Herniae Flashcards
What is a herniae?
The protrusion of an organ/part of an organ through a defect in the wall of the cavity containing it, into an abnormal position
Define reducible
The contents of the hernia can be completely replaced into the cavity
Define irreducible
The contents of the hernia cannot be completely replaced into the cavity
Define obstructed
Bowel contents cannot pass through the herniated bowel
Define strangulated
There is ischaemic of the contents of the hernia, which unless relieved will lead to gangrene and perforation
Define incarcerated
The contents of the hernia sac are stuck inside by adhesions
What is a direct inguinal hernia?
1/3 inguinal hernia
Acquired
Contents pass through a weakness of the anterior abdominal wall in the inguinal triangle
What is an indirect inguinal hernia?
2/3 inguinal hernia
Congenital
Contents pass through the inguinal canal due to a patent processus vaginalis
Where do indirect inguinal hernias exit the superficial ring?
Inside the cord - often pass into scrotum/labia majorus
Where do direct inguinal hernias exit the superficial ring?
Lateral to the cord
What factors predispose to the development of inguinal hernias?
Patent processus vaginalis (indirect) Chronic cough Straining at micturition/defecation Heavy lifting Smoking
What are the signs of bowel obstruction in a hernia?
Tinkling bowel sounds
Constipation
Build up of faecal matter
Which inguinal herniae are more likely to strangulate?
Indirect inguinal herniae
Which inguinal herniae are covered by the spermatic fascia?
Indirect inguinal herniae
What is a femoral herniae?
Herniation of viscus through the femoral canal
What are the symptoms of a femoral herniae?
50% present as a surgical emergency - obstruction
50% present as a globular lump inferolateral to the pubic tubercle
Cough impulse often absent
What is an umbilical herniae?
Hernia present at the umbilicus
What are the two main types of umbilical herniae?
True umbilical herniae
Paraumbilical herniae
Describe a true umbilical herniae
Occur in 3% of live births Result of a defect in the transversalis fascia at the umbilical ring - incomplete closure of the umbilical cicatrix Covered by skin Generally asymptomatic 90% retract by 2 yrs
Describe a paraumbilical herniae
Acquired herniae above/below umbilicus
Caused by raised IAP
Managed early w/ Mayo’s operation
What are the symptoms of a true umbilical herniae?
Generally asymptomatic
Rarely strangulate/obstruct
What are the symptoms of a paraumbilical herniae?
Localised dragging pain Enlarging herniae over time Tender w/ colic from intermittent obstruction Often reducible Commonly strangulate/obstruct
What are the signs of strangulation?
Nausea/vomiting Fever Sudden pain Change in colour of hernia Inability to pass stool/gas
What are incisional herniae?
Herniae arising due to a weakness in the abdominal wall post surgery
