Stoma/Hernia

Question 1

Complications of a stoma?

Answer 1

hemorrhage
infection
necrosis
retraction
prolapse
peristomal skin irritation
parastomal hernia
high output stoma

Question 2

A stoma on the left, what does it tend to be?

Answer 2

colostomy

Question 3

A stoma on the right, what does it tend to be?

Answer 3

ileostomy

Question 4

why does ileostomy has a stump?

Answer 4

due to pancreatic enzymes creating an alkaline environment that could cause skin irritation

Question 5

indirect inguinal hernia - where does it herniate?

Answer 5

through internal inguinal ring, down inguinal canal & out external ring

Question 6

indirect vs direct inguinal hernia?

Answer 6

indirect

• tend to extend into the scrotum
• quite large
• usually reducible
• held by pressure on the deep ring
• low risk of incarceration and complication

Question 7

inguinal vs femoral hernia?

Answer 7

inguinal tend to be above the pubic tubercle

femoral hernias are quite small, usually incarcerated (painful)

Question 8

direct inguinal hernia - where does it herniate?

Answer 8

through weak point in posterior wall of inguinal canal, into the Hesselbach’s triangle

Question 9

what is the Hesselbach’s triangle?

Answer 9

inferior epigastric artery
inguinal ligament
linea semilunaris (lateral border of rectus muscle)

Question 10

What are the risk factors for developing a hernia?

Answer 10

Family Hx
Weakness in abdominal musculature - increased age; surgery (incisional hernia)
increased intra-abdominal pressure
- obesity, pregnancy, other organomegaly, COPD/chronic cough, prostatism, constipation, heavy lifting

Question 11

Surgical hernia repair

Answer 11

usually open mesh repair (lichtenstein)
open suture repair (babinski/shouldice)
laparascopic
- TEP (total extraperitoneal procedure)
- TAP (trans-abdominal procedure)

Question 12

What is Richter’s hernia?

Answer 12

only part of a bowel wall herniates - allowing strangulation w/o obstruction

more common in fem hernia (narrow orifice)

Question 13

Hernia complications?

Answer 13

Incarceration - irreducible

1) obstruction (clinically - colic, constipation, vomiting, distension)
2) strangulation -> ischemia -> necrosis -> peritonitis

Question 14

Borders of the inguinal canal?

Answer 14

roof: internal oblique and conjoint tendon
deep ring: opening in the transversalis fascia @ midpoint of inguinal ligament
superficial ring: aperture in aponeurosis of ext oblique, superior to pubic tubercle
floor: inguinal ligament
front wall: external oblique