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.
What does the obturator nerve supply?
- Hip adductor
- Sensation to upper medial thigh
- Sensation to knee joint
The obturator nerve is crucial for movement and sensation in the medial thigh region.
What is a common symptom of an obturator hernia?
Medial thigh pain in the cutaneous distribution of the obturator nerve
This pain can indicate the presence of an obturator hernia.
What imaging techniques are usually required to diagnose an obturator hernia?
- Ultrasound (US)
- Computed Tomography (CT)
These imaging methods help visualize the hernia and assess its complications.
What is the recommended treatment for an obturator hernia?
Direct surgical repair
Surgery is typically necessary due to the risks associated with the hernia.
True or False: An obturator hernia has a low risk of incarceration or obstruction.
False
It has a high risk of incarceration/obstruction, making it a serious condition.
Fill in the blank: An obturator hernia usually presents a __________ diagnosis.
very challenging
The difficulty in diagnosis often necessitates advanced imaging.
