Herniaes Flashcards
Define a hernia?
A protrusion of an viscera through its surrounding wall.
Define the following terms:
- reducible/irreducible
- incarcerated
- strangulated
- sliding
Reducible/Irreducible: can you push it back in
Incarcerated: contents are stuck to the sack and therefore may become obstructed
Strangulated: an irreducible hernia with its blood supply cut off, patient will be in pain and unwell due to lactate build up.
Sliding: Referring to a hiatus hernia when its slides up through the oesophageal aperture.
Describe the risk factors of developing a hernia?
Weakness of a wall: Pregnancy Surgery Obesity Age Male
Raised Intra-abdominal pressure: Pregnancy Heavy lifting Chronic cough Constipation Mass/Ascites
How would you differentiate between a femoral or inguinal hernia?
Femoral hernias are inferolateral to pubic tubercle and are herniations through the femoral canal. They are much more common in females.
Inguinal hernias are superolateral to the pubic tubercle and are herniations through the deep ring or both deep and superficial ring. Occur in males.
What are the different types of inguinal hernias? Outline the boundaries of Hasselbachs triangle.
Direct and indirect.
Direct goes directly through the abdominal wall through the superficial inguinal ring (essentially a small hole in the internal oblique) which is found within hasslebachs triangle.* More common.
Indirect goes through both the deep ring and then the superficial ring.
Hasslebachs triangle’s borders are:
Medial border: Lateral margin of the rectus sheath
Superolateral border: Inferior epigastric vessels
Inferior border: Inguinal ligament
How can you tell differentiate between a direct and indirect inguinal hernia?
Ask patient to reduce the hernia.
Press on the deep ring and ask the patient to cough:
If it reappears = direct hernia
If it doesn’t = indirect hernia
If the hernia goes into the scrotum it is indirect.
Describe the locations of an incisional, epigastric and umbilical hernia?
Incisional are in any areas of previous surgery, tends to be bigger the scar the greater risk of a hernia.
Epigastric is in the epigastric region it is a peas sized swelling.
Umbilical from the umbilicus, usually are congenital as there is weakness from the umbilical cord. Can also occur in raised intra-abdominal pressure (ascites)
How should you describe any lump?
4 Students 3 Teachers round the CAMP FIRE
Site
Size
Shape
Surface
Tenderness
Temp
Transillumination
Consistency/colour
Appearance of pt
Mobility
Pulsatile
Fluctuence
Irreducible
Regional lymph nodes
Edges
Describe what causes an epigastric hernia?
It is caused by a defect in the linea alba (ligamentous band in the centre of the rectus abdominus)
What is divarication of the recti?
It is when there is weakness in the linea alba causing there to be a split between the 2 sides of the rectus abdominus.
Does not require surgery as there is no risk of any complications such as obstruction or strangulation.
Describe the management of obstructed or strangulated hernias?
Emergency surgery as there is risk of bowel necrosis and perforation.
Describe how an inguinal hernia may present on examination?
Above inguinal ligament.
Cough impulse.
May be reducible.
Describe how an femoral hernia may present on examination?
Below inguinal ligament and lateral to the pubic tubercle.
Cough impulse.
Less likely to reduce.
Describe how a lipoma may present on examination?
Mobile, soft and superficial.
Well demarcated.
Non tender.
Describe how lympadenopathy may present on examination?
Multiple lumps.
Rubbery and mobile.
Reactive:
- tender
- infection in legs or genital skin
Cancer:
- non tender
- multiple
- causes melanoma of the genital/anal/leg skin
Describe how a sebaceous cysts may present on examination?
Enlargement of a hair follicle.
Superficial.
May see a hair follicle.
If squeezed sebum may come out.
Describe how an abscess may present on examination?
Red hot tender lump. (may be an infected sebaceous cyst)
Describe how a saphena varix may present on examination?
Dilation of the saphenous vein at the junction with the femoral vein.
Lump at the top of the groin.
May appear bluish.
Disappears when the patient is lying down.
Describe how a femoral aa pseudoaneurysm may present on examination?
Damage to an aa which can cause bleeding a clot forms but blood keeps flowing due to the defect keeping it present.
Red inflamed swelling.
May be tender.
Pulsatile.
Name some differentials for a lump in the groin
Inguinal hernia, femoral hernia, lipoma, femoral aa aneurysm, saphenous ovarix, psoas abscess, lymph node, undescended testis
Describe the boundaries of the femoral triangle
Laterally: Satorius muscle
Medially: Abductus longus
Superiorly: Inguinal ligament
Which hernia are the most common in both males and females
Inguinal hernia.
Femoral hernias are more common in females than males but overall inguinal hernias happen more therefore are the most common type of hernia in females.
