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JL Gastrointestinal > Hernias > Flashcards

Flashcards in Hernias Deck (76)
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1
Q

What is an abnormal protrusion of a viscus outwith its normal body cavity?

A

Hernia

2
Q

Name 4 hernias, most common first?

A
  1. Inguinal
  2. Umbilical
  3. Incisional
  4. Femoral
3
Q

What may arise from natural openings or weak areas, caused by stretching or surgical inscision?

A

Abdominal wall hernias

4
Q

What type of hernias are inguinal, femoral, umbilicus, oesophageal hiatus and obturator?

A

Natural abdominal wall hernias

5
Q

What are incisional, parastomal, epigastric and paraumbilical herias a type of?

A

Weak area abdominal wall hernia

6
Q

What is the physiological predisposing factor of abdominal hernias?

A

Raised intra-abdominal pressure

7
Q

What can pregnancy and obesity lead to?

A

Abdominal hernias

8
Q

What predisposing factor of abdominal hernias can leads to bilateral inguinal hernia?

A

Prostatism

9
Q

Can constipation, coughing and heavy lifting cause abdominal hernias?

A

Yes

10
Q

What may hernias be classified as?

A

Reducible or irreducible

11
Q

If the hernia is irreducible, what may happen to its contents?

A

Incarcerated or strangulated

12
Q

What denotes compromise of the blood supply of the contents and its development increases morbidity and mortality?

A

Strangulation

13
Q

With strangulation hernias, what system is occluded first?

A

Low pressure venous system, then arterial supply

14
Q

When the arterial supply of a hernia becomes occluded, what can develop?

A

Gangrene

15
Q

In predisposed patients, to prevent an incisional hernia, what surgical measures are taken?

A

Tension sutures plus “mass closure” of the linea alba

16
Q

If you have a malignancy are you more likely to develop an incisional hernia?

A

Yes

17
Q

What two aetiological causes related to after an operation can be predisposing factors for incisional hernias?

A

Post-operative wound infection

Post-operative wound haematoma

18
Q

What does an ileus do that increases the chance of an incisional hernia?

A

Raises the intra-abdominal pressure

19
Q

What class of drug can be a predisposing factor for incisional hernias?

A

Steroids

20
Q

Is a vertical or transverse incision more likely to cause an incisional hernia?

A

Vertical

21
Q

What type of hernia is common in adult, obese patients?

A

Paraumbilical

22
Q

What to epigastric hernias arise from?

A

Congenital weakness of the linea alba

23
Q

What type of hernia usually contains extraperitoneal fat?

A

Epigastric

24
Q

What type of hernia has a male:female ration of 3:1 and occurs usually in late teens/early adult hood?

A

Epigastric hernia

25
Q

How do you repair an epigastric hernia?

A

With sutures or mesh

26
Q

What type of hernia is an umbilical hernia?

A

Congenital

27
Q

By what age has an umbilical hernia usually resolved, and what action is taken if it hasn’t by then?

A

Age 3, if > 3 operate

28
Q

What male:female ratio does a paediatric inguinal hernia have?

A

9:1

29
Q

What type of hernias are more common in pre-term and low birth weight infants?

A

Paediatric inguinal hernias

30
Q

What side are paediatric inguinal hernias commonly found on and what is there a 20% chance of developing?

A

Right side, developing a contralateral hernia

31
Q

With paediatric inguinal hernias, what is there an increased risk of aged

A

Strangulation

32
Q

What type of hernia is common in a thin, elderly female?

A

Femoral hernia

33
Q

What sign is there, of a femoral hernia?

A

Loss of groin crease

34
Q

What is the anatomical defect of a femoral hernia?

A

Defect through the femoral canal

35
Q

What are the 4 boundaries of the femoral canal?

A

Anterior - inguinal ligament
Medial - lacunar ligament
Lateral - femoral vein
Posterior - pectinate ligament

36
Q

What hernias are below and lateral to the pubic tubercle and usually flatten the groin crease?

A

Femoral hernias

37
Q

What hernia is present in a thin, elderly female with small bowel obstruction and no previous surgery?

A

Femoral hernia

38
Q

What type of hernia occurs above the pubic tubercle and increases the groin crease?

A

Inguinal hernia

39
Q

Name a type of inguinal hernia?

A

Inguino-scrotal

40
Q

With scrotal swellings, if you cannot get above the swelling what does it suggest?

A

Hernia

41
Q

What are 4 causes of scrotal swellings?

