Abdominal hernia Flashcards
types of abdominal hernia
Inguinal Femoral Incisional Epigastric Umbilical
What is a hernia
The protrusion of a viscus or part of a viscus through a weakening in its containing cavity.
Types of inguinal hernia
Direct
Indirect
Clinical presentation of inguinal H
Swelling in the groin that may appear with lifting, accompanied by pain.
Increase in swelling on cough.
Can reduce on reclination, larger requires manual reduction.
Differences in clinical presentation between direct and indirect inguinal h
indirect more prone to cause pain in the scrotum and ‘dragging’ sensation
Describe direct inguinal hernia
Caused by weakness in the abdominal wall
Located MEDIAL to inferior epigastric vessels
Protrudes directly through a weakness in the POSTERIOR WALL of the inguinal canal.
Describe indirect inguinal hernia
Caused by a congenital weakness of the internal inguinal ring
(Protrusion through the internal inguinal ring along with the inguinal canal through the abdominal wall.)
Located LATERAL to inferior epigastric vessels
More common than direct
Pathophysiology of inguinal hernia
High abdominal pressure causes the internal organs to push through a weakened section of the abdominal wall
Aetiology of inguinal hernia
Con be congenital
Heavy lifting is a risk factor and can weaken the wall
Epidemiology of direct inguinal hernia
More common in elderly and men
Epidemiology of indirect inguinal hernia
Accounts for 80% of inguinal hernias
More common in men
Diagnosis of inguinal hernia
Clinical diagnosis
Ultrasound (radiology)
Seek to identify if inguinal or femoral
Treatment of inguinal hernia
Infancy = Repair soon after diagnosis Adults = surgical repair in large hernias
Complications of any hernia
Incarcerate or strangulate
Clinical presentation of femoral hernia
Lump/mass in groin.
Tends to be irreducible.
Lateral and inferior to the pubic tubercle.
Increase in swelling on cough.
May be reducible on reclination or manually.
Pathophysiology of femoral hernia
High abdominal pressure causes the internal organs to push through a weakened section of the abdominal wall
Aetiology of femoral hernia
Idiopathic
OR due to a weakness in the femoral canal:
-located inferior and lateral to the pubic tubercle
-more common in females
-high risk of strangulation
Epidemiology of femoral hernia
More common in middle-aged and elderly women
Diagnosis of femoral hernia
Ultrasound
Seek to identify if inguinal or femoral
Treatment of femoral hernia
Surgical hernia repair (treatment of choice)
Pathophysiology of incisional hernia
Location depends on location of incision
Internal organs push through improperly healed section of abdominal wall
Risk of any abdominal operation
Aetiology of incisional hernia
Weakness caused by a surgical repair that has not fully healed
Epidemiology of incisional hernia
15% of abdominal operations result in this
Diagnosis of incisional hernia
observation
Treatment of incisional hernia
Urgent repair with reinforcing mesh
What % of large hernias show recurrence of incisional hernia
50%
Clinical presentation of epigastric hernia
Midline, above the umbilicus in the linea alba. Can be made to bulge by asking the patient to strain.
Usually asymptomatic, can present with epigastric pain.
Possible bloating, nausea and vomiting, often after meals
Pathophysiology of epigastric hernia
Internal organs push through a weakened section of abdominal muscle
Risk factor of epigastric hernia
Obesity
Epidemiology of epigastric hernia
Most common in men between 20-50
Diagnosis of epigastric hernia
Obese patients might need ultrasound or CT scanning
Treatment of epigastric hernia
Surgical correction
Clinical presentation of umbilical hernia
At the site of the umbilicus.
Can be asymptomatic.
Pain can occur if the abdominal wall contracts, worsened on straining.
Pathophysiology of umbilical hernia
Congenitally can occur as a result of a developmental error. Organs develop outside of the abdominal cavity and enter through an opening in the umbilicus.
Aetiology of umbilical hernia
Infancy - congenital
Adult - 90% are acquired through multiple and difficult pregnancies
Also ascites and obesity
Epidemiology of umbilical hernia
10-30% of all hernias
More common in males and due to weakness of the umbilicus
Diagnosis of umbilical hernia
Ultrasound can confirm
Treatment of umbilical hernia
<1cm: usually closes spontaneously by 5 years
>1.5cm: usually requires repair with preservation of the umbilicus
(usually is self-resolving)
What is the viscera
the internal organs in the main cavities of the body, especially those in the abdomen, e.g. the intestines
Signs and symptoms of inguinal hernia
Mass in the groin
Hernia accentuated by certain situations such as coughing or on standing
Reducible
Pain = hernia likely to be strangulated i.e. blood supply is comprimised
Complications of inguinal hernia
Strangulation
Incarceration
Types of hiatus hernia
Sliding
Rolling
Causes of hiatus hernia
Weakness in the diaphragm that allows the stomach and intestines to move into the chest cavity.
Risk factors that make this more likely such as obesity and constipation
Signs and symptoms of hiatus hernia
GORD signs and symptoms: Heartburn Acid taste in mouth Water brash (excess salivation) Dysphagia Nocturnal asthma/chronic cough Laryngitis
Investigations of hiatus hernia
Endoscopy
Barium study
Treatment of hiatus hernia
GORD:
Conservative - education, weight loss, raising head of bed at night and avoid precipitating factors such as smoking and large meals
Medical - Antacids (aluminium hydroxide); H2 receptor antagonists (ranitidine); proton pump inhibitors (omeprazole)
Surgical - Nissen’s fundoplication
Complications of hiatus hernia
Strangulation
Gastric volvulus
GORD complications: Barretts oesophagus etc
Complications of femoral hernia
Strangulation
Fistula formation
