Hernias and SBO

Question 1

Most Common Differentials for Groin Mass

Answer 1

MINT: Malformations, Infection/Inflammation, Neoplasm, Trauma

Question 2

Examples of Malformations that result in a groin mass

Answer 2

Hernias, varicoceles, hydroceles, undescended testicles

Question 3

Examples of Infection/Inflammation that results in a groin mass

Answer 3

Reactive Lymphadenopathy, mononucleosis (EBV), abscess (furuncles, carbuncles), sarcoidosis, lymphogranuloma venereum

Question 4

Examples of Neoplasms that result in a groin mass

Answer 4

Lymphoma, lipoma, metastatic cancer

Question 5

Examples of Trauma that result in a groin mass

Answer 5

Hematoma, Femoral aneurysm, or pseudoaneurysm

Question 6

What is SIRS?

Answer 6

Systemic Inflammatory Response Syndrome: Elevated WBC, Fever, Tachycardia, Pain, Redness in skin overlying affected area.

Question 7

How do hernias develop?

Answer 7

Structural weakness in the abdominal wall in conjunction with increased abdominal pressure.

Question 8

What is a hernia?

Answer 8

A protrusion of tissues or organs through a defect, most commonly in the abdominal wall.

Question 9

Three components of a hernia

Answer 9

The abdominal wall defect, the hernia sac which protrudes through the defect, and the contents within the sac.

Question 10

What is the difference between a reducible and incarcerated hernia? Strangulated hernia?

Answer 10

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.

Question 11

Overall incidence of strangulation in inguinal hernias

Answer 11

<1%

Question 12

Signs of a strangulated hernia

Answer 12

SIRS: fever, tachycardia, elevated WBC, redness in skin overlying hernia.

Question 13

Where does a direct inguinal hernia develop?

Answer 13

Hesselbach’s triangle: medial to inferior epigastric artery, superior to the inguinal ligament, and lateral to the rectus abdominis.

Question 14

Where does an indirect inguinal hernia develop?

Answer 14

Protrudes through the internal inguinal

ring lateral to the inferior epigastric artery

Question 15

Where does a femoral hernia develop?

Answer 15

Passes through the femoral canal, into

empty space medial to femoral vein

Question 16

What structures are in the empty space in the femoral canal?

Answer 16

NAVEL: Femoral Nerve, Artery, Vein, Empty space, Lymphatic.

Question 17

Pathophysiology of indirect inguinal hernias

Answer 17

Patent processus vaginalis

Question 18

Which type of hernia is most likely to incarcerate?

Answer 18

Femoral hernias

Question 19

Borders of Hesselbach’s triangle

Answer 19

Inferior epigastric vessels laterally, rectus abdominis medially, inguinal ligament inferiorly.

Question 20

What is a Richter’s Hernia?

Answer 20

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.

Question 21

What Is a Sliding Hernia?

Answer 21

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.

Question 22

What are the indications for surgical treatment of an umbilical hernia?

Answer 22

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.

Question 23

Nerves at risk of injury during hernia repair

Answer 23

Genitofemoral nerve, ilioinguinal nerve, iliohypogastric nerve, lateral femoral cutaneous nerve.

Question 24

What is the most common cause of SBO worldwide?

Answer 24

Hernias

Question 25

What is the Howship-Romberg sign?

Answer 25

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.

Question 26

4 Cardinal signs of a strangulated bowel

Answer 26

Fever, tachycardia, elevated WBC, localized abdominal tenderness

Question 27

Closed loop obstruction

Answer 27

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.

Question 28

Most common causes of SBO

Answer 28

Crohn’s disease, Gallstone Ileus, Hernia, Intra-abdominal adhesions, Intussusception, Neoplasm, Volvulus

Question 29

What electrolyte abnormalities result from emesis in patients with SBO?

Answer 29

Dehydration, prerenal azotemia, and hypochloremic hypokalemic metabolic acidosis.

Question 30

Classic radiographic findings of SBO

Answer 30

Dilated loops of small bowel, air-fluid levels, bowel stacking.

Question 31

Three steps to management of a SBO

Answer 31

Fluid resuscitation, electrolyte repletion, and placement of a nasogastric tube. If no improvement, surgical intervention is warranted.

Question 32

What causes varicoceles?

Answer 32

Dilation of the pampiniform plexus veins