A
  1. Inguino-scrotal hernia (indirect)
  2. Hydrocoele
  3. Epididymal cyst
  4. Testicular swelling
42
Q

How should you examine a patient for an inguinal hernia?

A

Examine the patient upright

43
Q

If the hernia is to scrotum, what does it suggest?

A

Indirect

44
Q

If a hernia is above and medial to the pubic tubercle, what is it?

A

Inguinal

45
Q

If a hernia is below and lateral to the pubic tubercle, what does it suggest?

A

Femoral

46
Q

When examining inguinal hernias, what should you ask the patient to do?

A

Pressure over the deep inguinal ring and get patient to cough

47
Q

When trying to differentiate clinically between indirect and direct, where should you place a little finger?

A

In the canal (behind cord)

48
Q

When differentiating between direct and indirect hernias at operation, what does medial to inferior epigastric vessels suggest?

A

Direct

49
Q

When differentiating between direct or indirect hernias during operation, what does lateral to inferior epigastric vessels suggest?

A

Indirect

50
Q

What type of inguinal hernia is this: lateral to the inferior epigastric vessels and with the cord, may reach to the scrotum (inguino-scrotal), congenital hernias are indirect and MF ratio is 10:1?

A

Indirect inguinal hernia

51
Q

What hernia is this: psoterior bulge through transversalis fascia, medial to inferior epigastric (branch of ext iliac) and often bilateral?

A

Direct inguinal hernia

52
Q

Where is the deep inguinal ring located?

A

Mid-inguinal point

53
Q

Where is the superficial inguinal ring located?

A

Above and medial to pubic tubercle

54
Q

What are the four bondaries for the inguinal canal?

A

Anterior - external oblique aponeurosis
Floor - inguinal and lacunar ligament
Roof - conjoint tendon coming over
Posterior - transversalis fascia and conjoint tendon (med)

55
Q

What is Hesselbach’s triangle boundaries?

A
  1. Inguinal ligament inferiorly
  2. Inferior epigastric vessels laterally
  3. Lateral border of rectus sheath medially
56
Q

Who are indirect inguinal hernias more common in?

A

Young men

57
Q

How are indirect inguinal hernias controlled?

A

By digital pressure over the internal ring

58
Q

What hernias are poorly controlled by digital pressure, more common in older men and have a 0.3% per annum strangulate?

A

Direct inguinal hernias

59
Q

What are the three factors for operating on an inguinal hernia?

A
  1. Hernia at risk of complications even if no symptoms (e.g. femoral)
  2. Hernia with previous symptoms of obstruction
  3. Hernia interfering with life-style
60
Q

What complication of an inguinal hernia occurs in relation to the wound or scrotum?

A

Haematoma

61
Q

What complications of inguinal hernias are related to testicles?

A

Testicular pain and atrophy

62
Q

What are chronic neurogenic pain, hernia recurrence, wound infection and acute urinary retention complications of?

A

Inguinal hernias

63
Q

What are the three types of inguinal hernia operations?

A
  1. Suture (bassini)
  2. Open mesh (Lichtenstein)
  3. Laparoscopic (intraperitoneal - TAPS, extraperiotneal - TEPS)
64
Q

What is herniotomy?

A

Excision of peritoneal sac

65
Q

What is herniorraphy?

A

Repair of the defect of the wall

66
Q

What surgical repair method is used for congenital hernias?

A

Herniotomy

67
Q

What is an embryonic development outpouching of the peritoneum?

A

Processus vaginalis

68
Q

What does inguinal hernia in children result from?

A

Patent processus vaginalis, failed to obliterate after the descent of the testis through it.

69
Q

Why do femoral hernias almost always require surgical management?

A

Due to risk of strangulation

70
Q

In obturator hernias, where does the abdominal contents protrude through?

A

The obturator foramen

71
Q

What patients are obturator hernias more common in?

A

Females getting older and losing weight

72
Q

What hernia is the Howship-Romberg sign typical of?

A

Obturator hernia (pain in medial thigh is provoked by thigh extension, medial rotation and abduction)

73
Q

What hernia is uncommon and occurs below the level of the umbilicus/arcuate line, as there is a lcak of posterior retus sheath here, between the rectus muscle medially and semilunar line laterally?

A

Spigelian

74
Q

What hernias are small, but there risk of strangulation is high, therefore are almost always surgically repaired unless contra-indicated?

A

Spigelian

75
Q

What is an inguinal hernia laying medial to the epigastric vessels?

A

Direct

76
Q

What is an inguinal hernia laying lateral to the epigastric vessels?

A

Indirect