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Flashcards in Surgery 2 Deck (194)
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1

What is a direct inguinal hernia?

passes through Hesselbach's triangle in the abdominal wall
passes through superficial inguinal ring

2

What are the borders of Hesselbach's triangle

inguinal ligament at base
lateral border of the rectus sheath
inferior epigastric vessels laterally

3

What is an indirect inguinal hernia

passes through patent process vaginalis through deep inguinal ring

4

Where is the deep inguinal ring found?

midpoint of the inguinal ligament
= between ASIS and pubic tubercle

5

What is found at the midinguinal point?

femoral artery
= between ASIS and pubic symphysis

6

What is the relation of the inguinal hernias to the inferior epigastric vessels

direct = medial to the inferior epigastric vessels
indirect = lateral to the inferior epigastric vessels

7

What are the risk factors for inguinal hernias

heavy weight lifting
chronic cough
obesity
chronic constipation
male

8

what are the signs of an inguinal hernia

lump media and superior to the pubic tubercle
positive cough impulse
reducible?
if enters scrotum - can you get above it?

9

What is the treatment for an inguinal hernia

reduction - open or laparoscopic mesh

laparoscopic preferred for bilateral or recurrent inguinal hernias

10

What are the complications of an inguinal hernia repair

early: bruising, wound infection
late: chronic pain, recurrence
damage to vas deferens or testicular vessels

11

Define hernia

the protrusion of part or whole of an organ or tissue through the wall of the cavity that normally contains it.

12

What are the symptoms and signs of an irreducible or incarcerated hernia

painful, tender, and erythematous lump

features of bowel obstruction

13

What is an irreducible or incarcerated hernia?

bowel unable to return to original cavity

14

What is an strangulated hernia

compression of bowel has cut off blood supply to bowel, so ischaemia occurs

15

How can direct and indirect inguinal hernias be differentiated on examination?

reduce hernia
occlude deep femoral ring at mid point of inguinal ligament
cough impusle
if hernia does not protrude = indirect
if hernia still protrudes = direct

16

What is the differential diagnosis for an inguinal hernia

Femoral hernia
Saphena varix
Inguinal lymphadenopathy
Lipoma
Groin abscess
Internal iliac aneurysm

17

What are the differential diagnoses for a mass in the scrotum

varicocoele
hydrocoele
inguinal hernia
testicular mass

18

When is an USS recommended when diagnosing an inguinal hernia

if there is diagnostic uncertainty
or to exclude other pathology.

19

What is the annual risk of strangulation of an inguinal hernia?

3%

20

What is a femoral hernia

protrusion of bowel through the femoral ring into the femoral canal

21

What are boundaries of the femoral ring

anterior = inguinal ligament
posterior = pectineal ligament
lateral - femoral vein
medial = lacunar ligament

22

What are risk factors for a femoral hernia

female
multiple pregnancies
obesity
chronic constipation or coughing

23

What are the signs of a femoral hernia

lump in groin
inferior and lateral to the pubic tubercle
below inguinal ligament
medial to femoral pulse

24

Why are femoral hernias prone to strangulation

tight ligament borders of the femoral ring

25

What are the differential diagnoses in femoral hernia

Low presentation of inguinal hernia
Femoral canal lipoma
Femoral lymph node
Saphena varix
Femoral artery aneurysm

26

What is the gold standard investigation for femoral hernia

USS

27

Why are all femoral hernias meant to be surgically managed

due to high risk of strangulation

28

What is the surgical management of a femoral hernia

reduction of the hernia
surgical narrowing of the femoral ring with the use of interrupted sutures

29

What is the risk of strangulation of femoral hernia at 3m and 21m after initial diagnosis

3m = 22%
21m = 45%

30

Describe a hiatus hernia

protrusion of the stomach into the thorax through the oesophageal hiatus