Hernia Flashcards
definition of hernia?
Protrusion of a viscus or part of a viscus through the walls of its containing cavity into an abnormal position.
definition of reducible hernia?
Sac can return to the abdominal cavity either spontaneously or w manipulation.
definition of irreducible hernia?
Sac cannot be reduced despite pressure or manipulation
definition of strangulated hernia?
Blood supply of contents is compromised due to pressure at the neck of the hernia.
Maydl’s hernia?
Herniating double loop of bowel. Strangulated portion may reside as a single loop inside the abdomen.
what is Littre’s hernia?
any Hernial sac containing strangulated Meckel’s diverticulum.
what is Amyand’s hernia?
Inguinal hernia containing strangulated Appendix
what is a pantaloon hernia?
type of inguinal (related to the groin) hernia that involves a direct and indirect hernia on the same side of the groin.
(simultaneous direct and indirect hernia)
herniotomy?
Excision of hernial sac
what is a herniorrhaphy?
Suture repair of hernial defect
what is a hernioplasty?
Mesh repair of hernial defect
pathophysiology of congenital hernia?
patent processus vaginalis
- should obliterate following descent of the testes
- if it stays,, may fill with fluid -> hydrocele or bowel / omentum -> indirect hernia
causes of acquired hernia?
things that increase intra abdominal pressure
Chronic cough: COPD, asthma
Prostatism
Constipation
Severe muscular effort: e.g. heavy lifting
Previous incision/repair
Ascites / obesity
Appendicectomy
what is an indirect hernia?
80% of hernias: commoner in young
Congenital patent processus vaginalis
Emerge through deep ring
Same 3 coverings as cord and descend into the scrotum
Can strangulate
what is a direct hernia?
20%: commoner in elderly
acquired
emerge through hesselbachs triangle
rarely descend into scrotum/ strangulate
ix of hernia if type is uncertain?
US
features of hernia in children?
lump in groin which may descend into scrotum
exacerbated by crying
commonly obstruct
features of hernia in adults?
lump in groin, exacerbated by straining / coughing
may be clear precipitating event e.g. heavy lifting
dragging pain radiating to groin
may present w obstruction/ strangulation
impt features to ask about hernia?
reducible?
episodes of obstruction/ strangulation?
predisposing factors: cough, straining, lifting?
occupation and social circumstances?
mx of hernia?
non surgical:
reduce risks: cough, constipation
lose weight
truss (hernia support belt)
surgical:
tension free mesh repair
lap if bilateral/ recurrent
open if primary unilateral
children only require sac excision (herniotomy)
complications of hernia surgery?
Early:
Haematoma / seroma formation: 10%
Intra-abdominal injury (lap)
Infection: 1%
Urinary retention
Late:
Recurrence
ischaemic orchitis
chronic groin pain/ parasthesia
definition of femoral hernia?
Protrusion of viscus through the femoral canal
why are femoral hernias more common in females?
Femoral canal larger in females due to shape of pelvis
and changes in its configuration due to childbirth
features of femoral hernia?
painless groin lump
- neck inferior and lateral to pubic tubercle
- cough impulse
- often irreducible
commonly presents w obstruction/ strangulation
- tender, red and hot
abdo pain, distension, vomiting, constipation
mx of femoral hernia?
urgent surgery
50% risk of strangulation within 1 mo
elective: Lockwood approach
Emergency: McEvedy Approach
(high approach in inguinal region to allow inspection and resection of non viable bowel then herniotomy and herniorrhaphy)
definition of incisional hernia?
hernia arises through a previously acquired defect
risk factors of incisional hernia?
preop:
increased age, obesity, malnutrition, comorbidities, drugs: steroids, chemo, radio
intra-op:
surgical technique: too small suture bites/ inappropriate suture material
incision type e.g. midline
placing drains through wounds
post-op:
- increased intra-abdo pressure: chronic cough/ straining, post op ileus
infection
haematoma
mx of incisional hernia?
surgery not appropriate for all patients
- must balance risk of operation and recurrence w risk of obstruction/ strangulation
usually broad necked-> low risk of strangulation
conservative:
manage risk factors e.g. constipation, cough
weight loss
elasticated corset or truss
surgical:
preop- optimise cardioresp function
nylon mesh repair: open or lap
umbilical hernia
- congenital
- defect in umbilical scar
risk factors of umbilical hernia?
afro-caribbean
trisomy 21
congenital hypothyroidism
mx of umbilical hernia?
usually resolves by 2-3 yrs of age
mesh repair if no closure
may recur in adulthood: pregnancy, gross ascites
what does paraumbilical hernia herniate through?
defect through linea alba just above or below umbilicus
- acquired: usually middle aged obese men
small defect -> strangulation (often omentum)
risk factors of paraumbilical hernia?
chronic cough
straining
mx of paraumbilical hernia?
May (double breast linea alba w sutures)/ mesh repair
what is a spigelian hernia?
hernia through linea semilunaris
hernia lies between layers of abdo wall
palpable mass more likely to be colon ca
what is an obturator hernia?
old aged F>M
sac protrudes through obturator foramen
pain on inner aspect of thigh or knee
frequently present obstructed/ strangulated
what is a lumbar hernia?
middle aged M> F
typically follow loin incisions
herniates through superior/ inferior lumbar triangles
what is a sciatic hernia?
hernia through lesser sciatic foramen
usually presents as SBO + gluteal mass
what is a gluteal hernia?
hernia through greater sciatic forament
usually presents as SBO+ gluteal mass
inguinal vs femoral hernias?
