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A. MLA Map Paediatrics > Ventral/Epigastric/Random Hernias > Flashcards

Ventral/Epigastric/Random Hernias Flashcards

1
Q

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

A

2 - direct inguinal hernia

  • these are the most common forms of ventral hernias
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2
Q

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

A

3 - midline defect in linea alba

  • close to umbilicus
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3
Q

What % of the adult population will experience a ventral hernia?

1 - 0.2-0.5%
2 - 2-5%
3 - 20-50%
4 - >60%

A

2 - 2-5%

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4
Q

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

A

2 - male gender

  • 3:1 more common in females
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5
Q

Are congenital or acquired paraumbilical/umbilical hernias more common?

A
  • 10% are congenital
  • 90% are acquired
  • involution of umbilical vessels is most common cause of congenital hernia
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6
Q

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

A

4 - respiratory distress

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7
Q

When is a paraumbilical/umbilical hernia a medical emergency?

1 - incarcerated
2 - pain
3 - change in bowel habits
4 - strangulated

A

1 - incarcerated
- can be chronic or asymptomatic
- normally involves abdominal wall fat

4 - strangulated
- can involve large bowel
- cause a bowel obstruction

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8
Q

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

A

3 - sister josephs node

  • 50% are GI malignancy
  • 25% are gynaecological cancer
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9
Q

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

A

3 - stretched and weakened linea alba

  • distance between rectus abdominus becomes larger
  • also referred to as diastasis
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10
Q

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

A

4 - gender

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11
Q

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

A

2 - <1cm

  • generally repaired laparoscopically
  • either mesh or just repair
  • always a risk of infection and/or chronic pain
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12
Q

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

A

3 - defect in linea alba between umbilicus and xiphoid process

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13
Q

What % of hernias in adults are accounted for by epigastric hernias?

1 - 0.2-0.3%
2 - 2-3%
3 - 22-33%
4 - >50%

A

2 - 2-3%

  • relatively rare
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14
Q

Which of the following is NOT typically a risk factor for an epigastric hernia?

1 - gender
2 - obesity
3 - pregnancy
4 - older age

A

1 - gender

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15
Q

Are epigastric hernias more common in men or women?

A
  • men are 4 times more likely
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16
Q

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

A

3 - falciform ligament

17
Q

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

A

1 - bowel obstruction

  • bowel not generally involved due to falciform ligament
18
Q

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

A

3 - bowel obstruction

19
Q

Generally epigastric hernias are managed conservatively unless they enlarge or become symptomatic

A
20
Q

How big are epigastric hernias generally?

1 - <0.5cm
2 - <1cm
3 - <2cm
4 - <4cm

A

1 - <0.5cm

21
Q

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

A

3 - weakness of abdomen due to previous surgery

22
Q

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%

A

4 - 70%

  • sutures can cut through tissue leaving a defect
23
Q

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

A

2 - cause necrosis of tissue and tissue weakens

24
Q

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

A

2 - gender

  • diabetes and immunosuppression (including steroids) can cause poor wound healing and increase risk of infection
25
Q

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

A

4 - anorexia

26
Q

When is an incisional hernia a medical emergency?

1 - incarcerated
2 - pain
3 - change in bowel habits
4 - strangulated

A

1 - incarcerated
4 - strangulated

27
Q

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

A

3 - CT

  • useful for looking at abdominal wall prior to surgery
28
Q

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

A

5 - stop oral contraception

29
Q

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

A

3 - inguinal hernia containing meckels diverticulum

30
Q

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

A

1 - inguinal hernia containing the appendix

31
Q

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

A

2 - herniation of part of the bowel

  • common in femoral hernias
32
Q

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

A

4 - hernia occurring along the semilunar line

33
Q

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

A

2 - herniation of bowels through the obturator foreman of pelvis

A. MLA Map Paediatrics (75 decks)

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