Y4 Gastrointestinal > Hernias > Flashcards

Hernias Flashcards

(38 cards)

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1
Q

Define what a hernia is

A

Any protrusion of a viscus (any large interior organ) or part of a vicus through a defect of the walls that contains it into an abnormal position

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2
Q

What are the risk factors for the development of hernias ?

A
  • Anatomical e.g. sites where structures exit through an opening in the cavity.
  • Inherited collagen disorders
  • Sites where surgical incisions are made
  • Obesity
  • Ascites
  • Increasing age
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3
Q

List the different types of abdominal wall hernias

A
  • Epigastric
  • Umbilical
  • Paraumbilical
  • Inguinal Hernia
  • Femoral Hernia
  • Spigelian Hernia
  • Lumbar Hernia
  • Incisional Hernia
  • Parastomal Hernia
  • Port-Site Hernia
  • Obturator hernia
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4
Q

Ignoring the classification based on anatomical location what are the different classifications of abdominal wall hernias ?

A
  • Reducible - Hernia can be easily pushed back into the abdomen.
  • Incarcerated or Irreducible hernia - When a hernia cannot be manipulated back to the abdomen.
  • Strangulated Hernia - Vascular supply to the contents contained within the hernia is compromised, resulting in ischaemic and gangrenous tissue. Patient becomes toxic and requires surgery
  • Obstructed hernia - bowel contents cannot pass through the hernia, classical symptoms of intestinal obstruction soon appear
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5
Q

What defect results in an epigastric hernia ?

A

A fascial defect in the linea alba between the xiphoid process and the umbilicus.

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6
Q

What are the typical features of an epigastric hernia ?

A
  • Lump in the midline between umbilicus and the xiphisternum
  • Asymptomatic (75%) or can present with pain.
  • If incarcerated or strangulated symptoms depend on organ involved.
  • Most common in men aged 20-30 years
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7
Q

What is the management of epigastric hernias ?

A

Either conservative or surgical.

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8
Q

What are the risk factors for paraumbilical hernias and what age group do they occur in ?

A
  • Occur in all age groups.
  • Risk factors include stretching of the abdo wall by obesity, multiple pregnancy and ascites.
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9
Q

What are the typical presenting features of paraumbilical hernias ?

A
  • Asymmetrical bulge - half the sac is covered by skin of the abdomen directly above or below the umbilicus
  • Often painful
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10
Q

What usually causes umbilical hernias ?

A

Persistent elevation of intra-abdo pressure

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11
Q

What are the typical presenting features of an umbilical hernia ?

A
  • Symmetrical bulge under the umbilicus
  • Often painful
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12
Q

What is the management of paraumbilical & umbilical hernias and why ?

A

Surgical - because they do not resolve spontaneously and have a high incidence of incarceration and strangulation.

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13
Q

Who is at greatest risk of infantile umbilical hernia development and how are they managed ?

A
  • Symmetrical bulge under the umbilicus
  • More common in premature and Afro-Caribbean babies
  • The vast majority resolve without intervention before the age of 4-5 years
  • Complications are rare
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14
Q

Describe the anatomy of the inguinal canal, specifically its:

  • Start and finish
  • Borders
  • What it transmits
A

Starts at deep inguinal ring and ends in superficial inguinal ring.

Boundaries:

  • Anterior –External oblique aponeurosis
  • Floor – ligament
  • Roof – Conjoint tendon
  • Posterior – Transversalis fascia

Transmits the spermatic cord and ilioinguinal nerve in males and the round ligament of the uterus and ilioinguinal nerve in females

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15
Q

What are the 3 coverings of the spermatic cord ?

A
  1. Internal Spermatic Fascia
  2. Cremasteric Fascia
  3. External Spermatic Fascia
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16
Q

What are the 6 contents of the spermatic cord ?

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A
  1. Vas Deferens
  2. 3 Arteries: Testicular Artery, Artery to the Vas and Cremasteric Artery
  3. Pampiniform Plexus (Veins)
  4. Lymphatics
  5. Nerves: Genital branch of Genitofemoral nerve + Sympathetic Twigs
  6. Remains of the Processus Vaginalis
17
Q

What are the 3 things that form the hesselbach triangle ?

