Hernia Flashcards
What is a hernia?
Protrusion of internal tissue through an anatomical structure.
What are the most common types of hernias?
Groin, ventral, and incisional hernias.
What characterizes a reducible hernia?
Contents can be pushed back into the abdominal cavity, disappears with manual pressure or lying down, increases with higher intrabdominal pressure.
What are the symptoms of an incarcerated hernia?
Irreducible, firm bulge with mild discomfort or pain, no signs of strangulation. There will be a persistent bulge with mild discomfort or pain.
What symptoms indicate an obstructed hernia?
Bowel obstruction Without vascular compromise , distended abdomen, absent bowel sounds, abdominal pain, vomiting, constipation.
What defines a strangulated hernia?
Compromised blood supply, tender, erythematous, oedematous, non-reducible. There may be severe localised pain,f ear, nausea and signs of ischaemia. Bowel obstruction occurs if bowel is in the herniated sac.
What can cause hernias?
Increased pressure from Kyphoscoliosis, ascites, obesity, straining from chronic constipation, pregnancy,
What causes weakness for hernia?
congenital defects, ageing, collagen disorders, trauma, poor healing, drugs like steroids.
What is the gold standard treatment for symptomatic inguinal hernia?
Open or laparoscopic mesh repair for recurrent or bilateral hernias..
What is the most common type of hernia?
inguina, through the abdominal muscles or inguinal canal, treated through hernia repair surgery.
Risk of complications is low because the tissue around the hernia neck is soft and stretchy but gold standard for symptomatic inguinal hernia is an open or laparoscopic mesh repair.
Which demographic is most affected by inguinal hernias?
Most common in males, peak age is 70, BMI is a risk and obesity is protective factor.
What is a direct inguinal hernia?
Medial to the epigastric vessels due to weakness in the posterior wall of Hesselbach’s triangle. It is more common in older patients, oftensecondary to abdominal wall laxity or a significant increase in intra-abdominal pressure.
What is an indirect inguinal hernia?
Lateral to the epigastric vessels, travels via the deep inguinal ring, most common in younger patients from incomplete closure of the processes vaginal is, an embryological remnant of the peritoneal otpouching. Greater risk of strangulation than direct and this can cause ischaemia of testicles..
What is Hesselbach’s triangle?
Bounded superiorly by inferior epigastric vessels, inferiorly by inguinal ligament, and medially by rectus abdominis muscle.
What are incisional hernias?
Hernias that occur at the site of previous abdominal surgery, typically managed with surgical mesh repair.There is a greater irks with emergency surgery, high BMI, midline incision, post-operative wound infection increases risk to 70%, advantaging age, smoking and diabetes. CT imaging can be used to confirm diagnosis.
What are the symptoms of incisional hernia?
with bulge/swelling, pain or discomfort, feeling of pressure/heaviness in abdomen, nausea or coming, difficulty passing stool.
What is a femoral hernia?
Rare hernia occurring in the femoral canal, more common in women in their 50s. occurring in the femoral canal to medial upper thigh Risk of complications like bowel obstruction with femoral hernia is high as the hernial neck is narrow and the border is hard so they often present with bowel obstruction and strangulation due to its proximity to the external iliac artery and vein.
What are the risk factors for femoral hernia?
Risk factors being pregnancy, obesity and chronic strain. Always treated through hernia repair surgery with mesh.
What are the contents of the femoral canal?
Femoral canal anatomy from lateral to medial: NAVEL
Nerve of femoral
Artery of femoral
Vein of femoral
Empty space
Lymphatics
What are the symptoms of a hiatus hernia?
Heartburn, regurgitation, sharp or dull chest pain, difficulty swallowing, nausea or vomiting, burping, or bloating.
What are the ventral hernias?
Ventral hernias occur anywhere on the abdominal wall, caused by obesity, pregnancy, previous abdominal surgery or congenital defect.t here will be a visible bulge or swelling in the abdomen, with pain and digestive issues like nausea and vomiting.
They include umbilical, epigastric and spigelian hernias.
What is an epigastric hernia?
Epigastric hernia occurs through part of the intestine in the abdominal muscles through the linea alba, more common in men and causes pain especially during physical activity. It can be mistaken for diversification of the recti, which is stretching of the linea alba common with surgery. Treatment involves surgery if symtpomatic
What is an umbilical hernia?
Most common ventral hernia where intestine protrudes near the belly button, often congenital and covered by skin so they are soft and redcibel. Typically resolves in infants and management is conservative with simple suture repair if small but may require emergency laparoscopy surgery if over 4cm.
Who tends to get acquired umbilical hernia?
Older women are at increased risk of acquiring it with chronic increase in intrabdominal pressure with ascites with risk of containing organs. There is a bulge or swelling around belly button area, pain or discomfort when coughing, sneezing or lifting, and bulge appearing when crying or straining. If it becomes strangulated, there is nausea and vomiting.
What is a muscle hernia?
Occurs due to sudden injury or repetitive strain, often in the lower leg.
What is a Richter’s hernia?
Partial herniation of the bowel with high risk of bowel ischaemia. Patinets will present with a tender irreducible mass and it is typically a surgical emergency requiring intervention.
What is a Littre hernia?
Abdominal hernia containing Meckel’s diverticulum.
What is an obturator hernia?
Occurs through the obturator foramen, more common in older women due to having a wider pelvis and in older patients that lack fat in the obstruct or canal.
It presents with a lump in the upper medial thigh and there is a high risk of obstruction. Risk of compression of obturator nerve to cause Howship-Romberg sign (inner thigh pain occurring with internal rotation of the hip)
What is a hiatal hernia?
Hiatal hernia is a condition caused by abnormal protrusion of stomach or internal organs through diaphragm hiatus, which can compromise the lower oesophageal sphincter and cause gastrointestinal-oesophageal reflux disease.
It is caused by muscle weakness from age0related weakness prominent in older people, elevated intrabdominal pressure from chronic constipation and COPD.
What are the four types of hiatal hernias?
- Type I: Sliding type
- Type II: Rolling/A paraesophageal hernia
- Type III: Mixed
- Type IV: Stomach and additional organ herniation.
What is type 1 hiatal hernia?
The sliding type,representingmore than 95% of hiatal hernias.This type occurs when the GEJ is displaced toward the hiatus and stomach cardia slides up into the chest with similar treatment to GERD due to association.
What is type 2 hiatal hernia?
Rolling/A paraesophageal hiatal hernia, which occurs when part of the stomach migrates into the mediastinum parallel to the esophagus. This is a true hernia with a peritoneal sac which can result in a gastric volvulus and reccomendations include surgical repair.
What is type 3 hiatal hernia?
mixed, A paraesophageal hernia combined with a sliding hernia, where both the GEJ and a portion of the stomach have migrated into the mediastinum
What is type 4 hiatal hernia?
The stomach and an additional organ, such as the colon, small intestine, or spleen, herniate into the chest which has a risk of volvulus so requires urgent treatment that can cause ischaemia and necrosis.
What is the gold standard for diagnosing hiatal hernia?
Endoscopy
Barium enema
Oesopageal manometer
24 hour pH test.
What treatment is recommended for hiatal hernia?
Double dose of PPI, smoking cessation, reduction in alcohol intake.
What are the surgical options for hiatal hernia?
Cruroplasty to reduce hernia from thorax into abdomen with suture or mesh
Fundoplication
What is fundoplication?
Surgical procedure where gastric fundus is wrapped around lower oesophagus to strengthen the lower oesophageal sphincter.
