Hernias and SBO Flashcards
Most Common Differentials for Groin Mass
MINT: Malformations, Infection/Inflammation, Neoplasm, Trauma
Examples of Malformations that result in a groin mass
Hernias, varicoceles, hydroceles, undescended testicles
Examples of Infection/Inflammation that results in a groin mass
Reactive Lymphadenopathy, mononucleosis (EBV), abscess (furuncles, carbuncles), sarcoidosis, lymphogranuloma venereum
Examples of Neoplasms that result in a groin mass
Lymphoma, lipoma, metastatic cancer
Examples of Trauma that result in a groin mass
Hematoma, Femoral aneurysm, or pseudoaneurysm
What is SIRS?
Systemic Inflammatory Response Syndrome: Elevated WBC, Fever, Tachycardia, Pain, Redness in skin overlying affected area.
How do hernias develop?
Structural weakness in the abdominal wall in conjunction with increased abdominal pressure.
What is a hernia?
A protrusion of tissues or organs through a defect, most commonly in the abdominal wall.
Three components of a hernia
The abdominal wall defect, the hernia sac which protrudes through the defect, and the contents within the sac.
What is the difference between a reducible and incarcerated hernia? Strangulated hernia?
Reducible hernia: the contents within the sac can be pushed back through the defect into the peritoneal
cavity. Incarcerated hernia: the contents are stuck in the hernia sac. Strangulated hernia: a type of incarcerated
hernia in which there is compromised blood flow to the herniated organ.
Overall incidence of strangulation in inguinal hernias
<1%
Signs of a strangulated hernia
SIRS: fever, tachycardia, elevated WBC, redness in skin overlying hernia.
Where does a direct inguinal hernia develop?
Hesselbach’s triangle: medial to inferior epigastric artery, superior to the inguinal ligament, and lateral to the rectus abdominis.
Where does an indirect inguinal hernia develop?
Protrudes through the internal inguinal
ring lateral to the inferior epigastric artery
Where does a femoral hernia develop?
Passes through the femoral canal, into
empty space medial to femoral vein
What structures are in the empty space in the femoral canal?
NAVEL: Femoral Nerve, Artery, Vein, Empty space, Lymphatic.
Pathophysiology of indirect inguinal hernias
Patent processus vaginalis
Which type of hernia is most likely to incarcerate?
Femoral hernias
Borders of Hesselbach’s triangle
Inferior epigastric vessels laterally, rectus abdominis medially, inguinal ligament inferiorly.
What is a Richter’s Hernia?
It is a type of hernia that occurs when only part of the circumference of the bowel wall is trapped within the hernia sac. The herniated segment can become strangulated and result in ischemic changes.
What Is a Sliding Hernia?
A type of indirect hernia that occurs when a retroperitoneal organ (usually colon or bladder) typically herniates with the sac and essentially makes up the posterior wall of the sac. It usually occurs in males and more often on the left side.
What are the indications for surgical treatment of an umbilical hernia?
Persistence beyond age 4, hernia defect larger than 2 cm in diameter (unlikely to close spontaneously), strangulation, or progressive enlargement after 1–2 years of age.
Nerves at risk of injury during hernia repair
Genitofemoral nerve, ilioinguinal nerve, iliohypogastric nerve, lateral femoral cutaneous nerve.
What is the most common cause of SBO worldwide?
Hernias
What is the Howship-Romberg sign?
Pain in the medial aspect of the thigh with abduction, extension, or internal rotation of the hip due to compression of the obturator nerve by an obturator hernia.
4 Cardinal signs of a strangulated bowel
Fever, tachycardia, elevated WBC, localized abdominal tenderness
Closed loop obstruction
Form of bowel obstruction in which a segment of intestine is obstructed both proximally and distally. Gas and fluid accumulates within this segment of bowel and cannot escape. This progresses rapidly to strangulation with risk of ischemia and perforation.
Most common causes of SBO
Crohn’s disease, Gallstone Ileus, Hernia, Intra-abdominal adhesions, Intussusception, Neoplasm, Volvulus
What electrolyte abnormalities result from emesis in patients with SBO?
Dehydration, prerenal azotemia, and hypochloremic hypokalemic metabolic acidosis.
Classic radiographic findings of SBO
Dilated loops of small bowel, air-fluid levels, bowel stacking.
Three steps to management of a SBO
Fluid resuscitation, electrolyte repletion, and placement of a nasogastric tube. If no improvement, surgical intervention is warranted.
What causes varicoceles?
Dilation of the pampiniform plexus veins
