3- hernia

Question 1

what is hernia?

Answer 1

= rupture, protruded viscus →abnormal exit of tissue or organ through wall of cavity in which normally residues

Question 2

what are classifications of hernia?

Answer 2

hiatal hernia = herniating into thoracic cavity

internal hernia (within abdomen) = rare, not visible and common in weight loss surgery

external hernia = common

Question 3

what are risk factors for hernia?

Answer 3

• obesity (causes pressure)
• chronically increased intra-abdominal pressure →cough, constipation, straining
• abdominal surgery
• pregnancy
• smoking
• peritoneal dialysis
• collagen disorders

Question 4

what hernia’s are in diaphragm?

Answer 4

• Hiatal hernia
• Congenital

Question 5

what hernia’s are in abdominal wall?

Answer 5

• Incisional (hernia at the site of scar)
• Ventral (midline, general term)
• Umbilical (specifically located)
• Spigelian (specifically located)
• Parastomal

Question 6

what hernia’s are in groin?

Answer 6

• Inguinal (direct, indirect, pantaloon, sliding)
• Femoral

Question 7

what is treatment for hiatal hernia?

Answer 7

treat with omeprazole (reduces symptoms) = large symptoms you consider surgery (often re-occur)

• also manage lifestyle factors as treatment

Question 8

what are direct and indirect inguinal hernias?

Answer 8

direct inguinal hernia = abdominal contents directly pushes through weakness posterior wall of the inguinal canal/anterior abdominal wall (directly pops out)

indirect inguinal hernia = enter the deep ring (the start) of the inguinal canal →using inguinal canal as area of weakness to push through

• both types exit throughsuperficial ring of inguinal canal (and sometimesenter scrotum = more common forindirectto do this as path through both anatomical inguinal rings offers less resistance)

Question 9

does femoral or inguinal hernia have a higher risk of strangulation?

Answer 9

femoral (Strangulation of a hernia is a serious complication that occurs when the blood supply to the herniated tissue becomes compromised)

Question 10

what are midline hernia’s?

Answer 10

1. Epigastric
2. Divarication of recti (not hernia)
3. Supraumbilical
4. Umbilical

Question 11

what is divarication of recti?

Answer 11

• not true hernia
• Thinning of linea alba →happens in pregnancy = can sometimes see bulge or gap
• Rarely treated unless during repair for a neighboring hernia

Question 12

what is a spigelian hernia?

Answer 12

rare abdominal wall hernia
- Linea semilunaris line
- At lateral border of rectus sheath as it meets the oblique muscles
- usually operate

Question 13

what is incisional hernia?

Answer 13

• failure of fascia to restore strength in surgical wound

Question 14

what are risk factors for incisional hernia?

Answer 14

obesity, smoking, post op wound infection, post op resp failure, early return to heavy lifting

Question 15

what is parastomal hernia?

Answer 15

• specific type of incisional hernia
• common with stomas
• difficult to repair without reversing stoma

Question 16

what is obturator hernia?

Answer 16

= a rare external abdominal hernia formed by protrusion of the abdominal visceral organs or extraperitoneal fat through the obturator foramen of the hip bone (may extend to femoral triangle)
- usually presents as obstruction

Question 17

what are signs & symptoms of hernia?

Answer 17

• 1/3 asymptomatic
• if no pain - might not do surgery
• might have pain particularly when straining

Question 18

what are complications of hernias?

Answer 18

• Irreducible (a.k.a. ’incarcerated’) = The hernia content cannot be manipulated back into the abdominal cavity
• Obstructed = Bowel loop gets trapped in hernia and becomes non-functioning but no compromise to blood supply
• Strangulation = Bowel loop gets trappped in hernia & Blood supply to bowel is compromised leading to ischaemia, perforation and peritonitis

Question 19

what are treatment options for hernia?

Answer 19

• do nothing - just watch
• conservative = hernia belt, avoid straining
• surgical repair = open surgery, laparoscopic conventional, laparoscopic robotic

Question 20

what are surgical complications of hernias?

Answer 20

• hole in bowel = most feared
• most common = seroma (fluid under wound- settles with time)
• can get necrosis of fat
• hematoma →often leave drains in
• mesh infection - rare (not good when happens)
• chronic pain (have to be willing to risk)
• big pressure problems - cause breathing problems etc

Question 21

what factors does treatment of hernias depend on?

Answer 21

• Symptoms
• Emergency or not
• Site and size
• Previous surgery
• Comorbidity

Question 22

what is femoral triangle?

Answer 22

a space in the groin region, bordered by the inguinal ligament superiorly, the sartorius muscle laterally, and the adductor longus muscle medially