Hernia Flashcards
What is a hernia?
Protusion of a viscus into an abnormal space
What are the most common types of abdominal hernia?
Inguinal
Femoral
Incisional
Hiatus
What is an inguinal hernia?
Abdominal cavity contents enter into the inguinal canal
Difference between direct and indirect inguinal hernias
Direct
- bowel enters inguinal canal through weakness in posterior abdominal wall
- enters through Hesselbach’s triangle
- medial to inferior epigastric vessels
Indirect
- bowel enters inguinal canal bia deep inguinal ring
- lateral to inferior epigastric vessels
What are the borders of the inguinal canal?
Anterior wall - aponeurosis of the external oblique
Posterior wall - transversalis fascia
Roof - transversalis fascia, internal oblique, transverus abdominis
Floor - inguinal ligament
What are the borders of Hesselbach’s triangle?
Medial - lateral border of rectus abdominis
Lateral - inferior epigastric vessels
Inferior - inguinal ligament
Risk factors of inguinal hernias
Male
Increasing age
Raised intra-abdominal pressure
Obesity
Clinical features of inguinal hernia
Lump in groin
- cough impulse
- reducible
- superomedial to pubic tubercle
Differentiate clinically between direct and indirect inguinal hernias
Locate deep inguinal ring
Reduce hernia
Apply pressure over deep inguinal ring
Ask patient to cough
Reappears = direct
Management of inguinal hernias
Symptomatic hernia
- surgical intervention
- open/laparoscopic repair
Complications of inguinal hernias
Incarceration
Strangulation
Obstruction
What is a femoral hernia?
Abdominal contents passes through femoral ring and into femoral canal
What are the borders of the femoral canal?
Medial - lacunar ligament
Lateral - femoral vein
Anterior - inguinal ligament
Posterior - pectineal ligament, superior ramus of pubis, pectineus muscle
Risk factors for femoral hernias
Female
Pregnancy
Raised intra-abdominal pressure
Increasing age
Clinical features of femoral hernias
Small lump in the groin
- inferolateral to pubic tubercle
- usually irreducible
Investigations for suspected femoral hernia
Surgical intervention
Ultrasound
Management of femoral hernia
Managed surgically due to high risk of strangulation
What is an incicsional hernia?
Protusion of the contents of a cavity through a previously made incision in the compartments wall
Causes of incisional hernias
Weakness in wall due to incision
Raised intra-abdominal pressure, contents are forced through the weakness
Risk factors of incisional hernia
Emergency surgery
Wound type
Obesity
Wound infection
Clinical features of incisional hernias
Non-pulsatile, soft, reducible and non-tender swelling at the site of a previous surgical wound
Investigations for a suspected incisional hernia
Diagnosis made on a clinical basis
Management of incisional hernias
Managed conservatively if asymptomatic
Repaired surgically if indicated
What is a hiatus hernia?
Protrusion of an organ from the abdominal cavity into the thorax through the oesophageal hiatus
What are the classifications of hiatus hernias?
Sliding hiatus hernia (80%)
- gastro-oesophageal junction, abdominal oesphagus and cardia of the stomach moves up through diaphragmatic hiatus
Rolling/para-oesophageal hernia (20%)
- upwards movement of gastric fundus
- lies alongside normally position GOJ
- creates a ‘bubble’ of stomach in thorax
Risk factors of hiatus hernia
Age
Pregnancy
Obesity
Ascites
Clinical features of hiatus hernias
Majority = asymptomatic
Gastroesophageal reflux symptoms - made worse by lying flat
Hiccups
Investigations for suspected hiatus hernia
OGD - shows upwards displacement of GOJ
Management of hiatus hernias
Conservative
- PPIs
- weight loss
- smoking cessation
Surgical (indicated if remains symptomatic or nutrional failure)
- Cruroplasty (hernia reduced)
