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33 Cards in this Set
- Front
- Back
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What are the 3 major types of hernias?
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-groin
-umbilical -epigastric |
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What are the subclasses of groin hernias?
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1. Inguinal
a. indirect b. direct 2. Femoral a. a bunch we don't need to know |
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What are the subclasses of umbilical hernias?
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1. Simple
2. Omphalocele 3. Gastroschisis |
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What is Hesselbach's Triangle?
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-look at notes/noteservice for actual pic
-borders are inferior epigastric artery (to the upper left), rectus sheath (medially), and inguinal ligament (to the lower left) |
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Hernias originating lateral (to the left) of the inferior epigastric artery are...
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-Indirect hernias
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Hernias originating MEDIAL (to the right) of this artery are...
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Direct hernias
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****What is the MC hernia in both sexes and in all age groups?
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-INDIRECT INGUINAL
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***Why do males get indirect inguinal hernias?
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-from a congenital defect, during devel, the testes are inside the abd
-they begin to drop down into the scrotum taking fascia with them -they leave behind an opening called the "processus vaginalis" -if this does not close can get the inguinal hernia |
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***Why do females get indirect inguinal hernias?
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-F have the round ligament which follows a similar path
-goes through the inguinal canal and attaches to the labia majora |
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Approximate relative incidence of hernia type for:
Males |
1. Direct: 40%
2. Indirect: 50% 3. Femoral:10% |
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Approximate relative incidence of hernia type for:
Females |
1. Direct: Rare
2. Indirect: 70% 3. Femoral: 30% |
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Approximate relative incidence of hernia type for:
Children |
1. Direct: Rare
2. Indirect: 100% 3. Femoral: Rare |
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***What happens when the bowel slips through the process vaginalis (congenital opening) and becomes stuck?
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-it is called INCARCARATED
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What is it called when an incarcarated bowel slip is compressed by swelling of the inguinal canal?
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-Strangulation
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How is does inguinal hernia take a serpentine path?
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-snakes it's way through the opening down toward the scrotum
-"slow to appear and slow to disappear" |
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How does one examine an inguinal hernia?
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-place your finger next to the inguinal canal and ask the person to cough (increase abd pressure)
-you can feel the bowel press up against your finger |
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If the bowel makes its way to the testicle it must be differentiated from what 2 testicular masses?***
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-hydroceles
-varicoles |
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***What is a hydrocele?
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-it is water in the testicle
-way to distinguish this and a hernia is to shine a light on the nut -if light transluminates through the scrotum BELOW the testicle then you know its water -if it transluminates ABOVE it is a hernia |
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***What is a varicocele?
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-enlarged testicular veins
-these feel like a bunch of worms |
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Direct inguinal hernias?
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-proceed DIRECTLY thru the posterior inguinal wall and directly out the abd into your finger waiting to palpate
-when pt coughs it presses directly out on the pad of your finger, instead of sideways like indirect |
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****TQ: INDIRECT vs DIRECT
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1. Indirect: embryologic, young man's (<50), appears slowly, disappears slowly, requires reduction, may become scrotal, may strangulate, impulse touches tip of exam finger
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****TQ: INDIRECT vs DIRECT
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2. Direct: Acquired, old man's (>50), appears rapidly, disappears rapidly, spontaneous reduction, not usually scrotal, strangulation is rare, impulse touches pulp of exam finger
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Why are femoral hernias more common in females compared to males?
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-bc F have wider hips
-these are ACQUIRED hernias -VERY susceptable to incarceration and strangulation due to the rigid nature of the thigh |
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***What is the femoral hernia type that is most interest to us on the test?
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-Taele's Prevascular Hernia--> it flips upward above the inguinal ligament where the rest of the femoral hernias flip downward into the thigh
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What is Truss therapy
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-were devices designed to hold the fascia tight and keep the bowel from pushing out of it's proper place
-were ineffective and only wound up increasing scarring and risk of incarceration rather than treating the hernia |
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What are the 3 types of umbilical hernias?
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-simple
-omphalocele -gastrochisis |
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What is a SIMPLE umbilical hernia?
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-very common in infants and usually benign
-incomplete closure of the abd wall so the bowel or omentum pushes thru the belly button -unless serious complication, ignore bc most heal spontaneously |
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What is a OMPHALOCELE umbilical hernia?
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-slightly more severe, but pretty uncommon
-also involve incomplete closure of abd wall, but involve a slippage of the abd contents into the umbilical cord -so instead of full layer or skin protecting these, its merely a thin layer of peritoneum or amnion |
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What is a Gastroschisis umbilical hernia?
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-there is no covering of the intestingal contents and they protrude into the world unprotected
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Tx of umbilical hernias?
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-reduction of the abdominal contents
-establishing abdominal wall continuity (just like every other hernia) |
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Abdominal hernias?
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-Rose says they aren't on his test but they are on the boards
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***What are the 3 main types of repair for hernias?
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1. Patch (such as Kugel patch or lichenstein patch)
2. Plug (mesh plug to plug hole) 3. Laproscopic repair (difficult to learn and can be very very expensive) |
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Anatomy of skin to peritoneum
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Skin -->
SubQ fat --> Camper's fascia --> Scarpa's fascia --> External oblieque aponeurosis --> Spermatic cord -> Transversus abd aponeurosis --> Transversalis fascia --> Preperitoneal tissues --> Peritoneum |
