Hernias

Question 1

Patho of Hernia

Answer 1

protrusion of an organ as part of an organ through the body wall that normally contains it

Question 2

Most common type of hernia

Answer 2

groin

Question 3

Most common hernia

Answer 3

inguinal

Question 4

Types of groin hernias

Answer 4

inguinal and femoral

Question 5

Types of ventral hernias

Answer 5

umbilical, epigastric, spigelian

Question 6

Incisional hernias are due to? What type of hernia?

Answer 6

• Due to open abdominal procedure and incision through the abdominal wall
• Ventral hernia

Question 7

Reducible Hernia

Answer 7

tissue is easily movable and can be reduced from the sac and easily pushed back in

Question 8

Incarcerated Hernia

Answer 8

Trapping of hernia within the sac without compromise of vasculature

Question 9

Strangulated Hernia

Answer 9

Circulation of hernia contents is compromised

Question 10

What do we worry about with strangulated hernias?

Answer 10

ischemia–> dead bowel–> sepsis

Question 11

2 types of inguinal hernias

Answer 11

direct and indirect

Question 12

Direct inguinal hernia

Answer 12

• inferior to epigastric vessels and doesn’t pass through inguinal canal
• ACQUIRED

Question 13

Indirect inguinal hernia

Answer 13

• passes through the inguinal ring

- CONGENITAL

Question 14

Femoral hernia

Answer 14

inferior to the inguinal ligament

Question 15

Hesselbach’s triangle contains

Answer 15

inguinal ligament, epigastric vessel and rectus muscle

Question 16

Cause of Acquired groin hernias

Answer 16

weakening or disruuption of fibromuscular tissue due to:

• trauma
• drugs
• connective tissue abnormality (Marfan/ DE)
• chronic overstretching of musculoaponeurotic structures

Question 17

Age of groin hernias for men/women

Answer 17

Women get it later in life 60-80; men 50-70

Question 18

Risk factor for groin hernia

Answer 18

• HX of hernia or repair
• old age
• male
• white
• chronic constipation
• abdominal wall injury
• smoking
• family history of hernias

Question 19

Clinical Presentation/PE of groin hernia

Answer 19

• bulge in the groin that may be tender to palpate but generally has no pain
• heavy/discomfort in groin
• slight pelvic pain in women
• worst at end of day/ prolonged sitting
• radiating twinge of pain with sitting/standing

Question 20

Who is more likely to get groin hernias?

Answer 20

patients who work in manual/physically active professions

Question 21

Clinical presentation of reducable hernias

Answer 21

• some pain

- asymptomatic

Question 22

Clinical presentation of incarcaerated hernias

Answer 22

• +/- N/V, pain, block
• tenderness, bowels may not move due to obstruction
• fever

Question 23

Clinical presentation of strangulated hernias

Answer 23

• painful
• +/- N/V, pain, block
  ischemia–> pain out of proportion

Question 24

How do you examine inguinal canal?

Answer 24

use small finger to go into it and have patient cough.
If you feel bulge next to finger–> direct
If you feel bulge hit finger–> indirect

Question 25

Dx Groin Hernias

Answer 25

H/PE | Use US if occult, differentiation, determining if strangulation/incarceration

Question 26

Tx groin hernias

Answer 26

``` ASx- monitor Surgical: - moderate to severe sx - Urgent- incarceration - Emergency- strangulation, bowel obstruction - Laproscopic/open - Mesh: durable and longevity - Aloderm: human cadaver skin; less likely to get infected ```

Question 27

Tx Femoral Hernia

Answer 27

Surgery

Question 28

Pantaloon Hernia

Answer 28

both direct and indirect hernia on the same side

Question 29

How do you see an incisional hernia?

Answer 29

Have ptn lay down and sit up a little--> pop out

Question 30

Umbilical hernia is a protrusion through?

Answer 30

umbilical ring

Question 31

Who gets umbilical hernias?

Answer 31

Adults- acquired | Children- congenital; close spontaneously by 1.5yr

Question 32

RF for umbilical hernia

Answer 32

obesity pregnant ascites

Question 33

Where is an epigastric hernia?

Answer 33

in the epigastrium (upper/central abdomen)

Question 34

Where does the Spigelian hernia form?

Answer 34

through the spigelian fascia; ACQUIRED

Question 35

Clinical Spigelian hernia

Answer 35

- swelling lateral to the rectus muscle | - pain is dull/ constant

Question 36

Dx Spigelian hernia

Answer 36

US

Question 37

Tx Spigelian hernia

Answer 37

surgical because very painful and complicated; trapped easily

Question 38

Patho Richter's Hernia

Answer 38

- Part of circumference of bowel becomes incarcerated | - little piece of bowel wall is stuck in hernia-- weakening of the bowel wall, ischemia, or rupture

Question 39

Most common site of Richter's Hernia

Answer 39

femoral canal

Question 40

Clinical Richter's Hernia

Answer 40

- local inflammation | - overtime ischemia, gangrene, perforation

Question 41

Tx Richter's Hernia

Answer 41

- surgical

Question 42

Parastomal hernia common in patients with?

Answer 42

stoma (ileostomy or colostomy)

Question 43

Tx Parastomal hernia

Answer 43

based on sx

Question 44

Clinical Parastomal hernia

Answer 44

- bowels and intestine protrude out of stoma - skin is clean and normal looking - patient comfortable

Question 45

What is not a true hernia and why?

Answer 45

Rectus Abdominus Diastasis; not a break in the rectal wall only a seperation of the walls

Question 46

Biggest RF for Rectus Abdominus Diastasis

Answer 46

Pregnancy

Question 47

Cause Rectus Abdominus Diastasis

Answer 47

- weak/stretched abdominal wall fascia due to pregnancy/ obesity - some association with aneurysmal disease

Question 48

Dx Rectus Abdominus Diastasis

Answer 48

PE- prominent ridge between two rectus abdominous while sitting

Question 49

Tx Rectus Abdominus Diastasis

Answer 49

conservative- weight loss, abdominal exercise | surgical- cosmetic/ severe sx