3- hernia Flashcards
what is hernia?
= rupture, protruded viscus →abnormal exit of tissue or organ through wall of cavity in which normally residues
what are classifications of hernia?
hiatal hernia = herniating into thoracic cavity
internal hernia (within abdomen) = rare, not visible and common in weight loss surgery
external hernia = common
what are risk factors for hernia?
- obesity (causes pressure)
- chronically increased intra-abdominal pressure →cough, constipation, straining
- abdominal surgery
- pregnancy
- smoking
- peritoneal dialysis
- collagen disorders
what hernia’s are in diaphragm?
- Hiatal hernia
- Congenital
what hernia’s are in abdominal wall?
- Incisional (hernia at the site of scar)
- Ventral (midline, general term)
- Umbilical (specifically located)
- Spigelian (specifically located)
- Parastomal
what hernia’s are in groin?
- Inguinal (direct, indirect, pantaloon, sliding)
- Femoral
what is treatment for hiatal hernia?
treat with omeprazole (reduces symptoms) = large symptoms you consider surgery (often re-occur)
- also manage lifestyle factors as treatment
what are direct and indirect inguinal hernias?
direct inguinal hernia = abdominal contents directly pushes through weakness posterior wall of the inguinal canal/anterior abdominal wall (directly pops out)
indirect inguinal hernia = enter the deep ring (the start) of the inguinal canal →using inguinal canal as area of weakness to push through
- both types exit throughsuperficial ring of inguinal canal (and sometimesenter scrotum = more common forindirectto do this as path through both anatomical inguinal rings offers less resistance)
does femoral or inguinal hernia have a higher risk of strangulation?
femoral (Strangulation of a hernia is a serious complication that occurs when the blood supply to the herniated tissue becomes compromised)
what are midline hernia’s?
- Epigastric
- Divarication of recti (not hernia)
- Supraumbilical
- Umbilical
what is divarication of recti?
- not true hernia
- Thinning of linea alba →happens in pregnancy = can sometimes see bulge or gap
- Rarely treated unless during repair for a neighboring hernia
what is a spigelian hernia?
rare abdominal wall hernia
- Linea semilunaris line
- At lateral border of rectus sheath as it meets the oblique muscles
- usually operate
what is incisional hernia?
- failure of fascia to restore strength in surgical wound
what are risk factors for incisional hernia?
obesity, smoking, post op wound infection, post op resp failure, early return to heavy lifting
what is parastomal hernia?
- specific type of incisional hernia
- common with stomas
- difficult to repair without reversing stoma
what is obturator hernia?
= a rare external abdominal hernia formed by protrusion of the abdominal visceral organs or extraperitoneal fat through the obturator foramen of the hip bone (may extend to femoral triangle)
- usually presents as obstruction
what are signs & symptoms of hernia?
- 1/3 asymptomatic
- if no pain - might not do surgery
- might have pain particularly when straining
what are complications of hernias?
- Irreducible (a.k.a. ’incarcerated’) = The hernia content cannot be manipulated back into the abdominal cavity
- Obstructed = Bowel loop gets trapped in hernia and becomes non-functioning but no compromise to blood supply
- Strangulation = Bowel loop gets trappped in hernia & Blood supply to bowel is compromised leading to ischaemia, perforation and peritonitis
what are treatment options for hernia?
- do nothing - just watch
- conservative = hernia belt, avoid straining
- surgical repair = open surgery, laparoscopic conventional, laparoscopic robotic
what are surgical complications of hernias?
- hole in bowel = most feared
- most common = seroma (fluid under wound- settles with time)
- can get necrosis of fat
- hematoma →often leave drains in
- mesh infection - rare (not good when happens)
- chronic pain (have to be willing to risk)
- big pressure problems - cause breathing problems etc
what factors does treatment of hernias depend on?
- Symptoms
- Emergency or not
- Site and size
- Previous surgery
- Comorbidity
what is femoral triangle?
a space in the groin region, bordered by the inguinal ligament superiorly, the sartorius muscle laterally, and the adductor longus muscle medially
