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7- Surgery > Inguino Scrotal Swellings / Hernias > Flashcards

Inguino Scrotal Swellings / Hernias Flashcards

1
Q

Hernia definition

A

Protrusion of viscus from cavity from which it is enclosed through abnormal or weak opening in wall cavity

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2
Q

Commonest cause of small bowel intestinal obstruction in Ghana and other developing countries

A

Hernia

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3
Q

What is an external hernia

A

Sac protrudes through abdominal wall

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4
Q

What is an internal hernia

A

Sac does not protrude outside trunk even when well formed

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5
Q

Percentage of inguinal hernia in all hernia

A

80-92%

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6
Q

Percentage of femoral hernia

A

2-5 %

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7
Q

Where is femoral hernia more common

A

Europe / North America

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8
Q

What is umbilical hernia

A

Protrusion of viscus thorugh blended linea alba in the umbilicus

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9
Q

Where is umbilical hernia more common in the world

A

Developing countries

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10
Q

What is a para umbilical hernia

A

Protrusion above, below or by the side of umbilicus

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11
Q

What is an epigastric hernia

A

Protrusion through linea alba between xiphisternum and the umbilicus

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12
Q

What is an incisional hernia

A

Protrusion through abdominal surgical scar

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13
Q

What is a spigelian hernia

A

Protrusion in spigelian zone between the muscular fibres and aponeurosis of transversus abdominis lateral to rectus sheath

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14
Q

What is lumbar hernia

A

Protrusion through inferior or superior lumbar triangle

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15
Q

What is obturator hernia

A

Protrusion in the obturator canal

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16
Q

What is a sciatic hernia

A

Protrusion through the greater or lesser sciatic foramen

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17
Q

Predisposing factor of hernia

A

Defect or weakness of the wall of te abdominal cavity

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18
Q

Precipitating factor of hernia

A

Repeated increased intra abdominal pressure leading to protrusion of viscus

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19
Q

5 causes of defects or weakness of abdominal wall

A

Embryological or anatomical

Ageing, infection with weak scars , multiple pregnancies , obesity

Site of penetration of blood vessel weakened

Weakened muscle due to nerve damage

Straining / injury leading to muscular tear

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20
Q

Causes of increased intra abdominal pressure

A

Chronic cough
chronic urinary obstruction
chronic constipation
heavy Manual work
weightlifting
frequent pregnancies

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21
Q

Parts of hernia sac

A

Mouth
Neck
Body
Fundus

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22
Q

What content could you find in hernial sac

A

Omentum
Small intestine
Parts of colon
Appendix
Uterine Adnexa
Part of bladder

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23
Q

What is a reducible hernia

A

If content return completely into abdomen when patient lies down or pressure applied to it

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24
Q

Complications of hernia

A

Irreducibility
Strangulation
Fistula
Rupture

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25
Q

Main cause of hernial irreducibility

A

Formation of adhesion between sac and contents

Accumulation of impacted faeces in herniated colon

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26
Q

Percentage of inguinal hernia and femoral hernia that strangulate

A

5%- inguinal
30% - femoral

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27
Q

2 types of groin hernia

A

Inguinal hernia
Femoral hernia

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28
Q

What is the inguinal canal

A

Oblique passage downwards and forwards above groin

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29
Q

Content of inguinal canal

A

Testicular vessels
Spermatic cord
Ilioinguinal nerve
Genital branch of the genito-femoral nerve - male
Round ligament - female

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30
Q

Length of inguinal canal in adults

A

4cmm

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31
Q

Most lateral ring of inguinal canal

A

Internal inguinal ring

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32
Q

Most medial ring in inguinal canal

A

External inguinal ring

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33
Q

Shape of internal inguinal ring

A

U shaped

34
Q

What is the internal inguinal ring made of

A

Evagination in transversalis fascia

35
Q

Anatomical location of internal inguinal ring

A

1.25cm above mid inguinal point
Perpendicular to mid inguinal point

1.25 cm above midpoint to inguinal ligament
Medial to inguinal ligament t

36
Q

Length of opening of internal inguinal ring

A

12-20mm high
6-10 mm wide

37
Q

Boundaries of internal inguinal ring

A

Superior - lower arching fibers of internal oblique
Inferior / medial - inferior epigastric vessels

38
Q

Type of inguinal hernia going though internal inguinal ring

A

Indirect inguinal hernia

39
Q

Percentage of recurrence in indirect inguinal hernia repair

A

60-75%

40
Q

Location of external inguinal ring

A

Above and lateral to pubic tubercle
Opening in external oblique aponeurosis

41
Q

Shape of external inguinal ring

A

Triangular
Apex upwards and laterally
Base above pubic tubercle

42
Q

Size of external inguinal ring

A

2.5x1.25 cm

43
Q

Boundaries of inguinal canal

A

Anterior - external oblique aponeurosis
Laterally - muscular fibers of internal oblique
Posterior - transversalis fascia

