First Aid For Surgery - Hernias

Front 1

What is the distrubition of types of hernias?

Back 1

(1) 50% are indirect inguinal hernias, 25% are direct inguinal hernias, and 15% are femoral hernias; (2) Male-to-female ratio is 7:1; (3) Abdominal wall hernias are the most common condition requiring major surgery

Front 2

What is the MC hernia in males and females?

Back 2

INDIRECT INGUINAL HERNIA!

Front 3

Definition of a hernia

Back 3

Protrusion of a viscus through an abnormal opening in the wall of a cavity in which it is contained

Front 4

Hernia Calendar

Back 4

(1) 0-2 years: indirect inguinal; (2) 2-20 years: hernia uncommon; (3) 20-50 years: indirect inguinal; (4) >50yo: direct inguinal hernia

Front 5

Reducible hernia

Back 5

Protruding viscus can be returned to the abdomen

Front 6

Irreducible (incarcerated) hernia

Back 6

Protruding viscus cannot be returned to the abdomen

Front 7

Strangulated hernia

Back 7

Vascularity of the viscus is compromised - SURGICAL EMERGENCY!

Front 8

Layers of Abdominal wall

Back 8

Skin, subcutaneous fat, Scarpa’s fascia, external oblique muscle, internal oblique muscle, transversus abdominis muscle, transversalis fascia, peritoneal fat, and peritoneum.

Front 9

Contents of spermatic cord

Back 9

Begins at the deep ring and contains the vas deferens and its artery (descend to the seminiferous tubules), one testicular artery and two to three veins, lymphatics (incline superiorly to the kidney region), autonomic nerves, and fat.

Front 10

Boundaries of Hesselbach's triangle

Back 10

Inguinal ligament, rectus abdominis, inferior epigastric vessels. Direct inguinal hernias go through this site

Front 11

Direct inguinal hernia

Back 11

Enters inguinal canal through its weakened posterior wall; Hernia does NOT pass through the internal ring and instead lies posterior to the spermatic cord. Wide neck, practically never enters scrotum and occurs almost exclusively in older males/smokers due to weakened connective tissue

Front 12

Indirect inguinal hernia

Back 12

Herniation through the internal inguinal ring traveling to the external ring. If complete, can enter the scrotum while exiting the external ring; If congenital, associated with a patent processus vaginalis. MOST COMMON HERNIA in both males and females - occurs at all ages; In first decade of life, right-sided hernia is more common than left (because of late descent of right testis)

Front 13

Femoral hernia

Back 13

Form of indirect hernia arising out of femoral canal beneath the inguinal ligament (medial to femoral vessels); (1) Female-to-male ratio of 2:1; males affected are in a younger age group; (2) uncommon - only 2.5% of all groin hernias; right sided more common because of sigmoid colon tamponading the left femoral canal; (3) common in elderly patients; (4) high incidence of incarceration 2/2 narrow neck; (5) 28% strangulate after 3 months, 45% after 21 months

Front 14

Acquired umbilial hernia

Back 14

Abdominal contents herniate through a defect in the umbilicus; common site of hernias, esp. in females. Associated with ascites, obesity, and repeated pregnancies

Front 15

Pediatric umbilical hernia

Back 15

Secondary to a fascial defect in the linea alba with protruding abdominal contents, covered by umbilical skin and subcutaneous tissue; Caused by a failure of timely closure of umbilical ring, and leaves a central defect in linea alba. Common in infants, incarceration is RARE and reduction is contraindicated because usually close spontaneously within 3 years if defect is <1cm; surgical repair indicated if defect is >2cm, child 3-5yo, or protrusion is disfiguring

Front 16

Hiatal hernia

Back 16

Stomach protruding through the esophageal hiatus of the diaphragm; (1) Sliding - characterized by upward dislocation of cardia in the posterior mediastinum; (2) Rolling - aka paraesophageal - characterized by upward dislocation of gastric fundus alongside a normally positioned cardia; (3) Combined sliding-rolling or mixed characterized by both upward dislocation of both cardia and gastric fundus. Treatment is Nissen Fundoplication

Front 17

Richter’s hernia

Back 17

Only part of intestine wall circumference is in the hernia; may strangulate without obstruction - seen commonly in femoral or obturator hernias

Front 18

The hernias associated with obesity

Back 18

(1) Direct inguinal; (2) Paraumbilical; (3) Hiatal hernias

Front 19

Incisional hernia

Back 19

Resulting as a surgical complication. These could enlarge beyond repair! Associated with DM, obesity, and infection