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AIP: Abdominal pain > Obstructed/ strangulated hernia > Flashcards

Obstructed/ strangulated hernia Flashcards

1
Q

What are abdominal hernias?

A

the protrusion of intra-abdominal contents through congenital/acquired areas of weakness in the abdominal wall

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2
Q

What are the 4 categories of anatomically classified abdominal hernias?

A
  1. Ventral hernias (e.g. epigastric, umbilical, incisional hernias)
  2. Groin hernias (inguinal and femoral hernias)
  3. Pelvic hernias (obturatory, sciatic and perineal hernias)
  4. Flank/lumbar hernias
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3
Q

What are the 3 most common types of hernias?

A
  1. Inguinal
  2. Incisioal
  3. Umbilical
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4
Q

What key factor increases the risk of abdominal hernias?

A

persistently raised intra-abdominal pressure (e.g. due to ascites, pregnancy, intra-abdominal tumours, chronic cough)

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5
Q

What are 4 features of uncomplicated hernias?

A
  1. Asymptomatic
  2. Non-tender
  3. Completely reducible
  4. Expansile cough impulse
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6
Q

What are 3 forms of complicated hernias?

A
  1. Incarcerated
  2. Obstructed
  3. Strangulated
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7
Q

What are 4 features of complicated hernias?

A
  1. Tenderness
  2. Irreducibility
  3. Features of bowel obstruction
  4. Absent cough impulse
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8
Q

What is a diagnosis of abdominal hernias often based on?

A

clinical examination

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9
Q

When is imaging used to help diagnose abdominal hernias?

A

to confirm the diagnosis and evaluated the contents of the hernia

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10
Q

What 2 types of imaging may be useful to aid the diagnosis of abdominal hernias?

A

Ultrasound, CT

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11
Q

What is the management of complicated hernias or those with a narrow neck?

A

surgical repair: primary repair/ mesh repair

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12
Q

What are 3 examples of hernias with a narrow neck (therefore needing surgical repair)?

A
  1. Femoral hernia
  2. Obturator hernia
  3. Paraumbilical hernia
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13
Q

What is usually the typical course of congenital umbilical hernias?

A

typically close spontaneously bt 5 years of age

have a wide so low risk of complications, surgical intervention rarely necessary

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14
Q

What are 4 examples of ventral hernias?

A
  1. Epigastric hernia
  2. Umbilical hernia
  3. Incisional hernia
  4. Spigelian hernia
  5. Parstomal hernia
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15
Q

What is an epigastric hernia?

A

herniation through the linea alba, between the xiphoid process and the umbilicus

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16
Q

What is a Spigelian hernia?

A

hernia that can occur anywhere along the semilunar line, most commonly below the arcuate line (i.e. below the umbilicus)

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17
Q

What are 2 examples of groin hernias?

A
  1. Inguinal hernia (direct/ indirect)
  2. Femoral hernia
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18
Q

What are 3 examples of pelvic hernias (all rare)?

A
  1. Obturator hernia
  2. Sciatic hernia
  3. Perineal hernia
19
Q

What is an obturator hernia?

A

herniation through the obturator foramen, especially on the right side (as the sigmoid colon blocks the obturator canal on the left)

20
Q

What is a sciatic hernia?

A

herniation through greater or lesser sciatic foramen

21
Q

What is a perineal hernia?

A

herniation through the pelvic floor

22
Q

What are 2 examples of flank hernias?

A
  1. Incisional hernias
  2. Lumbar hernias
    • superior lumbar hernia: herniation through the superior lumbar triangle
    • inferior lumbar hernia: herniation through the inferior lumbar triangle
23
Q

What is meant by a reducible hernia?

A

hernial contents completely return to the abdominal cavity through the abdominal wall defect on lying down or upon application of mild external pressure

24
Q

How do most reducible hernias manifest?

A

asymptomatic nontender mass - increases on straining (e.g. sitting up from recumbent position), decreases completely on lying down

25
Q

What are 3 features of a reducible hernia?

A
  1. Visible cough impulse present: expansion when asked to cough
  2. Edges of fascial defect palpable
  3. Bowel sounds may be heard over the mass (if hernial content is bowel)
26
Q

What is meant by an irreducible/incarcerated hernia?

A

hernias contents become adhered to the hernial sac and cannot be reduced into the abdominal cavity

27
Q

What are 4 features of an irreducible/incarcerated hernia?

A
  1. Irreducible non-tender mass
  2. Visible cough impulse present
  3. May decrease partially on lying down
  4. Increased risk of obstruction and strangulation
28
Q

What is meant by an obstructed hernia?

A

the abdominal wall defect acts as a tourniquet around the hernial contents, causing oedema and distension of the hernial contents

29
Q

What are 3 features of an obstructed hernia?

A
  1. Acute pain at the site of the hernia
  2. Features of a closed loop bowel obstruction (if the hernial content is bowel) (2 points of bowel obstructed at the same point)
  3. Absent cough impulse
30
Q

What is a strangulated hernia?

A

ischaemia and necrosis of the hernial contents due to compromised vascular supply

31
Q

What are 6 clinical features of a strangulated hernia?

A
  1. Acute pain at the site of the hernia
  2. Features of bowel obstruction (if hernial content is bowel)
  3. Signs of strangulation
  4. Toxic appearance, fever, signs of sepsis
  5. May lead to intestinal gangrene
  6. Fatal if left untreated
32
Q

What are 3 signs of hernia strangulation?

A
  1. Tender, irreducible hernia
  2. Absent cough impulse
  3. Oedeatous, erythematous, warm overlying skin
33
Q

How does the risk of incarceration relate to the size of the hernial orifice?

A

the smaller the orifice the higher the risk

34
Q

When is ultrasound scanning especially useful to aid the diagnosis of an abdominal hernia?

A

especially useful to identify ventral hernias (epigastric, incisional, umbilical, Spigelian)

35
Q

What type of CT scan can be used if there is diagnostic uncertainty about a hernia/ to identify the contents?

A

IV and oral contrast enhanced CT scan

36
Q

When is it useful to perform a CT scan for a patient with a hernia?

A

for suspected hernias that may be difficult t identify on physical examination (e.g. lumbar, obturator, perineal or sciatic hernia)

37
Q

What will imaging likely show if a patient has a hernia?

A

abdominal wall defect with/without protrusion of intra-abdominal contents through it

38
Q

What modality of imaging is indicated if an obstructed and/or strangulated hernia is suspected?

A

abdominal x-ray

39
Q

What are 4 findings of an obstructed/strangulated hernia on abdominal x-ray?

A
  1. features of bowel obstruction
  2. dilated bowel loops proximal to obstruction
  3. collapsed bowel loops distal to obstruction
  4. multiple air-fluid levels within dilated bowel loops
40
Q

What is the treatment for most abdominal hernias?

A

surgical hernia repair

41
Q

What does surgical repair of abdominal hernias involve?

A

open or laparoscopic tension-free closure of the abdominal wall defect with/without a mesh

42
Q

How does the type of surgery differ for reducible and incarcerated hernias vs obstructed or strangulated hernias?

A

elective surgery for reducible and incarcerated hernias

emergency surgery for obstructed or strnagulated hernias

43
Q

What are 2 key indications for conservative management of hernias?

A
  1. Congenital umbilical hernia in children <5 years of age
  2. Asymptomatic wide-necked hernias in patients with high operative risk: a truss or corset may be considered in these patients to decrease the risk of obstruction and strangulation

AIP: Abdominal pain (20 decks)

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