Hernia Flashcards
Deep inguinal ring location
Mid point between the ASIS and the pubic tubercle
Superficial inguinal ring location
Superiolateral to pubic tubercle
In external oblique
Contents on inguinal canal
Spermatic cord Vas deferens Round ligament of uterus Genitourinary nerve Ilioinnguinal nerve
Direct inguinal hernia definition
Buldging of abdominal contents directly through the abdominal wall
-> re appear with pressure over deep ring
Always acquired so rare
Indirect inguinal hernia definition
Passage of abdo contents down in the inguinal canal
-> reduced by pressure over the deep inguinal ring
May enter scrotum
Most common in young males-> patent processes vaginalsis
More liable to strangulation as narrow neck
Pantaloon hernia definition
Both direct and indirect
Hernia predisposing factors
Male middle age Congenital predisposition Work or sport exacerbation Age Patent processus vaginalis Obesity Chronic cough Heavy lifting Straining Changes in abdo contents
Strangulated hernia definition
Neck constricts sac -> obstruction of venous drainage -> swelling -> obstruction of arterial supply -> necrosis Tender and red with symptoms of bowel obstruction
Femoral hernia definition
Protrusion of the abdo contents through the saphenous opening
More common in females, multiparous, middle age
Always acquired
Bellow the inguinal ligament
Femoral hernia symptoms
Small lump bellow the inguinal ligament Rarely have a cough impulse Usually irreducible May be intermittent 40% strangulated -> no obvious local symptoms with distal bowel obstruction
Richters hernia definition
Part of the bowel wall herniated
Lumen remains patent but peristalsis is disturbed
Differentials of a lump in the groin
Sebaceous cyst Lipoma Fibrous Haematoma Tumour Aneurysm Varicosity Lymph node Ectopic testis and ovary
Inguinal hernia investigations
Mainly clinical
USS if difficult to define
Inguinal hernia management
Tend to be progressive so offer surgery if fit -> narrow neck -> femoral -> irreducible Trus belt is an alternative Treat predisposing conditions Weight reduction
Umbilical hernia embryology
Vitelli-intestinal duct to yolk sac Blood vessels to placenta Herniation of bowel Bladder to alantois -> doesn't close
True umbilical hernia definition
Protrusion through the umbilical scar reverting the umbilicus
Congenital
-> only babies
Para umbilical hernia definition
Hernia through the weakest area of the umbilical scar
-> superior aspect between the umbilical vie in and upper margin
Displaces umbilicus
Para umbilical hernia clinical features
Middle aged and obese females Local pain and swelling Commonly recurrent obstruction-> small neck Crescent shape umbilicus Cough impulse Advise repair
Umbilical hernia clinical features
Exerted umbilicus
Dates back to infancy
As cites
Look for malignancy
Epigastric hernia anatomy
Junction of the rectus sheath-> lines alba
-xiphoid process to symphysis pubis
Extra peritoneal fat protrudes through the upper half
Epigastric hernia clinical features
3/4 asymptomatic Local pain exacerbated by exertion Worse after meals ?peptic ulcer Repair if symptomatic
Divaricatioh of rectus abdominis definition
Stretching and widening of linea alba
-pregnant women
Ridge down abdomen which is more prominent on straining
2cm wide
Risk factors for incisional hernia pre op
Age Malnutrition Sepsi Uraemia Jaundice Obesity DM Steroids Peritonitis
Risk factors for incisional hernia peri op
Vertical incisions
Poor suture technique
Bowel or urinary tract
Drains
