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Flashcards in Hernias Deck (27)
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1
Q

what is a hernia?

A

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

2
Q

what are the 3 layers of a hernia?

A

sac (peritoneum)
coverings of the sac
contents

3
Q

who are femoral/inguinal hernias more common in?

A
femoral = women
inguinal = men
4
Q

femoral hernias are an emergency, true or false?

A

true

5
Q

what is the inguinal canal?

A

4cm long intermuscular slit to allow passage of spermatic cord

6
Q

what are the components of the spermatic cord?

A
3 arteries
- testicular artery
- artery to vas cremasteric artery
3 nerves
- ilioinguinal
- genital branch of genito femoral
- sympathetic
3 other things
- pampiniform venous plexus
- vas deferens
- lymphatics
7
Q

what are the risk factors for inguinal hernia?

A

male
age
chronic cough
.

8
Q

what vessel runs up from femoral artery, behind inuinal canal to supply the abdominal wall?

A

inferior epigastric

9
Q

what is the significance of the inferior epigastric vessels in terms of hernias?

A

lateral to vessels = indirect

medial to vessels = direct

10
Q

indirect hernia = does not reappear, true or false?

A

true

direct will reappear if cover deep ring and ask patient to cough

11
Q

how are inguinal hernias repaired?

A

often not fixed if small or asymptomatic

can be repaired with surgery (20-70%)

12
Q

what are the 2 types of hernia repair surgery?

A
open
- Lichtenstein method
- spinal or local anaesthetic
- high rate of chronic pain due to nerve damage
laparoscopic
- less pain, faster recovery
- requires general anaesthetic
13
Q

what complications can occur with inguinal hernia repair?

A
recurrence
urinary retention
bleeding
chronic pain
numbness
testicular atrophy/ischaemic orchitis
wound infection
14
Q

what emergency situations can arise from an inguinal hernia?

A

irreducible
strangulate
obstruction (bowel)

15
Q

what is done in an emergency inguinal hernia?

A

reduction under analgesia

operative repair after resuscitation

16
Q

how do femoral hernias present?

A

usually elderly females who’ve had several children (multi-parous)

17
Q

where is the femoral canal?

A

anterior border = inguinal ligament
posterior border = pectineal ligament
medial border = lacunar ligament
lateral = ileopectineal????

18
Q

how can a femoral hernia be repaired?

A

inguinal ligament sutured to pectineal ligament
- low approach = elective
- high approach = emergency
laparoscopic repair

19
Q

where do inguinal/femoral hernias originate?

A
inguinal = above and medial to pubic tubercle
femoral = below and lateral to pubic tubercle
20
Q

why are femoral hernias more of an emergency?

A

higher risk of incarciration

21
Q

what is an epigastric hernia?

A

defect in linea alba between xiphisternum and umbilicus

more common in males

22
Q

what in an umbilical hernia?

A

true umbilical = more common in children (resolve by 4)

paraumbilical = adults, obesity, pregnant, ascites

23
Q

how are paraumbilical hernias repaired?

A

reduced and mesh inserted

24
Q

what are the risks for incisional hernia?

A
obesity
age
surgical site infection
smoking
post chest infection
.
.
25
Q

how do paediatric inguinal hernia present?

A
more common in pre-term babies
99% are indirect
groin swelling on crying
"silk sign"
often not easy to find on examination
26
Q

how are paediatric inguinal hernias repaired?

A

always repaired

herniotomy

27
Q

what is an obturator hernia?

A

hernir through obturator foramen (in pelvis)
medial thigh pain
elderly women bowel obstruction

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