Hernia Flashcards
hernia is defined as what?
the protrusion of any body part through a cavity
What are the most common type of hernias, accounting for approximately 75- 80% of all hernias.
Inguinal Hernias
What is the Hasselbach’s Triangle
Inguinal Triangle
(b) Inferior epigastric vessels (superior border)
(c) Lateral aspect of the Rectus Abdominis (medial border)
(d) Inguinal Ligament (inferior border)
True/False
Inguinal hernias are more common in females than males
FALSE
Two main types of Inguinal hernias
Direct hernia
Indirect hernia
What type of inguinal hernia?
Abdominal contents herniate DIRECTLY through Hasselbach’s
triangle
Direct hernia…..
What type of inguinal hernia?
Abdominal contents herniate through the inguinal canal
Indirect hernia
What type of hernia?
(a) Most common (R>L)
(b) Abdominal content herniate through the inguinal canal
1) The spermatic cord and round ligament traverse this canal in males and females respectively.
(c) Caused by a patent processus vaginalis, leaving an open communication between the intraperitoneal and the inguinal canal/scrotum.
1) In males: The testes develop in the peritoneal cavity and then pass through the inguinal canal into the scrotum.
(d) Increases in intra-abdominal pressure force abdominal contents through the widened internal ring into the inguinal canal, resulting in a clinically detectable hernia.
(e) Frequently incarcerate and strangulate, particularly in the first year of life and in females.
(f) These hernias do not herniate directly through a weakness in the abdominal musculature.
Indirect Inguinal Hernia
What type of hernia?
(a) Herniation of abdominal contents through the abdominal wall musculature (Hasselbach’s Triangle). Due to muscular weakness in this location
(b) They are acquired defects that do not involve passage through the inguinal canal.
(c) They occur predominantly in adults and rarely incarcerate and strangulate.
(d) Recurrence after repair is more frequent than for an indirect inguinal hernia.
Direct Inguinal Hernia
What type of hernia?
(a) Typically a congenital hernias (born with it)
1) “out-y belly button”
2) Increased prevalence in African American children.
3) In children majority resolve by 5 years old
4) Rarely incarcerate
(b) May also be acquired (i.e. Pregnancy, laparoscopic surgical incisions).
1) Present in adulthood
2) More likely to incarcerate than congenital
Umbilical Hernia
(a) Patients may have a bulging mass at the site of herniation:
(b) _____: Lower anterior abdominal mass
(c) _____: Scrotal mass
(d) _____: “out-y” belly button
Direct
Indirect
Umbilical
All hernias have the ability to present with signs and symptoms of what?
Small Bowel
Obstruction
Unrelieved strangulation may result in what?
(a) Perforation
(b) Abscess formation
(c) Peritonitis
(d) Septic shock
This issue may have bruising or overlying redness at the location of herniation
-will present with tachycardia +/- fever with extreme pain with palpation of the defect.
Incarcerated hernias
In males, palpation of the inguinal canal is easily performed by _____________________________________________________.
(a) The patient is then asked to _____ or ____.
1) “Turnyour head and cough”
(b) If an indirect inguinal hernia is present the examiner should feel a _________ at the tip of the finger
(c) In a direct inguinal hernia, the hernia will bulge ______, pushing against the side of the finger on examination. You will also be able to see a anterior inferior abdominal bulge with increase in intra-abdominal pressure.
inversion of the scrotal skin and passage of a finger through the external ring.
a) cough or bear downcough or bear down
b) tapping sensation
c) anteriorly
Disposition: Hernia
Acutely irreducible incarcerated hernia- all ages
MEDEVAC for immediate surgical eval/repair
Disposition Hernia
Adult patients with reducible hernias
(a) Referred to general surgery for discussion of elective surgical repair.
(b) Be advised to avoid conditions that increase intra- abdominal pressure, such as heavy lifting.
After surgical evaluation, patients who are not candidates for operative repair may be fitted with _______
trusses
Disposition: Hernia
Return to medical if the patient has recurrence and is unable to what?
reduce the hernia promptly
Management and Treatment: Hernia
If strangulation is suspected or shock is present what meds would you consider?
broad- spectrum antibiotics and fluid resuscitation
True/False
Incarcerated hernias require immediate attention.
True
If there is any question of the duration of the incarceration, no attempt at reduction should be made. Why?
so that dead bowel is not introduced into the abdominal cavity.
If there is a reliable history that the incarceration is of recent onset, an attempt may be made to reduce the hernia. Within how long?
24 hours
Patients presenting with asymptomatic or reducible hernias should be referred to
general surgery for evaluation and definitive treatment (routine).
Closed Passive Reduction Technique:
1) Place the patient in the position. This allows gravity to assist with hernia reduction.
2) Administer narcotic (morphine 0.1-0.15mg/kg IC x1 prior) for analgesia and diazepam 5mg one time for muscle relaxation. After sedation, allow for passive reduction of the hernia over a ______ period.
1) supine Trendelenburg
2) 30-40-minute
Closed Active Reduction Technique:
If passive technicque is unsuccessful
1) _______ to guide its contents into the peritoneal cavity.
2) Use the other hand to provide gentle and steady _______ over the hernia.
1) Place one hand over the neck of the hernia sack
2) distal-to-proximal compression
