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Inguinoscrotal Lumps Flashcards

1
Q

What percentage of general surgical referrals do inguinoscrotal swellings account for?

A

Up to 20%

Inguinoscrotal swellings may lead to serious complications and require emergency attention.

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2
Q

What are the layers of the abdominal wall?

A
  • Skin
  • Subcutaneous fat
  • Scarpa’s fascia
  • External oblique muscle
  • Internal oblique muscle
  • Transversus abdominis
  • Transversalis fascia
  • Preperitoneal fat
  • Peritoneum
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3
Q

What is the anatomical location of the inguinal canal?

A

4-6 cm long, from internal to external ring, anteroinferior of pelvic basin

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4
Q

What is the midpoint of the inguinal ligament?

A

Halfway between the pubic tubercle and the anterior superior iliac spine

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5
Q

Define the deep (internal) ring of the inguinal canal.

A

Found above the midpoint of the inguinal ligament, lateral to the epigastric vessels, created by transversalis fascia

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6
Q

What forms the superficial (external) ring of the inguinal canal?

A

Triangle-shaped opening formed by the evagination of the external oblique

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7
Q

What structures are found anterior to the inguinal canal?

A

External oblique aponeurosis

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8
Q

What are the contents of the inguinal canal in males?

A
  • Spermatic cord
  • Cremasteric muscle fibers
  • Vas deferens
  • Testicular artery
  • Pampiniform plexus of veins
  • Lymphatics
  • Fibrofatty tissue
  • +/- Hernia sac
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9
Q

What is Hesselbach’s triangle?

A

A weak point of the abdominal wall made up of the inguinal ligament, inferior epigastric vessels, and rectus abdominis

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10
Q

What are the types of hernias classified by Nyhus?

A
  • Type I: Indirect Hernia
  • Type II: Indirect Hernia
  • Type IIIA: Direct Hernia
  • Type IIIB: Indirect Hernia with posterior wall involvement
  • Type IIIC: Femoral Hernia
  • Type IV: Recurrent Hernia
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11
Q

What is the incidence of inguinal hernias?

A

5-10% lifetime risk, 75% of abdominal wall hernias

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12
Q

What are the two etiologies of inguinal hernias?

A
  • Congenital
  • Acquired
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13
Q

What is a congenital hernia?

A

Occurs due to lack of closure of the processus vaginalis during descent of the testes

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14
Q

List some presumed causes of groin herniation.

A
  • Coughing
  • Valsalva’s maneuvers
  • Chronic obstructive pulmonary disease
  • Ascites
  • Obesity
  • Upright position
  • Straining
  • Congenital connective tissue disorders
  • Constipation
  • Defective collagen synthesis
  • Previous right lower quadrant incision
  • Pregnancy
  • Arterial aneurysms
  • Cigarette smoking
  • Heavy lifting
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15
Q

What is the difference between indirect and direct inguinal hernias?

A

Indirect hernias occur through the internal ring, while direct hernias enter through a gap in the transversalis fascia

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16
Q

What symptoms may indicate an inguinal hernia?

A
  • Groin pain or discomfort
  • Painless lump in groin or scrotum
  • Change in bowel habits
  • Urinary symptoms
  • Local sharp pains
  • Duration and progressiveness of symptoms
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17
Q

What is the significance of a cough impulse during hernia assessment?

A

Indicates the presence of hernial contents

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18
Q

What is a pantaloon hernia?

A

Co-existence of direct and indirect hernias on the same side

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19
Q

What is a sliding hernia?

A

A part of the bowel wall is strangulated without bowel obstruction

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20
Q

What physical examination technique is used to differentiate between direct and indirect inguinal hernias?

A

Palpation and comparison of bulging on both sides

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21
Q

How often does a bilateral hernia occur in children and elderly men?

A

Commonly observed, especially if a left inguinal hernia is present

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22
Q

What is the purpose of examining the contralateral side during a hernia evaluation?

A

To compare the extent of bulging on both sides for diagnosis of hernia

The extent of bulging can indicate if the hernia is present on one or both sides.

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23
Q

What is the main technique to differentiate between a direct and indirect inguinal hernia during a physical exam?

A

Using finger placement in the inguinal canal while the patient exerts pressure or coughs

A direct hernia will contact the tip of the finger, while an indirect hernia will not bulge out when the internal ring is closed.

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24
Q

What makes the examination of a femoral hernia difficult?

A

The hernia presents under the inguinal ligament, and fat presence can cause diagnostic errors

Femoral pseudohernia can complicate the diagnosis.

