Hernias Flashcards
What are abdominal hernias?
Protrusion of a viscus or part of a viscus through a defect of the walls of its containing cavity into an abnormal position.
What are irreducible hernias?
Cannot be pushed back into place
What are obstructed hernias?
Bowel contents cannot pass
What are strangulated hernias?
Ischaemia occurs
What are incarcerated hernias?
Contents of the hernial sac e.g. bowel are stuck inside by adhesions. Care must be taken with reduction as it is possible to push an incarcerated hernia back into the abdominal cavity, giving the initial appearance of a successful reduction.
What are the different types of abdominal hernia?
Epigastric, (para)umbilical, spigelian, inguinal, femoral, lumbar, Richter’s, Maydl’s, Littre’s, sciatic, sliding and obturator.
What is the most common type of abdominal hernia?
Inguinal is most common.
What are the risk factors of abdominal hernias? (x10)
Male, chronic cough (smoking, COPD), obesity, pregnancy, constipation, urinary obstruction, heavy lifting, ascites, past abdominal surgery, connective tissue disease.
What are the symptoms of abdominal hernia?
Pain and palpable mass (made larger on standing or exercises that increase intra-abdominal pressure). Additional symptoms are associated with complications e.g. obstruction leading to nausea and vomiting.
What are the symptoms of strangulated hernias?
Always painful, tenderness, irreducible mass, symptoms associated with obstruction (N&V, fever).
What are the symptoms of obstructed hernias?
Nausea, vomiting, fever. Pain and mass.
What are the complications of abdominal hernia? (x6)
Inflammation, obstruction, strangulation, hydrocoele of the hernial sac, haemorrhage, autoimmune problems.
What are the signs of abdominal hernia on physical examination? (x3)
Palpable mass with tenderness. May be irreducible. May be covered by red/purple skin.
How are hernias managed pre-operatively? (x2)
Weight loss and stop smoking (cause of chronic cough)
How are hernias managed? (x3)
- Truss: external device to maintain hernia reduction
- Herniorrhaphy: reducing the herniated tissues and mending the weakness in the muscle tissue
- Mesh prosthesis: a polypropylene mesh reinforces the posterior wall
What are the different types of laparoscopic repair of hernias? (x2)
Transabdominal pre-peritoneal (TAPP): enter peritoneal cavity and place mesh on posterior abdominal wall; and totally extraperitoneal (TEP): peritoneal cavity is not entered and mesh is used to seal hernias from outside the peritoneum (see photo).
What are indirect and direct inguinal hernias?
Indirect pass through the internal inguinal ring and – if large – out through the external ring (see photo). Direct push their way directly forward through the posterior wall of the inguinal canal into a defect in the abdominal wall (Hesselbach’s triangle). NB: indirect can descend into scrotum; direct cannot.
What are the landmarks of Hesselbach’s triangle?
Medial to the inferior epigastric vessels and lateral to the rectus abdominus.
!!! How do the signs and symptoms of inguinal and femoral hernias compare? (x4)
- WHERE: above and medial to the pubic tubercle; below and lateral
- COUGH IMPULSE: usually present; absent
- STRANGULATION: less common; more common
- DIRECTION: points towards groin; points towards leg
!!! How do the signs and symptoms of direct and indirect inguinal hernias compare? (x3)
- WHERE: medial to epigastric vessels; lateral
- REDUCIBILITY: Reduce the hernia and occlude the deep (internal) ring with two fingers. Ask the patient to cough or stand. If the hernia is restrained, it is indirect; if not, it is direct.
- STRANGULATION: rarely strangulate; can strangulate
What are Maydl’s hernias?
Involve a herniating ‘double loop’ of bowel. Two adjacent loops of small intestine are within a hernial sac with a tight neck. The intervening portion of bowel within the abdomen is deprived of its blood supply and eventually becomes necrotic.
