Gen Surg: Hernias Flashcards
What is a hernia?
A protrusion of a viscus/part of a viscus (organ) through a defect of the wall of its containing cavity into an abnormal posiiton
What is meant if a hernia is irreducible?
Contents cannot be pushed back into place
What is meant when a hernia is described as obstructed?
Bowel contents cannot pass - features of intestinal obstruction (painful)
What is meant by a strangulated hernia?
A hernia that is cutting off the blood supply to the intestines and tissues in the abdomen.
(painful- pateint becomes toxic and requires urgent surgery)
What is meant by incarceration of a hernia?
Contents of the hernial sac are stuck inside by adhesion
What is the cause of hernias?
Abdominal wall hernias occur at sites of inherent wekaness
Operations + advancing age + obesity + malnutrition = further loss in muscle strength
Raised intra-abdominal pressure is a risk factor (chronic cough, constipation, urinary obstruction, heavy lifting)
General presentation of hernia
Lump
Normally painless (unless complicated)
Expansible cough imulse
Diagnosis of hernias
Clinical
US if unsure
Complications of hernias
Obstruction
Strangulation
Irreducable/incarcerated
What is a femoral hernia?
Bowel enters the femoral canal, presenting as a mass in the upper medial thigh or above the inguinal ligament where it points down the leg
What sex do femoral hernias occur most commonly in?
Females - especially middle aged and elderly
What is the anterior boundary of the femoral triangle?
Inguinal ligament
What is the medial boundary of the femoral canal?
The lacunar ligament and pubic bone
What is the lateral border of the femoral triangle?
Iliopsoas and femoral vein
What are the contents of the femoral canal?
- Fat
- Cloquet’s node/lacunar node
- Empty sapce
- Loose conective tissue
- Lymphatic vessles
What is the differential diangosis for someone presenting with features of a femoral hernia?
- Inguinal hernia
- Saphena varix - dilatation at top of long saphenous vein due to vascular inconpetance (soft and compressable, dissapears on lying down, +ve expansable cough impulse)
- Inguinal lymphadenopathy
- Groin abscess
- Enlarged Cloquet’s node
- Lipoma
- Femoral aneurysm
- Psoas Abscess
How would you manage a femoral hernia?
Surgical repair
- Herniotomy - excision of hernia sac
- Herniorrhaphy - repair of hernia defect
Reduction of hernia and narrowing of femoral ring.
Surger recommended as hernia is prone to strangulation and osbtruction.
What is a TRUSS?
Life a corset thing. For those excluded from surgery.
Where are paraumbilical hernias found?
Occur just above of below the umbilicus
What are risk factors for paraumbilical hernias?
- Obesity
- Ascites
How would you manage a paraumbilical hernia?
Leave it, or repair of rectus sheath (Mayo repair)
What are epigastric hernias?
Hernias which pass through the linea alba above the umbilicus