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25
List some conditions that can complicate the physical examination for hernias.
* Over-weight individuals * Recurrent hernia * Hernias not found in physical exam
26
What imaging techniques are most commonly used for hernia diagnosis?
* Sonography * CT * MRI ## Footnote Each imaging technique has its own advantages and disadvantages.
27
What are the treatment options for uncomplicated hernias?
* No treatment * Support with a truss * Operative treatment
28
What is the surgical management approach for complicated hernias?
Always requires surgery, often urgently
29
What are the two main types of surgical procedures for inguinal hernias?
* Herniotomy * Herniorrhaphy
30
What is the goal of herniorrhaphy?
To alleviate symptoms such as pain, pressure, and protrusion of abdominal contents
31
What is the difference between herniotomy and herniorrhaphy?
* Herniotomy: excises the sac * Herniorrhaphy: repairs the defect
32
What is Lichtenstein Tension-Free Repair?
A tension-free repair involving placement of a mesh to strengthen the inguinal region
33
What materials are commonly used for permanent mesh in hernia repair?
* Prolene (polypropylene) * Polyester * Mosquito-net mesh
34
What is the significance of a femoral triangle in clinical practice?
It is an area of anatomical and clinical importance with large neurovascular structures
35
What defines a femoral hernia?
Protrusion of extraperitoneal fat, peritoneal sac, or abdominal contents through the femoral canal
36
What is the typical presentation of a femoral hernia?
Groin or upper thigh lump, discomfort, often asymptomatic
37
What management is required for all femoral hernias?
Surgical repair due to narrow, unyielding neck
38
What are common causes of inguinal lymphadenopathy?
* Primary lymphatic disease (e.g., lymphoma) * Malignant disease * Benign physiological reactions
39
What is the typical management approach for sebaceous cysts?
Incise and drain if infected; excise when not inflamed
40
What are the clinical features of a femoral artery aneurysm?
Pulsatile lump in groin, associated with other aneurysmal disease
41
What is the management for a psoas abscess?
Drain and treat the underlying cause
42
What is the clinical significance of undescended testes in adults?
Prone to infertility and testicular cancer
43
What types of lumps can be found in the scrotum?
* Solid lumps (mostly malignant) * Cystic lumps (usually benign)
44
What is the primary assessment tool for testicular lumps?
Ultrasound to determine lump origin
45
What is the main surgical complication risk associated with inguinal hernia repair?
Low overall risk of complications
46
What factors contribute to recurrence of hernias?
* Patient factors (malnutrition, immunosuppression, etc.) * Technical factors (mesh size, prosthesis fixation) * Tissue factors (wound infection, tissue ischemia)
47
What is the recommended position for a patient during the reduction of an incarcerated hernia?
Trendelenburg position
48
What is the typical approach for laparoscopic hernia repair?
Preperitoneal approach using mesh
49
What is the clinical relevance of the saphenous opening?
It allows access for procedures like coronary angiography
50
What is a cystadenoma?
A benign tumor that can occur in various tissues, including the epididymis.
51
What is an adenomatoid tumor?
A benign tumor commonly found in the epididymis.
52
What are the types of cystic lumps in the scrotum?
* Epididymal cyst * Spermatocele * Hydatid of Morgagni
53
What is the primary assessment tool for scrotal lumps?
Ultrasound
54
What is the usual age range for testicular tumors?
2nd to 4th decades of life
55
What percentage of testicular tumors are germinal?
95%
56
What are the types of germinal testicular tumors?
* Seminoma * Embryonal Cell Carcinoma * Choriocarcinoma * Teratoma
57
What is a hydrocele?
A collection of serous fluid in the tunica vaginalis.
58
What are the types of hydroceles?
* Hydrocele of tunica vaginalis * Hydrocele of spermatic cord * Hydrocele of canal of Nuck
59
What is a primary vaginal hydrocele?
An idiopathic condition characterized by excessive secretion or lymphatic obstruction.
60
What are the clinical features of a primary vaginal hydrocele?
* Painless pure scrotal swelling * Large * Tense * Develops slowly
61
What is a secondary vaginal hydrocele?
A hydrocele that develops rapidly and is secondary to inflammation, trauma, or tumor.
62
What are the complications of a hydrocele?
* Infection * Hematocele * Rupture * Calcification * Testicular atrophy
63
What is a hematocele?
Blood in the tunica vaginalis.
64
What characterizes a pyocele?
Presence of fever, erythematous scrotal skin, and painful swelling.
65
What is a varicocele?
Varicosity of the pampiniform and cremasteric plexus of veins.
66
What is the most common age range affected by varicocele?
20 to 50 years
67
What are the two types of varicocele?
* Primary * Secondary
68
What is the clinical picture of a varicocele?
* Heavy or dragging sensation in scrotum * Appears on standing and disappears on lying down * Described as 'bag of worms'
69
What investigations are done for varicocele?
* Duplex ultrasound * Semen analysis
70
What is the management for a varicocele?
* Conservative treatment * Surgery if subfertility or severe pain
71
What is acute epididymo-orchitis?
An infection causing rapid onset of painful swelling, usually due to E. coli.
72
What are the clinical features of Fournier’s Gangrene?
Necrotizing fasciitis of the perineum affecting immunocompromised patients.
73
What differentiates an epididymal cyst from a spermatocele?
Transillumination test: positive in epididymal cyst, negative in spermatocele.
74
What is testicular torsion?
Twisting of the spermatic cord causing interference with blood supply.
75
What age group has the highest incidence of testicular torsion?
10-20 years
76
What are the clinical features of testicular torsion?
* Sudden severe pain in the scrotum * Swollen, tender testis * Elevation of the scrotum increases pain
77
What is the emergency treatment for testicular torsion?
* Surgical exploration * Untwist the testis * Fix to scrotum if viable
78
What classification exists for testicular tumors?
* Germ Cell Tumors * Sex Cord-Stromal Tumors * Mixed Germ Cell and Stromal Elements
79
What are common germ cell tumors?
* Seminoma * Embryonal carcinoma * Teratoma * Choriocarcinoma * Yolk sac tumor
80
What is the typical clinical picture of testicular cancer?
* Painless swelling of the testis * Heaviness in the scrotum * Hard enlarged testis
81
What are the tumor markers for testicular cancer?
* AFP (alpha-fetoprotein) * β-HCG (beta-human chorionic gonadotropin)
82
What is the treatment for seminomas?
Radiotherapy plus chemotherapy.
83
What is the treatment for teratomas?
Combination chemotherapy with multiple drugs.

Surgery II (5 decks)

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