The Abdominal Wall & Hernias (CP1 Standard)

  • Created by: NDumps97
  • Created on: 12-03-19 16:04
What is a hernia?
Where part of an organ is displaced and protrudes through the wall of the cavity containing it (often involving the intestine at a weak point in the abdominal wall)
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What is the difference between a reducible and irreducible hernia?
Reducible = the contents of the hernia can be completely replaced into the cavity. Irreducible = the contents of the hernia cannot be pushed back into place.
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What is a strangulated hernia? What will this mean for the patient?
This is when there is severe restriction of blood supply to the hernia (perhaps because it's twisted) and therefore ischaemia occurs. The patient would require urgent surgery.
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What is an incarcerated hernia?
Where the hernia has become 'trapped' - the contents of the hernial sac may be stuck inside by adhesions.
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What is the most common type of hernia in both males and females?
Inguinal hernia (indirect is more common than direct)
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Do inguinal hernias occur more in men or women?
Men
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What are the boundaries of the inguinal canal? How long is the canal?
~4cm. Floor = inguinal ligament. Post wall = transversalis fascia. Roof = transversalis facscia + internal oblique. Ant wall = aponeurosis of the external oblique + the internal oblique laterally
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The deep (internal) ring, or entry to the inguinal canal, is found just above the midpoint of what?
Located just above the midpoint of the inguinal ligament.
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What is located at the midpoint of the inguinal ligament?
The femoral pulse
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Where is the superfical ring of the inguinal canal located?
Just superior to the pubic tubercle, marking the end of the inguinal canal.
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What is the contents of the inguinal canal (in males)?
The spermatic cord (containing the vas deferens, obliterated processus vaginalis, arteries to the vas + testis, the pampiniform plexus + veins) + the ilioinguinal ligament.
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Describe where indirect inguinal hernias pass through
They pass through the deep (internal) inguinal ring and may push out through the external (superficial) ring into the scrotum.
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What fails to obliterate to facilitate indirect inguinal hernias occurring?
The processus vaginalis (an embryonic peritoneal outpouching) which allows the hernia to enter the inguinal canal.
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Are indirect inguinal hernias more or less common than direct inguinal hernias?
Indirect is more common (80%) than direct (20%)
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True or false: indirect hernias rarely strangulate.
False: indirect hernias can strangulate. (Strangulation occurs rarely in direct hernias)
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What route do direct inguinal hernias take?
These push their way directly through the posterior wall of the inguinal canal.
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True or false? Direct hernias are easily reducible (i.e. can be pushed back to where they should be)
True.
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What are some risk factors for inguinal hernias? (Name at least 3)
Anything which increases intra-abdominal pressure: obesity, pregnancy, chronic respiratory conditions (cough), heavy lifting, constipation straining etc
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What is a femoral hernia?
When the bowel enters the femoral canal
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How will a femoral hernia present? (include location)
It will present as a mass in the upper medial thigh, inferior + lateral to the pubic tubercle. It points down towards the leg unlike an inguinal hernia which points towards the groin. 50% will present as a clinical emergency due to obstruction.
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Describe the borders and contents of the femoral canal
It is surrounded by rigid structures: inguinal ligament, sartorius and adductor longus. It contains the femoral nerve, artery and vein from lateral to medial.
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True or false? Femoral hernias occur more in women?
True (but the most common hernia in women is still indirect inguinal)
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True or false? Femoral hernias easily reduce and rarely strangulate and are often asymptomatic.
Femoral hernias are often asymptomatic however they are rarely reducible and at high risk of strangulation because of the rigid borders of the femoral canal. Because of this risk ~30% = emergencies.
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What is a Richter's hernia? What makes it so dangerous?
This is where part of the intestinal wall herniates, however not the lumen of the bowel meaning there is no obstruction. This part of the wall is at risk of strangulating and perforating without any warning signs so can be very severe.
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In what % of live births are there 'true' umbilical hernias? What is the embryological reason for them occurring?
3% of live births. Result from a defect in the transversalis fascia.
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Would surgical care be considered for umbilical hernias?
