Hernias, C36 P209-223 Flashcards
What is a hernia?
P209
(L. rupture) Protrusion of a peritoneal
sac through a musculoaponeurotic barrier
(e.g., abdominal wall); a fascial defect
What is the incidence?
P209
5%–10% lifetime; 50% are indirect
inguinal, 25% are direct inguinal, and
≈5% are femoral
What are the precipitating factors?
P209
Increased intra-abdominal pressure: straining at defecation or urination (rectal cancer, colon cancer, prostatic enlargement, constipation), obesity, pregnancy, ascites, valsavagenic (coughing) COPD; an abnormal congenital anatomic route (i.e., patent processus vaginalis)
Why should hernias be repaired?
P209
To avoid complications of incarceration/
strangulation, bowel necrosis, SBO, pain
What is more dangerous:
a small or large hernia defect?
P209
Small defect is more dangerous because a
tight defect is more likely to strangulate if
incarcerated
Define the following descriptive terms:
Reducible
P209
Ability to return the displaced organ or
tissue/hernia contents to their usual
anatomic site
Define the following descriptive terms:
Incarcerated
P209
Swollen or fixed within the hernia sac (incarcerated = imprisoned); may cause intestinal obstruction (i.e., an irreducible hernia)
Define the following descriptive terms:
Strangulated
P210 (picture)
Incarcerated hernia with resulting ischemia; will result in signs and symptoms of ischemia and intestinal obstruction or bowel necrosis (Think: strangulated = choked)
Define the following descriptive terms:
Complete
P210
Hernia sac and its contents protrude all
the way through the defect
Define the following descriptive terms:
Incomplete
P210
Defect present without sac or contents
protruding completely through it
What is reducing a hernia
“en masse”?
P210 (picture)
Reducing the hernia contents and
hernia sac
Define the following types of hernias:
Sliding hernia
P211 (picture)
Hernia sac partially formed by the wall of a viscus (i.e., bladder/cecum)
Define the following types of hernias:
Littre’s hernia
P211
Hernia involving a Meckel’s diverticulum
Think alphabetically: Littre’s Meckel’s = LM
Define the following types of hernias:
Spigelian hernia
P211
Hernia through the linea semilunaris
(or spigelian fascia); also known as
spontaneous lateral ventral hernia
(Think: Spigelian = Semilunaris)
Define the following types of hernias:
Internal hernia
P211
Hernia into or involving intra-abdominal
structure
Define the following types of hernias:
Petersen’s hernia
P211
Seen after bariatric gastric bypass—
internal herniation of small bowel
through the mesenteric defect from the
Roux limb
Define the following types of hernias:
Obturator hernia
P211
Hernia through obturator canal
females > males
Define the following types of hernias:
Lumbar hernia
P211
Petit’s hernia or Grynfeltt’s hernia
Define the following types of hernias:
Petit’s hernia
P211
(Rare) hernia through Petit’s triangle
(a.k.a. inferior lumbar triangle)
(Think: petite = small = inferior)
Define the following types of hernias:
Grynfeltt’s hernia
P211
Hernia through Grynfeltt-Lesshaft
triangle (superior lumbar triangle)
Define the following types of hernias:
Pantaloon hernia
P212 (picture)
Hernia sac exists as both a direct and indirect hernia straddling the inferior epigastric vessels and protruding through the floor of the canal as well as the internal ring (two sacs separated by the inferior epigastric vessels [the pant crotch] like a pair of pantaloon pants)
Define the following types of hernias:
Incisional hernia
P212
Hernia through an incisional site; most
common cause is a wound infection
Define the following types of hernias:
Ventral hernia
P212
Incisional hernia in the ventral abdominal
wall
Define the following types of hernias:
Parastomal hernia
P212
Hernia adjacent to an ostomy (e.g.,
colostomy)
