Groin Hernia Exam Flashcards
Impossible to locate lower extremity of swelling
May extend into scrotum
Absent cough impulse
Incarcerated hernia
Alternative diagnosis
Other groin swellings – alternative dx
Lymph node
Lipoma
Sebaceous cyst
Saphena varix
Cough impulse reducible hernia
Reappears= direct
Held by pressure = indirect
Indirect inguinal hernia
Deep inguinal ring-inguinal canal- superficial inguinal ring Superior to pt Commonly extends into scrotum VERY LARGE Usually reducible held by pressure on deep ring Low risk incarceration Must repair (not 100% from clinical)
Direct inguinal hernia
Hesselbachs triangle Superior to pt Rarely extends into scrotum Moderate size Almost always reducible NOT held by pressure on deep ring Moderate risk of incarceration Sx
Femoral hernia
Through femoral canal under Ing lig Inferior to pt Impossible to extend into scrotum 3-5cm Rarely reducible- usually incarcerated with absent cough impulse Not held by pressure on deep ring Usually incarcerated with high risk strangulation Urgent surgical repair
Obstructive complications of irreducible hernias
Colic
Distension
Constipation
Vomiting
Strangulation complications of irreducible hernia
Ischaemia
Necrosis
Peritonitis
Open repair hernia
Mesh- Lichtenstein
Sutures- Babinski/ Shouldice
Lapro hernia repair
Total extra peritoneal procedure
Trans abdominal procedure
Risk factors hernias
Family history Weakness abdo muscles - increasing age (direct) - surgery (incisional) Increase intra abdo pressure
Increase abdo pressure
Obesity Organomegaly Pregnancy Prostatism COPD/ cough Constipation HEAVY LIFTING
Richters hernia
Strangulation without obstruction
Often femoral
Indirect inguinal hernia UW
Processus vaginalis
Weakness at deep ring
All 3 layers
YOUNGER