Not often as most resolve by 3 years (the hernia reduces and muscle wall forms over it) and there is low chance of complications such as obstruction. Surgery may be considered in those where it is very large or for patients >3 in which it persists
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How is exomphalos different? How is it distinguished from an umbilical hernia.
Exomphalos = a weakness in the baby's abdominal wall where the umbilical cord joined it. This causes the abdo. contents to protrude covered in a translucent sac rather than skin. Surgical repair needed.
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Where does a paraumbilical hernia occur? What are risk factor for it?
Just above or below the umbilicus. Risk factors include: obesity and ascites (anything which will cause increased intraabdominal pressure)
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Name two things that might herniate in a paraumbilical hernia?
Omentum or bowel, which protrudes through the weakness.
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What is 'Mayo's repair'?
The most common treatment for paraumbilical hernias: excision of the sac and stitching up of the rectus sheath.
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Why is surgical intervention recommended for paraumbilical hernias?
Because although they reduce - they may also easily strangulate or obstruct.
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What symptoms might accompany a paraumbilical hernia?
localised 'dragging' pain, a hernia which grows over time, and there may be tenderness and colicky pains from tranisent obstruction of the bowel
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What warning signs should you look out for which might suggest strangulation of hernias
Severe acute pain, vomiting, haematochezia, malaise, burning sensation round the hernia.
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What is an incisional hernia?
Hernia that occurs through a previously made incision in the abdominal wall, ie the scar left from a previous surgical operation
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Do incisional hernias have a wide or narrow neck? What does this mean for the likelihood of strangulation?
They usually have a wide neck which means they are less likely to strangulate.
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As contents of an incisional hernia increase - adhesions are more likely to occur. What does this mean for the reducibility of the hernia? What about the potential consequences?
If the hernia develops adhesions it will be much less reducible and is at greater risk of strangulation and obstruction.
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Incisional hernias make up __% of total hernias. About _% of abdominal incisions come with a hernia.
Incisional hernias make up 10% of total hernias. About 1% of abdominal incisions come with a hernia.
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Name two pre-op, two peri-op, and two post-op risk factors for incisional hernias
Pre-op: old age, sepsis, jaundice, obesity, obesity, steroids (decrease wound healing); peri-op: vertial incisions, knots that are too tight/loose, drains. Post op: coughing, wound infection, post-op ileus
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What kind of surgical incision is most likely to have a hernia protrude through it?
Large vertical abdominal incisions
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What is the recurrence rate for a) small incisional hernias b) large incisional hernias
small incisional hernias recur about 2-5% and large incisional hernias about 10-20%
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What is an 'incacerated hernia'? What symptoms does this lead to?
An incarcerated hernia means it has become 'trapped' or 'pinched' at a weak point at the abdominal wall often leading to severe pain. It is at risk of becoming strangulated.
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Where does an epigastric hernia protrude through and what does it usually contain?
They protrude through the linea alba above the umbilicus and usually just contain extra peritoneal fat.
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What symptom might indicate this needs some surgical repair?
75% = asymptomatic but some can be quite severely painful which might suggest a bit of strangulation - therefore surgery would often be done here.
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What is the difference between an epigastric hernia and a divarification of rectus abdominis?
Divarification of the rectus abdominis is when the recturs mucles do not join up at the linea alba meaning there is protrusion due to the splitting of the muscles when the patient contracts the abdo muscles (e.g. doing a sit up)
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How often would you give surgical intervention for divarification of the rectus abdominis?
Almost never - it is common in obese men, parous (has been pregnant) women, and those with increased intra-abdominal pressure.
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Other cards in this set

Card 2

Front

What is the difference between a reducible and irreducible hernia?

Back

Reducible = the contents of the hernia can be completely replaced into the cavity. Irreducible = the contents of the hernia cannot be pushed back into place.

Card 3

Front

What is a strangulated hernia? What will this mean for the patient?

Back

Preview of the front of card 3

Card 4

Front

What is an incarcerated hernia?

Back

Preview of the front of card 4

Card 5

Front

What is the most common type of hernia in both males and females?

Back

Preview of the front of card 5
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