Define the following types of hernias:
Sciatic hernia
P212
Hernia through the sciatic foramen
Define the following types of hernias:
Richter’s hernia
P212 (picture)
Incarcerated or strangulated hernia
involving only one sidewall of the bowel,
which can spontaneously reduce, resulting
in gangrenous bowel and perforation within
the abdomen without signs of obstruction
Define the following types of hernias:
Epigastric hernia
P213
Hernia through the linea alba above the
umbilicus
Define the following types of hernias:
Umbilical hernia
P213
Hernia through the umbilical ring, in
adults associated with ascites, pregnancy,
and obesity
Define the following types of hernias:
Intraparietal hernia
P213
Hernia in which abdominal contents
migrate between the layers of the
abdominal wall
Define the following types of hernias:
Femoral hernia
P213
Hernia medial to femoral vessels (under
inguinal ligament)
Define the following types of hernias:
Hesselbach’s hernia
P213
Hernia under inguinal ligament lateral
to femoral vessels
Define the following types of hernias:
Bochdalek’s hernia
P213
Hernia through the posterior diaphragm,
usually on the left (Think: Boch da
lek = “back to the left” on the
diaphragm)
Define the following types of hernias:
Morgagni’s hernia
P213
Anterior parasternal diaphragmatic
hernia
Define the following types of hernias:
Properitoneal hernia
P213
Intraparietal hernia between the
peritoneum and transversalis fascia
Define the following types of hernias:
Cooper’s hernia
P213
Hernia through the femoral canal
and tracking into the scrotum or labia
majus
Define the following types of hernias:
Indirect inguinal
P213
Inguinal hernia lateral to Hesselbach’s
triangle
Define the following types of hernias:
Direct inguinal
P213
Inguinal hernia within Hesselbach’s
triangle
Define the following types of hernias:
Hiatal hernia
P213
Hernia through esophageal hiatus
Define the following types of hernias:
Amyand’s hernia
P213
Hernia sac containing a ruptured appendix
Think: Amyand’s = Appendix
What are the boundaries of
Hesselbach’s triangle?
P214
- Inferior epigastric vessels
- Inguinal ligament (Poupart’s)
- Lateral border of the rectus sheath
Floor consists of internal oblique and the
transversus abdominis muscle
What are the layers of the
abdominal wall?
P214
Skin Subcutaneous fat Scarpa’s fascia External oblique Internal oblique Transversus abdominus Transversalis fascia Preperitoneal fat Peritoneum Note: All three muscle layer aponeuroses form the anterior rectus sheath, with the posterior rectus sheath being deficient below the arcuate line
What is the differential
diagnosis for a mass in a
healed C-section incision?
P214
Hernia, ENDOMETRIOMA
GROIN HERNIAS
What is the differential
diagnosis of a groin mass?
P214
Lymphadenopathy, hematoma, seroma,
abscess, hydrocele, femoral artery
aneurysm, EIC, undescended testicle,
sarcoma, hernias, testicle torsion
GROIN HERNIAS
DIRECT INGUINAL HERNIA
What is it?
P214
Hernia within the floor of Hesselbach’s
triangle, i.e., the hernia sac does not
traverse the internal ring (think directly
through the abdominal wall)
GROIN HERNIAS
DIRECT INGUINAL HERNIA
What is the cause?
P214
Acquired defect from mechanical
breakdown over the years
GROIN HERNIAS
DIRECT INGUINAL HERNIA
What is the incidence?
P214
≈1% of all men; frequency increases
with advanced age
GROIN HERNIAS DIRECT INGUINAL HERNIA What nerve runs with the spermatic cord in the inguinal canal? P214
Ilioinguinal nerve
GROIN HERNIAS
INDIRECT INGUINAL HERNIA
What is it?
P215 (picture)
Hernia through the internal ring of the
inguinal canal, traveling down toward the
external ring; it may enter the scrotum
upon exiting the external ring (i.e., if
complete); think of the hernia sac traveling
indirectly through the abdominal wall
from the internal ring to the external ring