RCSI: Hernias Flashcards
What is a hernia?
An abnormal protrusion of an organ (or part of an organ) through its containing body wall.
List the classifications of hernias according to anatomical location.
- Umbilical/periumbilical
- Parastomal
- Epigastric
- Spigelian
- Inguinal
- Femoral
- Obturator
- Sciatic
- Perineal
- Flank
What are congenital hernias?
Defects present from birth, including persistent processus vaginalis, gastroschisis, and omphalocoele.
What are common risk factors for acquired hernias?
- Ageing
- Smoking
- Steroid use
- Pregnancy
- Obesity
- Chronic cough
- Connective tissue disorders
- Heavy lifting
What is the incidence of inguinal hernias?
Inguinal hernias account for approximately 75% of all hernias repaired.
What is Richter’s hernia?
A partial thickness of bowel trapped within the hernial sac, leading to partial bowel obstruction.
True or False: A sliding hernia occurs when a peritoneal covered structure slides down extra-peritoneally.
True
Define a reducible hernia.
Contents re-enter their containing cavity (usually the abdomen) either spontaneously or with manipulation.
What is a strangulated hernia?
Ischaemia and necrosis of hernia contents due to decreased venous/lymphatic flow.
What is the male to female ratio for inguinal hernias?
8:1
What anatomical structures define Hesselbach’s triangle?
- Medial: rectus muscle
- Lateral: inferior epigastric vessels
- Inferior: inguinal ligament, pubic bone
Fill in the blank: Indirect hernias pass _____ the inguinal canal.
[in]
What are the three fasciae of the spermatic cord?
- External spermatic fascia
- Cremasteric fascia
- Internal spermatic fascia
What are the clinical features of an inguinal hernia?
- Can be incidental/asymptomatic
- Lump +/- pain
- Acute strangulation/obstruction
What is the management for strangulated hernias?
Surgical repair within 6–8 hours from onset to prevent bowel loss.
What are the contents of the inguinal canal?
- Testicular artery and vein
- Artery and vein to the vas deferens
- Cremasteric artery and vein
- Nerve to the cremaster
- Sympathetic nerves
- Ilioinguinal nerve
- Genital branch (genitofemoral nerve)
- Spermatic cord
- Vas deferens
- Lymphatics
What is the typical presentation of a femoral hernia?
A lump felt inferolateral to the pubic tubercle.
What are the surgical boundaries of the femoral triangle?
- Superior: inguinal ligament
- Lateral: medial border of sartorius muscle
- Medial: medial border of adductor longus
- Floor: iliacus, psoas major, pectineus, adductor longus
What is the female to male ratio for umbilical hernias?
3:1
What are the types of umbilical hernias?
- True: Always congenital, through umbilical cicatrix
- Periumbilical: Always acquired, not through umbilicus
What are common risk factors for incisional hernias?
- Post-operative wound infection
- Abdominal obesity
What is a Spigelian hernia?
A defect between the lateral border of the rectus abdominis and linea semilunaris.
What is an obturator hernia?
A defect through the obturator canal that causes medial thigh pain.
What is an obturator hernia?
A defect through the obturator canal from the lateral pelvis into the thigh
It involves the passage of tissue through the obturator canal.
