Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ch. 2 - Hernias > Whole Chapter > Flashcards

Whole Chapter Flashcards

1
Q

Name the hernias in this image superiorly to inferiorly

A

Epigastric
Umbilical/paraunbilical hernia
Spigelian Hernia
Left: Inguinal hernia Right: Femoral Hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define a hernia

A

Abnormal protrusion of an organ or part of an organ through increased abdominal pressure, weakened abdominal wall, and/or congenital defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hernias can be present in the Groin, flank, pelvic region, and anteriorly/ventral.

State the types within these categories

List the categories in order of decreasing incidence

A

Listed in decreasing order
Groin: Inguinal, Femoral, Pantaloon
Ventral: Umbilical, Paraumbilical, Parastomal, Spigelian, Gastroschisis, Omphalocele
Pelvic: Obturator, sciatic
Flank: Lumbar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most common type of hernia

A

Inguinal hernia (75%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the main causes of hernias

A

Primary:
Increased intra-abdominal pressure: Obesity, smoking, lifting, chronic cough

Weakened abdominal wall: Aging, post-menopause, steroid use, CTD (Marfan’s, Ehler Danlos)

Secondary:
Incision
Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

There are 3 uncommon hernias which are:
Richter’s Hernia:
Sliding Hernia:
Pantaloon Hernia:

Briefly explain what each is

A

Richter’s Hernia: Partial thickness of bowel trapped within sac leading to small bowel obstruction (picture)
Sliding Hernia: Peritoneal covered structure (colon bladder) slides extraperitoneally
Pantaloon Hernia: Direct + indirect hernia simultaneously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A hernia causing bowel obstruction is called

A

Incarcerated hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

An inguinal hernia most typically occurs in males 50+. What is the relation of an inguinal hernia to the pubic tubercle?

A

Above and medial to pubic tubercle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the different types inguinal hernias

A

Direct
Indirect
Pantaloon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the pathogenesis of a direct inguinal hernia?

A

Protrudes through the transversalis fascia in Hasselbach’s triangle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the path of an indirect inguinal hernia

A

Deep ring -> inguinal canal -> superficial ring +/- Spermatic cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Direct and indirect hernias can anatomically be identified on either side of a vessel. What is that vessel and what is the location of each type of inguinal hernia to it?

Hint: This vessel forms a boundary of Hasselbach’s triangle

A

Direct Inguinal hernia lies medial to the inferior epigastric vessels (and hence within the triangle)

Indirect inguinal hernia lies lateral to the inferior epigastric vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the boundaries to the Hasselbach triangle?

What type of hernia passes through it?

A

Direct inguinal hernia

Medial: Rectus muscle
Lateral: Inferior epigastric vessels
Inferior: Inguinal ligament/pubic bone (Inguinal hernias lie above and medial to the pubic tubercle)

Extra:
Anterior: Transverse facia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Direct and indirect hernias are associated with congenital abnormalities including Ehler danlos and marfan’s syndrome. There is another congenital abnormality that predisposes a person to an indirect hernia specifically. What is it?

Also, which part of the path of the inguinal hernia does it apply to?

For reference:
Deep ring -> inguinal canal -> superficial ring +/- Spermatic cord

A

Congenital persistent processus vaginalis

Superficial ring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

An indirect hernia may enter the spermatic cord causing increased sx. What are the contents of the spermatic cord (sorry)

A

3 vessels:
Testicular artery and vein
Vas deferens artery and vein
Cremesteric Artery and vein

3 Others:
Lymphatics
Spermatic cord (Cremesteric)
Vas Deferens

3 Fascia:
External spermatic fascia
Internal spermatic fascia
Cremesteric muscle and fascia

4 nerves:
Nerve to cremaster
Sympathetic nerves
Ilioinguinal nerve
Genitofemoral nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Inguinal hernias may be associated with some discomfort and pain. What exacerbated it?

A

Worse with prolonged standing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How can an inguinal hernia present?

A

Most commonly asymptomatic and due to appearance of a lump

Actual presentation
Lump
Pain worse with prolonged standing -> Severe pain with strangulation
+/- obstruction (nausea, vomiting, constipation)

18
Q

Is an inguinal hernia typically reducible?

A

Yes but can be irreducible (associated with incarceration)

19
Q

An inguinal hernia presenting with acute pain is an indication of?

A

strangulation

20
Q

A patient presents with a hernia which you identify as an inguinal hernia. What investigations will you perform to correctly diagnose it?

A

Bedside: clinical examination to confirm it (superior and medial to pubic tubercle)

Bloods: Routine FVS, CRP, lactate

Imaging: Groin Us (typically not needed as it is a clinical diagnosis)

21
Q

A 65 year old male patient presents with a lump and is disturbed of its appearance. He is otherwise well. What is the management you will provide to this patient?

A

Routine referral to surgical repair

22
Q

A 65 year old male patient presents with a lump and is disturbed of its appearance. He is otherwise well. You refer them to routine surgical repair. In general, what are the options you have?

How will you decide between them?

