Ventral/Epigastric/Random Hernias Flashcards
Which of the following is NOT categorised as a ventral hernia, which is a herniation in the anterior abdominal wall.
1 - paraumbilicial/umbilical hernia
2 - direct inguinal hernia
3 - epigastric hernia
4 - incisional hernia
2 - direct inguinal hernia
- these are the most common forms of ventral hernias
Where does a paraumbilicial/umbilical hernia occur?
1 - defect in deep inguinal ring
2 - linea semilunaris
3 - midline defect in linea alba
4 - rectus abdominus
3 - midline defect in linea alba
- close to umbilicus
What % of the adult population will experience a ventral hernia?
1 - 0.2-0.5%
2 - 2-5%
3 - 20-50%
4 - >60%
2 - 2-5%
Which of the following is NOT a common risk factor for a paraumbilical/umbilical hernia?
1 - increased abdominal pressure (pregnancy/ascites)
2 - male gender
3 - obesity
2 - male gender
- 3:1 more common in females
Are congenital or acquired paraumbilical/umbilical hernias more common?
- 10% are congenital
- 90% are acquired
- involution of umbilical vessels is most common cause of congenital hernia
Which of the following is NOT a common presentation of an paraumbilical/umbilical hernias?
1 - pain
2 - palpable/visible lump
3 - tenderness
4 - respiratory distress
4 - respiratory distress
When is a paraumbilical/umbilical hernia a medical emergency?
1 - incarcerated
2 - pain
3 - change in bowel habits
4 - strangulated
1 - incarcerated
- can be chronic or asymptomatic
- normally involves abdominal wall fat
4 - strangulated
- can involve large bowel
- cause a bowel obstruction
Malignancy of which lymph node is commonly linked with being a differential diagnosis for an paraumbilical/umbilical hernia?
1 - popliteal node
2 - virchows lymph node
3 - sister josephs node
4 - cloquet node
3 - sister josephs node
- 50% are GI malignancy
- 25% are gynaecological cancer
In addition to the sister mary joseph lymph node as a differential for paraumbilical/umbilical hernia is divarication of the rectus muscles. What is this?
1 - linea alba becomes stiff and ruptures
2 - abdominal muscles do not form in development
3 - stretched and weakened linea alba
3 - stretched and weakened linea alba
- distance between rectus abdominus becomes larger
- also referred to as diastasis
In patient who have divarication of the rectus, also known as diastasis which is a seperating of the linea alba is not typically treated surgically due to poor results. Which of the following is typically NOT a risk factor for diastasis?
1 - increasing age
2 - obesity
3 - increased abdominal pressure
4 - gender
4 - gender
Paraumbilical/umbilical hernias are commonly treated only when the patient becomes symptomatic or the opening enlarges. What size are Paraumbilical/umbilical hernias commonly?
1 - <0.1cm
2 - <1cm
3 - <2cm
4 - <4cm
2 - <1cm
- generally repaired laparoscopically
- either mesh or just repair
- always a risk of infection and/or chronic pain
What is the definition of an epigastric hernia?
1 - defect in linea alba between pubic symphysis and xiphoid process
2 - defect in linea alba between
arcuate line and xiphoid process
3 - defect in linea alba between umbilicus and xiphoid process
3 - defect in linea alba between umbilicus and xiphoid process
What % of hernias in adults are accounted for by epigastric hernias?
1 - 0.2-0.3%
2 - 2-3%
3 - 22-33%
4 - >50%
2 - 2-3%
- relatively rare
Which of the following is NOT typically a risk factor for an epigastric hernia?
1 - gender
2 - obesity
3 - pregnancy
4 - older age
1 - gender
Are epigastric hernias more common in men or women?
- men are 4 times more likely
Epigastric hernias are not commonly large defects in the linea alba and generally only contain abdominal fat. What stops the bowel being present in epigastric hernias?
1 - xiphoid process
2 - rectus abdominus
3 - falciform ligament
4 - pancreas
3 - falciform ligament
Epigastric hernias can be symptomatic of asymptomatic, depending on the size of the defect. If a patient presents with symptoms, which of the following is NOT a common symptom?
1 - bowel obstruction
2 - palpable lump
3 - pain
1 - bowel obstruction
- bowel not generally involved due to falciform ligament
Which of the following is NOT commonly included as a differential in patients with a suspected epigastric hernia?
