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Gastrointestinal > Hernias > Flashcards

Hernias Flashcards

1
Q

what is a hernia?

A

an abnormal protrusion of a viscus outwith its normal body cavity

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2
Q

what hernias arise from natural openings?

A 
inguinal
femoral
umbilicus
oesophageal hiatus
obturator
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3
Q

what hernias arise from weak areas?

A

incisional (caused by surgery)
parastomal
epigastric
paraumbilical

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4
Q

what are the 6 predisposing factors to abdominal hernias?

A 
heavy lifting
coughing
constipation
prostatism
pregnancy
obesity
(all cause raised intrabdominal pressure)
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5
Q

what is prostatism a symptom of?

A

compression/obstruction of the urethra

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6
Q

what is the main way that hernias are classified?

A

reducible or irreducible

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7
Q

what is a reducible hernia?

A

a hernia that can easily be pushed back into place

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8
Q

what is an irreducible hernia?

A

a hernia that won’t push back into place

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9
Q

what is the 2 subgroups of irreducible hernias?

A

obstructed hernias

incarcerated hernias

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10
Q

what is the difference between obstructed and incarcerated hernias?

A

obstructed hernia: neck is narrow enough to occlude bowel lumen
incarcerated: bowel isn’t affected

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11
Q

if an obstructed hernia isn’t treated quickly enough what can happen?

A

strangulated hernia can form

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12
Q

what is a strangulated hernia?

A

the neck has compromised the bowel blood supply

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13
Q

in a strangulated hernia which supply is usually compromised first?
(arterial or venous)

A

venous usually compromised first because of it’s lower pressure
(venous congestion causes purple appearance)

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14
Q

who gets paraumbilical hernias and who gets true umbilical hernias?

A

adults (and obese)- paraumbilical

children-umbilical

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15
Q

what does an epigastric hernia usually arise from?

A

congenital weakness of the linea alba

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16
Q

when do epigastric hernias usually present?

A

late teens/early adult

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17
Q

what age do congenital umbilical hernias usually resolve by?

A

age 3

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18
Q

if a congenital umbilical hernia hasn’t resolved by the age of 3 what should be done?

A

surgery

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19
Q

what is the processus vaginalis?

A

a bit of peritoneum that that descends with the testes during fetal development

20
Q

what usually happens to the processus vaginalis?

A

communication between processus vaginalis and peritoneal cavity close and the processus vaginalis becomes the tunica vaginalis

21
Q

what is it called when communication between the processus vaginalis and peritoneal cavity doesn’t close? (and what can this lead to)

A

patent processus vaginalis

can lead to hernias

22
Q

what is the difference between a scrotal hernia and an inguinal hernia in infants?
(caused by patent processus vaginalis)

A

scrotum hernia- peritoneum comes all the way to the bottom of the scrotum
inguinal hernia- similar but peritoneum only goes half way to the bottom of the scrotum

23
Q

what is hydrocele of the spermatic cord in infants?

A

presence of a non-communicating pocket of peritoneal fluid that failed to be obliterated, in the testes close to the spermatic cord

24
Q

what is a communicating hydrocele in infants?

A

a pocket of fluid within the scrotum sac that can communicate with the peritoneal cavity

25
Q

what is hydrocele of the tunica vaginalis in infants?

A

presence of a non-communicating pocket of peritoneal fluid that failed to be obliterated, in the testes in the area of the tunica vaginalis

26
Q

what is the typical patient of a femoral hernia?

A

thin elderly female

27
Q

what can you see on inspection of a femoral hernia?

A

loss of groin crease

28
Q

what natural opening does peritoneum protrude into in a femoral hernia?

A

defect through femoral canal

29
Q

what are the anterior, medial, lateral and posterior boundaries of the femoral canal?

A

anterior- inguinal ligament
medial- lacunar ligament
lateral- femoral vein
posterior- pectinate ligament

30
Q

what does the inguinal ligament run from?

A

anterior superior iliac spine

pubic tubercle

31
Q

where is the femoral hernia in relation to the pubic tubercle?

A

inferior and lateral to the pubic tubercle

32
Q

what do you usually see on inspection of an inguinal hernia?

A

increased groin crease

33
Q

where is an inguinal hernia in relation to the pubic tubercle?

A

superior and medial to the pubic tubercle

34
Q

what are the 4 major causes of scrotal swellings?

A

inguino-scrotal hernia
hydrocele
epidydymal cyst
testicular swelling

35
Q

what is a direct inguinal hernia?

A

occurs medial to the inferior epigastric vessels, abdominal contents herniate through weak spot in fascia of the posterior wall of the inguinal canal

36
Q

what is an indirect inguinal hernia?

A

occurs laterally o the inferior epigastric vessels, abdominal contents protrude through deep inguinal ring

37
Q

what type of inguinal hernia goes into the scrotum?

A

indirect

38
Q

what type of hernias are congenital inguinal hernias?

A

indirect hernias

39
Q

where does the inguinal canal run from?

A

deep ring to superficial ring

40
Q

where is the deep inguinal ring?

A

mid-inguinal point

41
Q

where is the superficial ring?

A

superior and medial to pubic tubercle

42
Q

what make up the anterior, the floor, the roof and the posterior boundaries of the inguinal canal?

A

anterior- external oblique aponeurosis
floor- inguinal and lacunar ligament
roof- conjoint tendon
posterior- transversalis fascia and conjoint tendon

43
Q

what are the boundaries of Hesselbach’s triangle?

A

inferior- inguinal ligament
lateral- inferior epigatric vessels
medial- lateral border of rectus sheath

44
Q

how are indirect hernias controlled?

A

controlled by digital pressure over the internal ring

45
Q

when do you operate on a hernia?

A
  1. if hernia is at risk of complications even if no symptoms
  2. hernia with previous symptoms of obstruction
  3. hernia interfering with lifestyle
46
Q

what surgical repair technique is use on congenital hernias?

A

herniotomy

47
Q

what is the surgical technique which repairs the defect of the wall?

A

herniorrhaphy

Gastrointestinal (15 decks)

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