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A
  • Laterally: Inferior Epigastric Artery
  • Medially: Lateral Border of the Rectus Muscle
  • Inferiorly: Inguinal Ligament
18
Q

What are the 2 types of inguinal hernias ?

Study These Flashcards
A

Direct & indirect

19
Q

Describe the anatomy of a direct inguinal hernia

Study These Flashcards
A
  • A direct inguinal hernia pushes directly forward through the posterior wall of the inguinal canal (transversalis fascia), into a defect in the abdo wall (hesselbachs triangle)
  • They sit within hesselbachs triangle medial to the inferior epigastric vessels & lateral to the rectus abdominus
20
Q

Describe the anatomy of an indirect inguinal hernia

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A

They pass through the deep inguinal ring & if large out through the superficial ring

21
Q

Who is much more commonly affected by inguinal hernias - M or F?

22
Q

What is thought to be the underlying cause of inguinal hernias ?

Study These Flashcards
A
  • Patent processus vaginalis + pathological change in connective tissue
  • Anything that increases intra-abdo pressure or past abdo surgery are also risk factors
23
Q

What are the characterisitc features of an inguinal hernia ?

Study These Flashcards
A
  • Groin swelling located above and medial to the pubic tubercle
  • usually disappears when lying down.
  • Discomfort/ache on activity - severe pain and strangulation is rare
  • Cough impulse - swelling expands upon coughing
  • May cause intestinal obstruction
  • More common to present on the Right side of the groin
24
Q

What investigation can be done if you are unsure a swelling is an inguinal hernia or not ?

25
What is the treatment of inguinal hernias ?
* Hernias associated with few symptoms may be managed conservatively. * Symptomatic hernias or those which are at risk of developing complications are usually treated surgically. * First time hernias may be treated by performing an open inguinal hernia repair with mesh. * Recurrent hernias and those which are bilateral are treated by laproscopic repair with mesh.
26
Who are congenital inguinal hernias more common in and what is the treatment of them ?
* Should be surgically repaired via herniotomy, rather than herniorraphy (with mesh) - due to risk of strnagulation * More common in premature babies and boys - usually indirect type due to patent processus vaginalis
27
Describe the anatomy of the boundries of the femoral ring/canal
* Anteriorly: Inguinal Ligament * Posteriorly: Iliopectineal Ligament * Medially: Lacunar ligament * Laterally: Femoral Vein
28
Describe what a femoral hernia is
It is where bowel enters the femoral canal, presenting as a mass in the medial thigh or above the inguinal ligament and points down the leg unlike inguinal which points to the groin
29
What are the typical features of a femoral hernia ?
* Below and lateral to the pubic tubercle * High risk of obstruction and strangulation
30
Who are femoral hernias most common in - M or F?
Females
31
What is the treatment of femoral hernias ?
Surgical repair
32
What are the typical features of an incisional hernia ?
They occur due to breakdown of closure of wound following abdo surgery
33
What are the risk factors for incisional hernias ?
* Wound Complications (Preoperative, perioperative and postoperative factors) * Inherited Collagen abnormalities * Advanced Age * Smoking * Morbid Obesity * Malignancy
34
What is the treatment of an incisional hernia ?
Conservative or surgery - surgical repair is not easy
35
What are the typical features of a spigelian hernia and how do they arise?
* Occur due to herniation through the linea semilunaris * Appears at the lateral edge of the rectus sheath, below & lateral to the umbilicus
36
What is a lumbar hernia ?
It is a herniation through either the inferior or superior kumbar triangles in the posterior abdo wall
37
What is a parastomal hernia ?
It is a hernia occuring at the site of a stoma
38
What is an obturator hernia and its typical features
* Herniation through the obturator canal * Typically causes pain along the medial side of the thigh in a thin women * Often causes obstruction
Y4 Gastrointestinal
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