Surgery Flashcards
Name some types of external hernia
inguinal femoral incisional umbilical epigastric
What are the 2 types of groin hernia?
femoral
inguinal
what type makes up around 80% of hernias?
inguinal
What are the signs and symptoms of inguinal hernia
visible lump that enlarges when coughing
heavy feeling/discomfort
pain/ache on exertion
constipation
What are the risk factors for hernia?
personal hx increasing age male white chronic cough/ chronic constipation due to raised intraabdominal hernia smoking
What anatomical landmark separates indirect and direct inguinal hernia?
inferior epigastric artery
Where is the inferior epigastric artery in relation to the spermatic cord?
medial
Where is an indirect inguinal hernia?
bowel enters inguinal canal through deep inguinal ring lateral to inferior epigastric artery
Where is a direct inguinal hernia?
Bowel enters the inguinal canal “directly” through a weakness in the posterior wall of the canal, termed Hesselbach’s triangle
medial to the inferior epigastric artery
What is the purpose of the inguinal canal embryologically?
testes descend from posterior abdomen to scrotum through the canal
Where is the femoral pulse palpated?
mid-inguinal point
halfway between pubic symphysis and ASIS
Where is the deep inguinal ring palpated?
just above halfway between pubic tubercle and ASIS
What are the contents of the inguinal canal?
spermatic cord in males
round ligament in females
part of the ilioinguinal nerve
genital branch of genitofemoral nerve
WHat nerve is most at risk during inguinal hernia repair?
ilioinguinal which supplies sensory innervation to genitals
What can cause an indirect inguinal hernia?
failure of processus vaginalis to regress
What can cause a direct inguinal hernia?
They occur more commonly in older patients, often secondary to abdominal wall laxity or a significant increase in intra-abdominal pressure
How does a strangulated hernia present?
irreducible, tender, tense lump
pain out of proportion
bowel obstruction
What are the two types of hernia repair surgery?
open repair (lichtenstein) or laparascopic (tep or TAPP)
What method of repair is preferred for a primary hernia?
open mesh repair
What method of repair is preferred for bilateral or recurrent hernia?
laparoscopy
How does laparascopic hernia repair compare to open repair?
longer operating times but quicker post-operative recovery, fewer complications, and less post-operative pain
When should bowel obstruction be managed surgically?
ischaemia
caused by strangulation/ tumour
not settled in 48hrs conservatively
Which cases of bowel obstruction rarely settle without surgery?
large bowel obstruction or virgin small bowel obstruction (ie no prev surgery)
What surgery is usually performed for bowel obstruction?
laparotomy
