contents emerge in the canal MEDIAL to the DEEP ring + INFERIOR epigastric vessels
Appear through Hesselbach’s triangle

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13
Q

What is an indirect inguinal hernia?

A

Protrusion THROUGH the DEEP inguinal ring, following the path of the inguinal canal
usually congenital

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14
Q

Describe the aetiology of inguinal hernias

A

Congenital: abdo contents enter the inguinal canal through a patent processus vaginalis
Acquired: increased intra-abdo pressure + weakness of abdo muscles

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15
Q

List 11 risk factors for inguinal hernias

A 
Male  
Prematurity 
Age  
Smoking: general defect in CT turnover in groin
Obesity  
FHx 
AAA 
Prev RLQ incision (e.g. for appendectomy)  
Defective transversalis fascia 
Chronic cough e.g. COPD  
CT disorder: Marfan's, Ehlers-Danlos
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16
Q

Describe the epidemiology of inguinal hernias

A

COMMON
Peak age in adults: 55-85 yrs
M > F

17
Q

How may inguinal hernias present?

A 
Asymptomatic  
Pt notices a 'lump in the groin' 
Discomfort + pain  
Irreducible  
Increased in size 
Complications (e.g. bowel obstruction; N+V, constipation)
18
Q

Describe physical examination of an inguinal hernia

A

Look for previous scars + check both sides; more common on R side
Can’t get above lump
Groin lump that extends to the scrotum or labia
If lump visible, ask pt to reduce it. If he can’t, make sure it is not a scrotal lump. If no lump visible, go straight to cough impulse.
Check for cough impulse
Auscultation: for bowel sounds over the hernia
Check for signs of complications
Repeat examination with pt standing

19
Q

Give 2 signs of complications of inguinal hernias on examination

A

Bowel obstruction + systemic upset (pyrexia, tachycardia etc.)
Tenderness if strangulated

20
Q

How do you distinguish between direct and indirect inguinal hernias?

A

Reduce the hernia + occlude the deep internal ring with 2 fingers.
Ask patient to cough/ stand.
If hernia is restrained= indirect.
If protrudes= direct

21
Q

What is the management plan for small, asymptomatic inguinal hernias?

A

Watchful waiting

22
Q

What investigations may be performed for inguinal hernias?

A

ABGs: may show lactic acidosis from bowel ischaemia
USS: exclude other causes of groin lump
Herniography (XR): rarely: requires intraperitoneal injection of non-ionic contrast admin beforehand
MRI: if unsure if there is herniation clinically

23
Q

What is the management plan for symptomatic uncomplicated inguinal hernias?

A

Elective repair:
Mesh Repair (open preferred for unilateral hernia, Laproscopic preferred for bilateral hernias)
Hernia is surgically reduced + a mesh is inserted to reinforce the defect in the transversalis fascia
Advise diet, if overweight, + to stop smoking before pre-op

24
Q

When is emergency surgery performed for inguinal hernias?

A

If obstructed or strangulated
Laparotomy with bowel resection may be indicated if the bowel is gangrenous
Abx prophylaxis e.g. single dose of a cephalosporin (e.g. cefazolin)

25
Q

List 5 complications of inguinal hernias

A

Incarceration
Strangulation
Bowel obstruction
Maydl’s hernia (strangulated W-shaped loop of small bowel)
Richter’s hernia (strangulation of only part of the bowel circumference)

26
Q

List 8 complications of surgery for inguinal hernias

A 
Pain + numbness 
Wound infection  
Haematoma  
Penile/ scrotal oedema  
Mesh infection  
Urinary retention for 24hrs after  
Wound seroma for a week after (don't drain routinely as may introduce an infection)   
Osteitis pubis
27
Q

What is the term used for presence of co-existing direct and indirect inguinal hernias?

A

pantaloon hernia

28
Q

How do you differentiate between inguinal and femoral hernias?

A

Inguinal: superior + medial to pubic tubercle
Femoral: inferior + lateral to pubic tubercle (+ medial to femoral pulse)

29
Q

Describe the anatomy of the inguinal ligament. What runs within the ligament?

A

Runs between ASIS + pubic tubercle.

Inguinal canal

30
Q

What passes through the inguinal canal?

A

Ilioinguinal nerve
+
Males: spermatic cord
Females: round ligament

31
Q

Describe the anatomy of the deep and superficial rings within the inguinal canal

A

Deep (entry): just above midpoint of inguinal ligament

Superficial (exit): just above + medial to pubic tubercle

32
Q

What is an irreducible hernia?

A

Can’t be pushed back into place

33
Q

What is a hernia?

A

protrusion of a viscus through a defect of the walls of its containing cavity into an abnormal space

34
Q

What is an obstructed hernia?

A

Bowel contents can’t pass through the no longer patent, compressed bowel lumen

35
Q

What is an incarcerated hernia?

A

contents of the hernial sac are stuck inside by adhesions

36
Q

What is a strangulated hernia?

A

Compression around the hernia prevents blood flow into the hernial contents causing ischaemia to the tissues within

37
Q

What is a reducible hernia?

A

Contents of hernia can be manipulated back into its original position through the defect from which it emerges

YR3: Gastro LO's (56 decks)

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