1 - divarication of the rectus / diastsis
2 - intra-abdominal mass
3 - bowel obstruction
4 - skin lesion
3 - bowel obstruction
Generally epigastric hernias are managed conservatively unless they enlarge or become symptomatic
How big are epigastric hernias generally?
1 - <0.5cm
2 - <1cm
3 - <2cm
4 - <4cm
1 - <0.5cm
What is an incisional hernia?
1 - a patients abdomen is punctured with a sharp object
2 - congenital weakness in linea alba
3 - weakness of abdomen due to previous surgery
4 - defect causes during embryological development
3 - weakness of abdomen due to previous surgery
Following surgery to the abdominal wall the strength of the abdominal wall is always reduced. What % of the original wall strength is the abdomen following surgery?
1 - 0.7%
2 - 7%
3 - 37%
4 - 70%
4 - 70%
- sutures can cut through tissue leaving a defect
Wounds closed under tension is a risk factor for an incisional hernia. Why does closing under tension increase the risk of an incisional hernia?
1 - damages peritoneum
2 - cause necrosis of tissue and tissue weakens
3 - can damage organs
4 - skin is unable to heal properly
2 - cause necrosis of tissue and tissue weakens
In addition to closing a wound under tension, there are multiple risk factors for an incisional hernia. Which of the following is NOT a risk factor?
1 - wound infections
2 - gender
3 - diabetes
4 - immunosuppression (including steroids)
5 - obesity
6 - midline incisions (up to 20% for midline laparotomies)
7 - smoking
2 - gender
- diabetes and immunosuppression (including steroids) can cause poor wound healing and increase risk of infection
The majority of incisional hernias are asymptomatic. However, they can be associated with symptoms. but which of the following is NOT common?
1 - bulge or lump at site of previous incision
2 - pain
3 - GI upset
4 - anorexia
4 - anorexia
When is an incisional hernia a medical emergency?
1 - incarcerated
2 - pain
3 - change in bowel habits
4 - strangulated
1 - incarcerated
4 - strangulated
Although ultrasound is used for smaller incisional hernias, what imaging technique is used for larger incisional hernias?
1 - MRI
2 - PET scan
3 - CT
4 - X-ray
3 - CT
- useful for looking at abdominal wall prior to surgery
Surgery to treat a patient with an incisional hernia can be simple or complex and be laparoscopic or laparotomy. This can include a parastomal hernia and large midline hernias. Prior to surgery patients are asked to optimise their ability to undergo complex surgery. Which of the following is NOT a common factor patients are asked to engage in?
1 - weight loss
2 - nutrition
3 - optimise medication
4 - improve cardiorespiratory fitness
5 - stop oral contraception
5 - stop oral contraception
There are lots of unusual hernias. What is a Littre hernia?
1 - inguinal hernia containing the appendix
2 - herniation of part of the bowel
3 - inguinal hernia containing meckels diverticulum
4 - hernia occurring along the semilunar line
3 - inguinal hernia containing meckels diverticulum
There are lots of unusual hernias. What is a Amyands hernia?
1 - inguinal hernia containing the appendix
2 - herniation of part of the bowel
3 - inguinal hernia containing meckels diverticulum
4 - hernia occurring along the semilunar line
1 - inguinal hernia containing the appendix
There are lots of unusual hernias. What is a Richters hernia?
1 - inguinal hernia containing the appendix
2 - herniation of part of the bowel
3 - inguinal hernia containing meckels diverticulum
4 - hernia occurring along the semilunar line
2 - herniation of part of the bowel
- common in femoral hernias
There are lots of unusual hernias. What is a Spigellian hernia?
1 - inguinal hernia containing the appendix
2 - herniation of part of the bowel
3 - inguinal hernia containing meckels diverticulum
4 - hernia occurring along the semilunar line
4 - hernia occurring along the semilunar line
There are lots of unusual hernias. What is an obturator hernia?
1 - inguinal hernia containing the appendix
2 - herniation of bowels through the obturatory foreman of pelvis
3 - inguinal hernia containing meckels diverticulum
4 - hernia occurring along the semilunar line
2 - herniation of bowels through the obturator foreman of pelvis
