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3: MED2 Y3 - Gastrointestinal [7] > [24] Femoral Hernia > Flashcards

[24] Femoral Hernia Flashcards

1
Q

What is a femoral hernia?

A

When abdominal viscera or omentum passes through the femoral ring and into the potential space of the femoral canal

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2
Q

What % of abdominal hernias are femoral hernias?

A

5%

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3
Q

Who are femoral hernias more common in?

A

Females (3:1)

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4
Q

Why are femoral hernias more common in females?

A

It is secondary to the wider anatomy of the female bony pelvis

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5
Q

Can femoral herniation occur in a child?

A

It is very rare

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6
Q

What is the femoral canal?

A

An anatomical compartment

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7
Q

Where is the femoral canal located?

A

In the anterior thigh

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8
Q

What does the femoral canal contain?

A

Lymphatic vessels
Lymph nodes
Some loose connective tissue

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9
Q

What makes up the superior border of the femoral canal?

A

The femoral ring

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10
Q

What is the femoral ring covered by?

A

The femoral septum (a connective tissue layer)

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11
Q

Why are femoral hernias very prone to complications requiring urgent surgical interventions?

A

Due to the rigidity of the borders of the femoral ring, especially the concave margin of the lacunar ligament

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12
Q

What are the main risk factors for developing a femoral hernia?

A

Female gender
Increasing age
Pregnancy
Increased intra-abdominal pressure

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13
Q

Give two examples of causes of increased intra-abdominal pressure leading to a femoral hernia?

A

Heavy lifting

Chronic constipation

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14
Q

How will femoral hernias commonly present?

A

As a lump in the groin

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15
Q

What % of femoral hernia cases present as an emergency?

A

Around 30%

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16
Q

Why is it important to identify the exact location of the lump in the groin?

A

In order to decide what type of hernia is present

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17
Q

Where in the groin is a femoral hernia lump found?

A

Infero-lateral to the pubic tubercle, and medial to the femoral pulse

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18
Q

Where in the groin is an inguinal hernia lump found?

A

Superomedial to the pubic tubercle

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19
Q

When is a femoral hernia often misdiagnosed as an inguinal hernia?

A

If it migrates superiorly to the inguinal ligament

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20
Q

Is a femoral hernia likely to be reducible?

A

No, due to the tightness of the femoral ring

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21
Q

What are the differential diagnoses for a lump in the groin?

A 
Low presentation of an inguinal hernia
Femoral canal lipoma
Femoral lymph noed
Saphena varix
Femoral artery aneurysm
Athletic Pubalgia
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22
Q

What are the features of a saphena varix?

A

Disappears when lying flat
Palpable thrill when coughing
Presence of varicose veins elsewhere

23
Q

What is athletic pubalgia?

A

A small tear in the rectus sheath, through which impingement of the abdominal wall musculature occurs

24
Q

Who is athletic pubalgia common in?

A

Young athletes

25
Q

Which patients with femoral hernias require surgical intervention?

A

All patients will eventually need surgical intervention

26
Q

What is the result of all patients with a femoral hernia eventually needing surgical intervention?

A

Routine pre-operative investigations should be performed if possible

27
Q

How is a diagnosis of femoral hernia usually made?

A

Clinical

28
Q

What is the gold standard of diagnosis for a femoral hernia?

A

Ultrasound scan

29
Q

How accurate are ultrasound scans in identifying the specific type of hernia?

A

96%

30
Q

What is the limitation of ultrasound scans in identifying hernias?

A

Operator dependant

31
Q

What should be done if there is significant doubt in the diagnosis of femoral hernia, or evidence of complications?

A

The lump should be surgically explored

32
Q

Why should all femoral hernias be surgically managed?

A

Due to the increased risk of strangulation

33
Q

What does surgical intervention for femora hernias involve?

A

Reduction of the hernia, then surgical narrowing of the femoral ring with the use of interrupted sutures

34
Q

What care should be taken during surgical narrowing of the femoral ring?

A

To avoid narrowing the femoral vein in the process

35
Q

What surgical approaches can be taken for the management of a femoral hernia?

A

Low approach

High approach

36
Q

How is a low approach to femoral hernia repair done?

A

The incision is made below the inguinal ligament

37
Q

What is the advantage of a low approach in femoral hernia repair?

A

It doesn’t interfere with inguinal structures

38
Q

What is the disadvantage of a low approach in femoral hernia repair?

A

It results in limited space for the removal or any compromised small bowel

39
Q

How is a high approach to femoral hernia repair done?

A

The incision is made above the inguinal ligament, via the posterior wall of the inguinal canal

40
Q

Where is a high approach to femoral hernia repair the preferred intervention?

A

In an emergency intervention

41
Q

Why is a high approach to femoral hernia repair preferred in an emergency intervention?

A

Due to the easy access to the compromised small bowel

42
Q

What is the main limitation of a high approach to femoral hernia repair?

A

The need to repair the inguinal canal on closure, thus providing a new area of weakness and potential secondary herniation

43
Q

What are the serious complications of a hernia that require urgent intervention?

A

Incarceration
Obstruction
Strangulation

44
Q

What is meant by an incarcerated hernia?

A

The contents of the hernia are unable to return to their original cavity

45
Q

What happens in obstruction caused by a hernia?

A

The bowel lumen becomes obstructed, leading to the clinical features of bowel obstruction

46
Q

What is a strangulated hernia?

A

Compression of the hernia compromises the blood supply, leading to the bowel becoming ischaemic

47
Q

How will a hernia that has become strangulated present?

A

As a irreducible and tender, tense lump, with the pain often being out of proportion to clinical signs
This may be accompanied with clinical features of obstruction

48
Q

Why is a strangulated hernia a surgical emergency?

A

Due to the time-dependant risk of bowel infarction

49
Q

How is a diagnosis of strangulated hernia made?

A

Typically a clinical one

Due to the time critical nature of the condition, further imaging will rarely be requested

50
Q

What does the specific management for strangulated hernias depend on?

A

The type of hernia involved

51
Q

How does the mortality from a strangulated hernia differ from elective hernia repairs?

A

It is much higher

52
Q

What is the risk of strangulation of femoral hernias?

A

The risk increases with time following diagnosis - after 3 months, the risk is 22%, and reaches 45% after 21 months

53
Q

What other risks are increased in strangulated femoral hernia repair compared to elective repair?

A

Bowel resection
Wound infection
Cardiorespiratory complications

3: MED2 Y3 - Gastrointestinal [7] (44 decks)

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