Abdominal wall hernias Flashcards
Define hernias of the abdominal wall
An abnormal protrusion of abdominal contents though the fascia of the abdominal wall
List the contents of a hernia
Always contains a portion of the peritoneal sac May contain viscera, usually small bowel and omentum
Describe the aetiology of congenital abdominal hernias
Associated with developmental disorders e.g. persistent processus vaginalis, failure of complete obliteration of the umbilical opening
Describe the aetiology of acquired abdominal hernias
Weakness of the abdominal wall due to ageing or previous surgery. Risk increased in conditions that increase intra-abdominal pressure.
What terms are used to describe an abdominal hernia?
Reducible: contents can be fully restored to the abdominal cavity, spontaneously or with manipulation. Incarcerated: part or all of the contents cannot be reduced due to narrow neck and/or adhesions. Strangulated: twisting or entrapment compromises blood supply to the hernia ➔ obstruction and infarction
What may be seen on examination of a hernia?
Occur at weak spot May reduce on lying down, or with direct pressure May have expansile cough impulse
Name 5 common types of abdominal wall hernias
Inguinal hernia (commonest) Femoral hernia Incisional hernia Epigastric hernia Umbilical hernia
What is the commonest type of abdominal hernia?
Inguinal hernia
What is the M:F ratio for inguinal hernias?
8:1
How can inguinal hernias be classified?
Direct: medial to inferior epigastric artery Indirect: lateral to inferior epigastric artery
Differentiate between an indirect and direct inguinal hernia
Indirect: occurs at any age (usually young), congenital, lateral to inf epigastric a, often descend to scrotum, narrow neck ➔ more likely to strangulate Direct: uncommon in children and young adults, acquired, medial to inf epigastric a, rarely descend to scrotum, wide neck ➔ rarely strangulate
Name 2 risk factors for indirect inguinal hernias
Prematurity Male
Name 3 risk factors for direct inguinal hernia
Male Obesity Constipation Chronic cough Heavy lifting
Describe the presentation of inguinal hernias
Lump in the groin May have sudden pain Expansile cough impulse Ache or dragging sensation, especially at the end of the day
Outline the management of inguinal hernias
Reassurance if small and asymptomatic Symptomatic hernias or Hx of incarceration or bowel obstruction ➔ offered hernia repair -Consider hernia truss: supports tissue and relieves pain Hernia repair: reduction or excision of sac, closure of defect with minimal tension.
What structure do indirect inguinal hernias travel through?
Inguinal canal: transmits the spermatic cord/round ligament, and the ilioinguinal nerve.