Hernia Flashcards
Inguinal hernia
The most common type of hernia
- Occurs when part of the bowel protrudes through the abdominal wall
Direct inguinal hernia
Bowel enters only through superficial ring
- Comes straight from bowel
- Enters medial to the epigastric vessels
Causes
- Weakness in abdominal wall
Indirect inguinal hernia
Bowel enters the deep inguinal ring and superficial ring
- Enters lateral to the epigastric vessels
- Usually congenital cause
Deep inguinal ring
- Description
- Location + Surrounding structures
- Variation
Made up of the transversals evagination
- Origin of the spermatic cord in males and round ligament of uterus in females
Location
- Just above midway of inguinal ligament
- Medial to the Inferior epigastric vessels
Larger in males than females
Superficial inguinal ring
- Description
- Location + surrounding structures
- Variation
Triangular opening that acts as an exit for the inguinal canal
- Created from external oblique aponeurosis
- Contains the spermatic cord in men and round ligament of the uterus in women
- Contains ilii-inguinal nerve
Location
- Immediately above pubic crest
- Superolateral to pubic tubercle
Hernia deifinition
- Reducible
- Irreducible
- Strangulated
Protrusion of part of a viscus through the wall containing its cavity
Reducible
- Protrusion can return to the abdominal cavity spontaneously or through manipulation
Irreducible
- Protrusion cannot be return despite pressure/ manipulation
Strangulated
- When the blood supply contents is compromised due to pressure.
Sliding hernia
- Definition
Where part of the sac in the protrusion is formed from bowel.
Maydl’s hernia
When the herniated bowel is a double loop
Littre’s hernia
A hernia sac containing Meckel’s diverticulum
Risk factors for inguinal hernia
Male (9:1)
Caucasian
Weak abdominal wall
Previous hernias
Smoking
Old age
Clinical features of inguinal hernia
Lump in the groin
- Exacerbated by straining/ coughing
- Cough have occurred after a strenuous event
Abdominal discomfort
Constipation
Complications of hernias
Incarceration
Bowel obstruction
Strangulation
Non-surgical management of inguinal hernias
If small and asymptomatic
- Watchful waiting= inform Pt to see medical attention if they develop red flag signs
Red flag signs of hernia
Abdominal pain
Nausea
Vomiting
Constipation
Abnormal colour
Management of strangulated/ incarcerated hernia
Viable bowel
- Tension free mesh repair
Strangulation
- Open surgical repair
Non-viable bowel/ contamination
- Bowel resection, non-primary tissue repair
Adjunct
- Prophylactic antibiotic
Management of a large/ symptomatic uncomplicated hernia
Open mesh repair
- Lichtenstein technique
- Under spinal, GA or LA
Adjunct- prophylactic antibiotics
Lichtenstein technique
Tension-free mesh repair method
Primary surgical method in UK
Complications
- Post-op pain
- Infection
Lap surgery for hernias
Transabdominal preperitoneal repair (TAPP)
- Access via peritoneal cavity
- Mesh is inserted through peritoneum when it is placed before closing the peritoneum
Totally extraperitoneal repair (TEP)
- Hernia site is accessed without entering the peritoneal cavity.
- Via per peritoneal plane
- More difficult than TAPP.
Femoral hernia
- Definition
- Epidemiology
- cause
Protrusion of viscus via femoral canal
F>M
- Middle age/ elderly
- Femal canal is larger in females
- 50% risk of strangulation within a month
Cause
- Increased intra-abdominal pressure
Clinical features of femoral hernia
Painless groin lump
- Neck is infer-lateral to pubic tubercle.
- Often reducible
Obstruction/ strangulation
- Tender, red and hot
- Abdo pain
- Vomiting, constipation
Femoral canal
- Contents
- Borders
The smallest, most medial compartment of the femoral sheath.
Contains lymphatic vessels and nodes.
Borders
- Anterosuperiorly= inguinal ligament
- posterior= Pectineal ligament
- Medially= lacunar liagment
- Lateral= femoral vein
Femoral sheath
Compartment in the leg containing
Lateral= femoral artery, femoral branch of genitofemoral
Intermediate= Femoral Vein
Medial= Femoral canal
-
Femoral triangle
- Borders
- Content
Compartment in the anterior upper third of thing.
- Below inguinal ligament
Borders
- Lateral= sartorius muscle
- Superior= inguinal ligament
- Medially= Adductor longus
- Floor= pectinous, adduct longus (medial), Iliopsoas (lateral)
- Rootf= fascia lata
Contents
- Femoral sheath= (lat to med) femoral artery, femoral vein, femoral canal
- Femoral nerve (Lateral)
