Hernia Flashcards
what is a hernia
abnormal protrusion of a cavity’s contents through a weakness in the wall of a cavity
causes of a hernia
anatomical
inherited collagen disorders
sites where surgical incisions are made
example of anatomical causes of a hernia
sites where structures exit through an opening in the cavity
types of hernia
epigastric spigelian femoral inguinal incisional umbilical
classification of hernia
reducible
incarcerated or irreducible
strangulated
describe reducible hernia
hernia can be easily pushed back into abdomen
describe incarcerated or irreducible hernia
hernia cannot be manipulated back to abdomen
describe strangulated hernia
vascular supply to contents contained within hernia is compromised, resulting in ischaemic and gangrenous tissue
treatment of hernias
conservative/non-surgical management
surgical
define epigastric hernia
fascial defect in the linea alba betune the xiphoid process and the umbilicus
clinical features of epigastric hernia
midline lump
asymptomatic - may present with pain
+incarcerated or strangulated = symptoms dependent on organ involved
epidemiology of paraumbilical hernia
occurs in all age group
aetiology of paraumbilical hernia
stretching of abdominal wall by obesity
multiple pregnancy
ascites
clinical features of paraumbilical hernia
pain
complications of paraumbilical hernia
do not resolve spontaneously
high incidence of incarceration and strangulation
treatment of paraumbilicial hernia
always surgical
aetiology of adult umbilical hernia
persistent elevation of intra-abdominal pressure
clinical features of adult umbilical hernia
pain
treatment of adult umbilical hernia
always surgical
complications of adult umbilical hernia
do not resolve spontaneously
high incidence of incarceration and strangulation
length of the inguinal canal
4cm
describe the pathway the inguinal canal
stars at deep inguinal ring and ends in superficial inguinal ring
boundaries of inguinal canal - anterior
external oblique and internal oblique muscle
boundaries of inguinal canal - floor
ligament
boundaries of inguinal canal - roof
transversals fascia
internal oblique and transverses abdominis
boundaries of inguinal canal - posterior
transversals fascia and conjoint tendon
function of inguinal canal - male
transmits the spermatic cord and ilioinguinal nerve
function of inguinal canal - female
transmits the round ligament of the uterus and ilioinguinal nerve
where does spermatic cord enter inguinal canal
through the deep inguinal ring in posterior wall
where does spermatic cord exit inguinal canal
through superficial inguinal ring on the anterior wall
contents of spermatic cord
3 coverings
6 contents
coverings of spermatic crd
internal spermatic fascia
cremasteric fascia
external spermatic fascia
contents of spermatic cord
vas deferens 3 arteries pampiniform plexus (veins) lymphatics nerves remains of processes vaginalis
arteries of spermatic cord
testicular artery
artery to Vas
cremasteric
nerves of spermatic cord
genital branch of genitofemoral nerve
sympathetic twigs
lateral edge of hesselbach triangle
inferior epigastric artery
medial edge of hesselbach triangle
lateral border of rectus muscle
inferior edge of hesselbach triangle
inguinal ligament
types of inguinal hernia
direct inguinal hernia
indirect inguinal hernia - most common
right sided hernias more common
describe direct inguinal hernia
bowel pushes through weak area in floor of inguinal canal - the hesselbach triangle
describe indirect inguinal hernia
bowel inters the inguinal canal via the deep inguinal ring and pushes out through the superficial inguinal ring
epidemiology of inguinal hernia
males
pathology of inguinal hernia
multifactorial - patent processus vaginalis and pathological change in connective tissue
clinical presentation of inguinal hernia
groin swelling that disappears when lying down, located above and medial to pubic tubercle
palpable cough impulse
tests of inguinal hernia
ultrasound - if in doubt about diagnosis
treatment of inguinal hernia
non surgical
surgical - open or laparoscopic
epidemiology of femoral hernia
older age
20% of hernias in woman
5% of hernias in men
clinical presentation of femoral hernia
strangulation in 40% of hernias
borders of femoral ring - anterior
inguinal ligament
borders of femoral ring - posterior
iliopectineal ligament
borders of femoral ring - medial
lacunar ligament
borders of femoral ring - lateral
femoral vein
treatment of femoral hernia
surgical
aetiology of incisional hernia
iatrogenic - most common complication of laparotomy
predisposing factors of incisional hernia
wound complications inherited collagen abnormlaites advanced age smoking morbid obesity malignancy surgical technique
management if incisional hernia
conservative or surgical