A

1) Open mesh repair (tension free) - First-line
2) Non-mesh repair (tissue approximation) - In the presence of an infection
3) Laparoscopic Herniorrhaphy - In the case of bilateral or recurrent hernias

23
Q

You are asked what an open mesh repair of an inguinal hernia is by your examiner

A

First line surgical treatment of an inguinal hernia. It utilizes non-absorbable mesh to strengthen the posterior wall of the deep ring/inguinal canal under local anaesthesia and sedation

24
Q

A laparoscopic herniorrhaphy is used to treat bilateral or recurrent inguinal hernias.
What are the 2 types?
What is it?

What are the contraindications?

A

TEP - Totally extraperitoneal repair
TAPP - Transabdominal pre-peritoneal repair

It is a more intensive mesh-based (both types) surgical procedure to repair recurrent or bilateral inguinal hernias via a tension force under GA

contraindications:
Infection
Ascites
GA intolerance
Previous pre-peritoneal surgery (total abdominal hysterectomy, C-section)

25
Q

What are the complications of surgical repair of a hernia?

A

General:
Infectious: Wound site infection, sepsis, UTI (catheter use during surgery), pneumonia
Bleeding: Post-op bleeding, haematoma
Thromboembolic: DVT, PE, stroke
Cardiovascular: MI, arrhythmia, A.fib, stroke
Anaesthetics: Atelectasis/barotrauma from intubation, GA intolerance, if spinal, LP (traumatic, incorrect)
Other: Chronic pain, delayed wound healing, Adhesions!!

Specific:
Urinary retention
Scrotum: Paraesthesia (labia majora in women), haematoma, atrophy
Recurrence

26
Q

A 65 year old male patient presents with a lump and is disturbed of its appearance. He is otherwise well. You refer them to routine surgical repair and they ask you if there is anything they should know for after the surgery. What will you tell them?

A

Avoid heavy lifting for 6-8 weeks post-procedure

27
Q

A 65 year old male patient presents with a lump and is disturbed of its appearance. He is otherwise well. You refer them to routine surgical repair. On followup, they are noted to experience 2 complications of the surgery which are testicular atrophy and paraesthesia in the scrotum. What are the causes of these?

A

Both due to damage to the spermatic cord

Paraesthesia in the scrotum or labia majora are due to damage to the ilioinguinal nerve

Testicular atrophy due to damage to the testicular artery

28
Q

What is the location of the femoral hernia compared to the pubic tubercle?

A

Below and lateral to the pubic tubercle (inferolateral)

29
Q

What is the typical presentation of a femoral hernia?

A

60% present with a lump (in a female typically >70)
40% present as emergency due to high risk of stangulation

30
Q

Why does a femoral hernia have a higher risk of strangulation than an inguinal hernia?

A

Due to the narrow neck

31
Q

Does a femoral hernia typically have a cough impulse?

A

no

32
Q

Femoral hernias What are the components of the Femoral triangle?

What are the contents of the femoral triangle?

What are the contents of the femoral canal?

A

Lymphatics + fat

33
Q

What is the management for a femoral hernia?

A

All should be surgically required due to high risk of strangulation

34
Q

What is Saphena Varix?
Where is the saphena varix located?
How would you examine it?

A

A saphena varix is a venous swelling caused by dilation of the saphenous vein at the SFJ (3cm inferolateral to pubic tubercle - same as femoral hernia)

Inspection: Blue lump in groin, disappears when supine (unlike femoral hernia), cough impulse

Palpation: Empties with pressure

Tourniquet and Trendelenburg test

35
Q

Explain both the Tournquet and Trendelenburg test?

A

Tourniquet test: Lie patient flat, perform straight leg raise and put on shoulder.

Milk empty veins by massaging blood back towards the groin and apply the tourniquet around the upper thigh.

Get patient to stand up and observe leg for refilling:
Rapid refilling on standing before tourniquet = incompetence below the SFJ
No refilling on standing and rapid filling on tourniquet release = SJF incompetence

Trendelenburg test is the same but use fingers to occlude SFJ (3 cm inferolateral to pubic tubercle)

36
Q

What are the 2 types of umbilical hernias? Give their etiology
How will you manage each?

A

True: Always congenital -> Typically closes spontaneously by 3 years. if not, surgical repair
Periumbilical: Always acquired -> Elective surgical repair, urgent if symptoms

37
Q

What are the 2 main RFs for an acquired umbilical hernia (periumbilical)

A

multiparity
pregnancy
obesity

38
Q

Incisional hernias are relatively common. They present typically as a lump/defect.

How does size affect prognosis?
Give 4 RFs
What is the main indication for surgical repair?

A

Smaller is worse as it has an increased risk of strangulation

RFs:
Post-op infection
Multiple operations in same site
Abdominal obesity
Poor muscle quality (smoking, anaemia)
Poor choice of incision
Inadequate closure technique

Surgical repair if symptomatic/strangulated

39
Q

What is a spigelian hernia?
How will you diagnose it?
How will you manage it?

A

Herniation through a defect between the lateral border of the rectus abdominus and the linea semiulnaris

Diagnosis is difficult clinically => requires US/CT

Management is direct surgical repair

40
Q

An obturator hernia is a defect through the obturator canal. What is the presentation of it? How is it diagnosed and managed?

A

Compression of the obturator nerve =>

Motor: Hip adduction -> Trendelenburg gait
Sensory: Pain and paraesthesia in medial thigh and knee joint

Dx: CT required like for spigelian
Mx: High risk of strangulation => direct surgical repair (also like spigelian)

Ch. 2 - Hernias (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions