Hernias Flashcards
What is the definition of a hernia?
The protrusion of a viscus or part of a viscus through a defect of the wall or its containing cavity into an abnormal position.
What type of hernia is this describing?
Contents cannot be pushed back into place.
Irreducible
What type of hernia is this describing?
Bowel contents cannot pass - features of intestinal obstruction.
Obstructed
What type of hernia is this describing?
Ischaemia occurs - patient requires urgent surgery.
Strangulated
What type of hernia is this describing?
Contents of hernia sac are stuck inside by adhesions.
Incarcerated
What is the most common type of hernia?
Indirect inguinal hernia
What type of hernia can most easily strangulate?
Indirect inguinal hernia
What type of hernia reduces easily and rarely strangulates?
Direct inguinal hernia
What type of hernia is more common in females, is irreducible and can easily strangulate?
Femoral hernia
Where are inguinal hernias located relative to the pubic tubercle?
Superior and medial
What are the risk factors for developing an inguinal henria?
Male, chronic cough, constipation, urinary obstruction, heavy lifting, ascites, past abdominal surgery.
Where is the deep inguinal ring located?
Mid-inguinal point (ASIS to pubic tubercle)
Where is the superficial inguinal ring located?
Just superior-medial to the pubic tubercle.
What is the route of an indirect inguinal hernia?
Pass through the internal inguinal ring and, if large enough, out through the external ring.
What is the route of a direct inguinal hernia?
Push through directly forwards through posterior wall of the inguinal canal, into a defect in the abdominal wall (Hesselbach’s triangle).
How can you distinguish a direct from an indirect inguinal hernia?
- With patient sitting, reduce hernia and occlude deep inguinal ring with two fingers.
- Ask patient to cough
- If the hernia is restrained, it is indirect, if not, it is direct.
- Repeat exam when patient is standing.
What is the management for an inguinal hernia?
- Weight loss if overweight and stop smoking pre-op.
2. Mesh techniques are mainstay - reinforce posterior wall of canal.
Where are femoral hernias located in relation to the pubic tubercle?
Inferior and lateral
What is the difference between inguinal and femoral hernias in which direction they point?
- Inguinal - towards groin
2. Femoral - down leg
What are the borders of the femoral triangle?
Inguinal ligament, sartorius (medial border), and adductor longus (medial border).
What is the path of a femoral hernia and how does it present?
- Bowel enters femoral canal.
2. Mass in the upper medial thigh or above the inguinal ligament.
What are the differentials for a femoral hernia and how do you differentiate?
- Inguinal hernia
- Saphnea varix - disappears when lying, blue tinge
- Enlarges Cloquet’s node - infection, metastases from anus/vulva.
- Lipoma
- Femoral aneurysm - pulsing
What is the treatment for a femoral hernia?
Surgical repair
