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Flashcards in Hernias Deck (29)
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1
Q

What is a hernia?

A

A protrusion of a viscus or part of a viscus through the wall which is designed to contain it.

2
Q

What are the 3 layers of a hernis?

A

The Covering of the sac (skin, fascia)
The sac- peritoneum
The contents.

3
Q

What is the most common groin hernia?

A

Inguinal

4
Q

What are the risk factors for inguinal hernias?

A

Male
Obesity,
Age,
open appendix surgery

5
Q

Which side is more common for inguinal hernias?

A

Right side

6
Q

What makes up the anterior, posterior and floor of the inguinal canal?

A

Anterior is the external oblique
Floor is the inguial ligament
Posterior wall is transverse fascia

7
Q

What is contained within the inguinal canal in men?

Anatomy (spermatic cord and ilio-inguinal nerve)

A

3 arteries: testicular artery, artery to vas deferans and cremasteric artery
3 nerves: ilioinguinal nerve, genital branch of genitofemoral nerve, Sympathetics (technically outside)
3 others: Panpiniform venous plexus, Vas deference, lymphatics

8
Q

Are most inguinal hernais direct or indirect?

A

Indirect

9
Q

Anatomically what is the difference between direct and indirect hernias?

A

Indirect: Enters the deep ring laterally and emerges through the superficially medially. Originates lateral to inferior epigastric artery
Direct: Emerges through the transverse facia of the posterior wall. Originals medial to inferior epigastric artery

10
Q

How can you clinically determine the difference between direct and indirect hernias?

A

Reduce hernia
Cover the deep inguinal ring and ask patient to cough.
Returns => direct
Remains reduced => indirect

11
Q

Do all inguinal hernias need to be fixed?

A

No if small and asymptomatic you can watchfully wait incase they grow or become symptomatic.

12
Q

Is incarceration of inguinal hernias common?

A

No- low risk

13
Q

25-75% of patients chose to get inguinal hernias repaired. How is this done?

A

1) Open lichtenstein method. GA, spinal or local. Mesh inserted near cord
2) Laproscopic: less pain, faster recovery, needs GA. More difficult op and takes longer. Reduced risk of infection or chronic pain

14
Q

What are the complications of inguinal hernia repair?

A

4% recure
Urinary retention
Bleeding/haematoma
Chronic pain-30% of patients get chronic groin pain
Numbness in groin
Testicular atrophy due to damage to testicular artery
Wound infection- infected mesh must be removed.

15
Q

What are the emergency presentations of any hernia?

A

Incarcerated hernia-stuck hernia (irreducible) => strangulation, obstruction

16
Q

How is an incarcerated hernia treated?

A

Try to reduce it under anasthetic- easier to operate if reduced
Operative repair after resuscitation.

17
Q

Which group of people get femoral hernias?

A

Older women

Multi-parous (children)

18
Q

How commonly do these present as emergency?

A

40%

19
Q

What surrounds the femoral canal?

A
Superior = inguinal ligament
Inferior = Pectoneal ligament
Medial = Lacunar ligament
Lateral is the femoral Vein
(Femoral artery and nerve are more lateral)
20
Q

How is a femoral hernia repaired in an emergency or elective?

A
Emergency = high approach
Elective = low approach (laproscopic)
21
Q

How should you assess a hernia?

A

Assess both standing and sitting. Get the patient to cough.
Is it reducible?
Yes- elective
No- Emergency

22
Q

How can you tell the difference between inguinal and femoral hernias?

A
Femoral = below and lateral to pubic tubercle
Inguinal = above and medial to pubic tubercle
23
Q

Why do epigastric hernias occur?

A

Men usually due to a defect in the linea alba

24
Q

What are the risk factors for paraumbilical hernias in adults?

A

Obesity, pregnancy, ascites

25
Q

How are para umbilical hernias repaired?

A

Reduction and inserting mesh behind abdominal wall to reinforce it.

26
Q

How commonly do incisional hernias occur and what are the risk factors?

A

10-15% of abdominal incisions

Risk factors: Obease, chest infection, smoking, old, steroid, malnutrition

27
Q

What are the 2 common paediatric hernias?

A

Umbilical

Inguinal

28
Q

How are paediatric umbilical hernias treated?

A

Usually resolve spontaneously by aged 4. If not operated to reduce- no mesh used.

29
Q

How are paediatric inguinal hernias treated and what are the risk factors?

A

Mostly indirect and in boys. More common in pre term.
Silk skin sign, crying and groin swelling- difficult to see.
Needs surgical repair- no mesh used