Hernia Flashcards
why are inguinal hernias more common in men
due to how testes develop, pass through inguinal canal
what is the usual presentation of a femoral hernia
elderly lady, presenting acutely
what makes up the posterior wall, floor, anterior wall and roof of the inguinal cana;
posterior wall= transversalis fascia
floor= inguinal ligament, lacunar ligament
anterior wall= aponeurosis of the external oblique, internal oblique
roof= tranversalis fascia, internal oblique, transverse abdominus
what does the inguinal canal contain
spermatic chord
what does the spermatic chord contain
3 arteries: testicular/ gonadal, cremasteric atery, artery to the ductus deferens (vas deferens)
3 nerves- ilio-inguinal, genital branch of genito femoral, sympathetic
3 other things- pampiform venous plexus, vas deferns, lymphatics
what are the risk factors for hernias
male, age, obesity, chronic cough, previous hernia, collagen disorder, AAA, previous appendicitis
what type of hernia is most common in men
right sided indirect inguinal hernia
where is an indirect hernia in relation to inferior epigastric vessels
lies lateral to it
which hernia goes through the ingiunal and emerges form the inguinal ring
indirect
where is a direct hernia in relation to the inferior epigastric vessels
medial to them
what is the path of a direct hernia
bulges through abdominal wall
how do you distinguish direct from indirect hernias
reduce hernia, cover deep inguinal ring, get patient to cough- if direct will bulge back out
what is the litchenstein method
mesh sutured in place around spermatic chord- open surgery
what are the complications of hernia repair
recurrence urinary retention bleeding/ haemotoma chronic pain numbness testicular atrophy. ishaemic orchitis (testicals shrivel up) wound infection
what is an emergency presentation of a hernia
irreducible, strangulation, obstruction
who gets femoral hernias
elderly women who have had lots of children (multi-parous)
what does the femoral canal connect
inferior iliac spine to the pubic tubercle
what makes up the medial, lateral, anterior and posterior borders of the femoral canal
lacunar ligament, femoral vein, inguinal ligament, pectinate ligament
what are the contents of the femoral canal
fat, lymphatics, lymph node of cloquet
what are the differences between emergency and elective repair of femoral hernias
low approach- elective, incision on top of inguinal ligament, can also be laparoscopic
high approach- emergency, cut in through abdomen
where is an iguinal hernia in relation to the pubic tubercle
above and medial
where is a femoral hernia in relation to the pubic tubercle
below and lateral
what are the differential diagnosis of a hernia
hydrocele (collection of fluid), undescended testical, saphena varix, inguinal lymphadenopathy, femoral artery aneurysm
what is an epigastric hernia
defect in linia alba between xiphisternum and umbilicus, more common in males 4:1
what is a paraumbilical hernia
defect around ubilicus
what is the risk factor for a paraumbilical hernia
obesity, pregnancy, ascites
what are the rsik factors for inscisional hernia
obesity, age, site, infection, smoking, malnutrition, steroids, poor technique, recurrence of incision
what is a paediatric hernia
umbilical hernia (true) or inguinal (3-5% of full term boys)
how does an obturator hernia present
medial thigh pain in elderly females, small bowel obstruction, obturator nerve compression
