Abdominal hernias Flashcards
What is a hernia
It is an abnormal protrusion of an organ or tissue through a defect in its surrounding walla
They commonly occur at:
- Inguinal
- Femoral
- Umbilical
- Linea alba
- Sites of previous incisions
What is a reducible hernia
It is when all contents can be replaced within the abdominal cavity
What are irreducible or incarcerated hernia
It is when the contents couldnt be reduced usually due to adhesions within the sac
What is a strangulated hernia
It is a hernia with a compromised blood supply to the contents of the hernia
What is a Richter Hernia
It is when a small portion of the antimesenteric wall of the intestine is trapped within the hernia and strangulation occurs without intestinal obstruction
What is teh difference between an external and internal hernia
External: Hernia protrudes through all layers of the abdominal wall
Internal: Hernia is a protrusion of teh intestine through a defect within the abdominal wall
What are the 4 types of groin hernia
Indirect
Direct
External supravesical
Femoral
What are the components of the spermatic cord
Cremasteric muscle fibres
Testicular artery and vein
Genital branch of the genitofemoral nerve
Va deferens
Lymphatic vessels
List teh boundaries of the inguinal canal
Anterior: Aponeurosis of the external and internal oblique muscle
Posterior wall (floor): Formed laterally by the aponeurosis of the transversus abdominus muscle and the transvesalis fascia
Superior: Formed by the arched fibres of the lower edge of the internal oblique muscle and the transversus abdominis muscle and sponeurosis
Inferior: Formed by the shelving lower border of the inguinal ligament
What is the deep and superficial inguinal rings
Deep ring:
- Normal defect in the transversalis fascia and transversus aponeurosis
Superficial ring:
- Triangular cleft in the aponeurosis of the external oblique
What is an indirect inguinal hernia
It is when the hernia passes through the deep inguinal ring and follows the spermatic cord in males and round ligament in females
What is a femoral hernia
It is a protrusion of preperitoneal fat or viscus through the femoral canal
What are the boundaries of the femoral canal
Anterior: Inguinal ligament
Posterior: Pectineal ligament and facia iliaca
Lateral: Connective tissue septum and the femoral vein
Medial: Aponeurotic insertion of the transversus abdominis muscle and the transversalis fascia
How is a hernia managed
Conservative:
- Use a truss (for patients with severe comorbidities)
Operative repairs:
- Tissue repair
- Tension free repair with prosthesis
- Preperitoneal repair, open or laproscopic
- Mesh repair
What are th epossible complications of hernia repair
Wound infection
Haematoma
Bleeding
Ischaemic orchitis
Testicular atrophy
Nerve injury
Hernia recurrence
