GI: Hernias Flashcards Preview

Year 3 - Junior surgery > GI: Hernias > Flashcards

Flashcards in GI: Hernias Deck (10)
Loading flashcards...
1
Q

which type of hernia is more common in males? in females? which are more at risk of strangulation?

A

Males: inguinal hernia - low risk
Females: femoral hernia (less common) - high risk

2
Q

describe the course of a femoral hernia

A

Protrudes through femoral ring into femoral canal (due to weakness in abdo. wall).

Can enlarge by passing through saphenous opening into subcutaneous tissue of thigh.

3
Q

describe the course of a direct inguinal hernia

A

Protrudes through weakness in transversalis fascia of Hesselbach’s triangle… traverses medial 1/3 of inguinal canal… exits via superficial inguinal ring (lateral to spermatic cord).

Rarely enters scrotum.

4
Q

describe the course of an indirect inguinal hernia.

A

Protrudes through patent processus vaginalis… through deep inguinal ring, traverses entire canal (within processus vaginalis) and exits via superficial inguinal ring… remains within spermatic cord and commonly passes into scrotum/labium majus.

5
Q

do direct/indirect inguinal hernias pass medial or lateral to inferior epigastric vessels?

A

indirect: passes lateral
direct: passes medial

6
Q

name the boundaries of Hesselbach’s trinagle

A

Medial: rectus abdominis
Lateral: inferior epigastric vessels
Inferior: inguinal ligament

7
Q

how would you differentiate between inguinal and femoral hernia based on location? and between direct and indirect inguinal?

A

Inguinal: usually superomedial to pubic tubercle.
Reduce hernia, apply pressure over deep inguinal ring and ask pt to cough. If hernia reappears, likely a direct inguinal hernia.

Femoral: usually inferolateral to pubic tubercle (and medial to femoral pulse)

8
Q

how would you manage a pt with a hernia?

A

If small and asymptomatic: watch and wait.

If expanding, large or symptomatic:

  • 1st hernia: open inguinal hernia repair - open inguinal canal, reduce hernia, repair defect and place prosthetic mesh posterior to cord structures.
  • recurrent or bilateral hernia laparoscopic inguinal repair - may also have mesh but typically lies posterior to deep ring.
9
Q

what are the possible compications of hernias?

A
  1. become irreducible/incarcerated - due to formation of fibrous adhesions.
  2. strangulation (3% risk/yr) - compression of hernia compromises blood supply causing ischaemic bowel
  3. bowel obstruction - can be result of strangulation
10
Q

name the boundaries of the inguinal canal

A

Floor = inguinal ligament
Anterior wall = external oblique aponeurosis
Posterior wall = transversalis fascia
Roof = internal oblique and transversus abdominis