44
Q

Name of triangle close to external inguinal ring

A

Hesselbach’s triangle

45
Q

Boundaries of hesselbach’s triangle

A

Lateral - inferior epigastric arteru
Medial - lateral border of rectum sheath
Inferior - inguinal ligament
Posterior. - transversalis fascia

46
Q

Type of inguinal hernia going though hesselbach triangle

A

Direct inguinal hernia

47
Q

Boundaries of femoral triangle

A

Superior - inguinal ligament
Medial - adductor longus
Lateral - sartorius
Lateral floor - iliopsoas
Medial floor - pectineus
Anterior - skin , superficial fascia , deep fascia lata

48
Q

Content of femoral triangle

A

Femoral canal
femoral vein
femoral artery
femoral nerve
lymph nodes

49
Q

Length of the femoral canal

A

1.25-3cm

50
Q

Which testes descend later than the other , right or left

A

Right

51
Q

Percentage of incense with incomplete descent of testes

A

4%

52
Q

Processes vaginalis becomes which structure in the scrotum soon after birth

A

Tunica vaginalis

53
Q

Consequences of failure of obliteration of the processus vaginalis

A

Indirect inguinal hernia
Encysted hydrocele of the cord
infantile hydrocele -noncommunicating
congenital hydrocele communicating

54
Q

Percentage of male with inguinal hernia

A

16%

55
Q

Percentage of male and female with inguinal hernia

A

95% of hernia in males
40-50% of hernia in females

56
Q

Percentage of indirect hernia between 20 to 49 years old

A

60%

57
Q

 Direct inguinal hernia is twice as common on the right or the left side

A

On the right side

58
Q

Percentage of indirect inguinal hernia that are bilateral

A

10 %

59
Q

 True or false , direct inguinal hernia are as common on the right as on the left in both sexes

A

True

60
Q

Main cause of indirect hernia

A

Congenital - due to patient processus vaginalis

61
Q

Main cause of direct inguinal hernia

A

Ageing or trauma or congenital deficiencies lead to weakening of transversalis fascia

62
Q

Is there often strangulation of direct inguinal hernia

A

No -> large neck

63
Q

Main symptoms of inguinal hernia

A

Swelling in the groin
pain in the groin

64
Q

Signs of inguinal hernia

A

Swelling in the groin
Swelling in the groin when coughing
Direct or indirect coughing test
Direction of hernia
Complete ( enters scrotum or labium majus ), incomplete

65
Q

How do you differentiate a direct from an indirect inguinal hernia in examination

A

Reduce swelling
Place finger over site of internal inguinal ring
Ask patient to cough -> if appears then most likely direct inguinal hernia

Oblique direction of hernia -> indirect
Directly forwards into canal. -> direct

66
Q

Type of inguinal hernial who can be complete

A

Indirect

67
Q

Differential diagnosis of inguinal hernia in male

A

Femoral hernia
vagina hydrocele
encysted hydrocele of the cord
malgaigne’s bulges
ectopic or undescended testes
cyst of the epididymis
inguinal lymphadenopathy
Saphena varix
sebaceous cysts
lipoma

68
Q

Differential diagnosis of inguinal hernia in the female

A

Femoral hernia
cyst of the Canal of Nuck
lipoma

69
Q

Treatment of inguinal hernia

A

Surgery

70
Q

Read about inguinal hernia repair

A
71
Q

Sex more at risk of femoral hernia

A

Female

72
Q

Women at risk of femoral hernia

A

Multifarious
Elderly

73
Q

Causes of femoral hernia

A

Stretching , weakness and breach of transversalis fascia near femoral ring due to increased intra abdominal pressure

74
Q

Shape of course of femoral hernia from its descent from abdominal cavity

A

J shaped

75
Q

Main symptoms of femoral hernia

A

Swelling in the groin
Discomfort or pain in the groin

76
Q

Signs of femoral hernia

A

Swelling below inguinal ligament t
Visible and palpable cough impulse
No lump disappearances possible when lying down
Reducible or irreducible

77
Q

Differential diagnosis of femoral hernia

A

Inguinal hernia
saphena varix
psoas abscess
lipoma
enlarged inguinal lymph nodes
femoral aneurysm
sebaceous cyst

78
Q

Treatment of femoral hernia

A

Surgery

79
Q

Types of umbilical hernia

A

Congenital (exomphalos) - defect through umbilicus with jelly like substance
Infantile - through blended aponeurosis of linea alba in umbilicus
Para umbilical - above or by the side of umbilicus

80
Q

Types of exomphalos

A

Major - sac diameter > 5cm
Minor - sac diameter < 5 cm

81
Q

What is gastroschisis

A

Full thickness tear of anterior abdominal wall on the right of the umbilicus

82
Q

Second most common hernia type in Ghana for female

A

Para umbilical hernia

7- Surgery (13 decks)

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