Block 3 - Pd: Hernias

Front 1

What are the 6 types of abdominal and pelvic hernias?

Back 1

Incisional hernias
Ventral hernias
Umbilical hernias
Inguinal hernias
Femoral hernias
Epigastric hernias

Front 2

Hernia is from the latin word meaning what?

Back 2

Rupture

Front 3

T/F

Hernias can occur all over the body.

Back 3

True!

Even the brain!

Front 4

What are hernias named based on?

Back 4

Anatomical site

Front 5

What is the descriptive term for when the contents can be replaced in the surrounding structures?

Back 5

Reducible

Front 6

What is the descriptive term for when contents cannot be replaced?

Back 6

Nonreducible

Front 7

What is the descriptive term for a nonreducible hernia with subsequent bowel obstruction?

Back 7

Incarcerated

Front 8

What is the descriptive term for a nonreducible hernia with obstruction of blood flow, with resultant gangrene?

Back 8

Strangulated

Front 9

T/F

A nonreducible hernia is a common cause of bowel obstruction.

Back 9

True!

Front 10

What (descriptive) types of hernias need surgery?

Back 10

Incarcerated and Strangulated

Front 11

What is the most common type of inhernia?

Back 11

70% of all hernias are inguinal hernias

Front 12

Two thirds of inguinal hernias are _______ one third are ________.

Back 12

Indirect, direct

Front 13

What percent of hernias are:
Incisional?
Ventral/umbilical?
Femoral and others?

Back 13

15% of all hernias are incisional
10% of all hernias are ventral or umbilical
5% are femoral and others

Front 14

Are men or women more likely to get inguinal hernias?

Back 14

Men are 25X more likely to have inguinal hernias than women

Front 15

T/F

Indirect inguinal hernias are the most common in men only.

Back 15

False!

BOTH men and women

Front 16

Are men or women more likely to have femoral hernias?

Back 16

Femoral hernias are 10X more likely in women

Front 17

Are men or women more likely to have umblical or incisional hernias?

Back 17

Umbilical and incisional hernias are 2X more prevalent in women. Because of pregnancy.

Front 18

Prevalence of all hernias increase with what?

Back 18

Age and obesity

Front 19

Prevalence of strangulation increases with what?

Back 19

Age

Front 20

Which hernias are most likely to strangulate?

Back 20

Femoral hernias

Front 21

What is the most common strangulation?

Back 21

Inguinal

Front 22

In which hernia does the sac enter the internal inguinal ring, passes through the inguinal canal, out the external inguinal ring and into scrotum?

Back 22

Indirect inguinal hernia

Front 23

On which side are indirect inguinal hernias most common?

Back 23

Right side

Front 24

In which hernia does the sac protrude medial to the inguinal canal and through the external inguinal ring?

Back 24

Direct inguinal hernia

It rarely extends into scrotum.

Front 25

In which hernia does the sac herniate through the femoral canal?

Back 25

Femoral hernia

Front 26

Which side is more common for femoral hernias, and why?

Back 26

Right due to the tamponading effect of the sigmoid colon on the left femoral canal.

Front 27

What is the strangulation rate of femoral hernias?

Back 27

20-25% strangulation rate, thus repair

Front 28

How are femoral hernias diagnosed?

Back 28

With CT scan

Front 29

T/F

Indirect and direct inguinal hernias are managed the same way.

Back 29

True!

Front 30

Which hernias are more common in infants?

Back 30

Umbilical hernias

Front 31

T/F

Umblical hernias usually close spontaneously in infants.

Back 31

True!

Front 32

T/F

Umblical hernias are less common in obesity.

Back 32

False!

They are more common in obesity.

Front 33

In umbilical hernias, the sac herniates through what?

Back 33

Defective umbilical ring

Front 34

In which hernia does the sac herniate through a defect in the Linea Alba, between the xyphoid process and the umbilicus?

Back 34

Epigastric (ventral) hernia

Front 35

Which hernias are more common in obesity, post-operation infection?

Back 35

Incisional hernia

Front 36

Why is a smaller defect in incisional hernias more dangerous?

Back 36

Strangulation is more likely

Front 37

Which hernia is caused by separation of the two rectus abdominus muscles?

Back 37

Diastasis recti (ventral hernia)

Front 38

When is diastasis recti visible?

Back 38

Only visible upon increased intra-abdominal pressure causing midline ridge.
Must be sitting up (not laying down)

Front 39

Diastasis recti are increased with what?

Back 39

Increased with pregnancies, obesity.

Front 40

In what positions can patients be evaluated for hernias?

Back 40

Patient must be evaluated supine and standing, or valsalva maneuver

Front 41

If you are doing exam supine, what do you need to have the patient do?

Back 41

Cough, otherwise you won't be able to feel it

Front 42

What does the differential diagnosis of inguinal hernias include?

Back 42

All pelvic tumors, and lymph nodes, as well as testicular pathology

Front 43

T/F

You can reliably tell direct from indirect inguinal hernias by palpating.

Back 43

False!

Not really, and doesn't really matter

Front 44

What radiologic tests are useful in diagnosis of inguinal hernias?

Back 44

US and CT

Front 45

T/F

Trusses are generally very effective.

Back 45

False!

Trusses generally not effective, but are sometimes done on older patients. They don't change the course of the hernia, but may help with some symptoms.

Front 46

All surgical techniques involve _________ repair.

What does this mean?

Back 46

“Tension free”

They don't even sew the tissues up, they use mesh instead

Front 47

When is surgery indicated with hernias?

Back 47

Surgery indicated in high rate of strangulation, or increased pain.

Generally assumed surgery is indicated due to the progressive nature of all hernias.

You can try to reduce them manually. If they reduce, you can be less worried about strangulation. If you can't get it back and it bothers them, you should be more worried about it.