hernias Flashcards
typical features of abdominal wall hernia
- soft lump protruding
- lump may be reducible
- lump may protrude on coughing or standing
- aching, pulling or dragging sensation
3 key complications of hernias
incarceration
obstruction
strangulation
3 key complications of hernias - incarceration
hernia is irreducible and bowel is trapped in herniated position
incarceration can lead to obstruction and strangulation of the hernia
3 key complications of hernias - obstruction
hernia causes blockage of faeces through bowel
3 key complications of hernias - stranglulation
hernia is non-reducible and base of hernia becomes so tight it cuts of blood supply, causing ischaemia
surgical emergency - bowel will die as well as mechanical obstruction
what feature of hernia to always comment on when assessing
size of neck/defect –>narrow or wide
wide at lower risk of complications
assessing this helps formulate risk assessment and Mx plan
Richter’s hernia
only part of bowel wall and lumen herniate through defect ,
with other side of section of bowel remaining in peritoneal cavity
can become strangulated and progress quickly to ischameia and necrosis
should be operaed on immediately
Maydl’s Hernia
two different loops of bowel are contained within the hernia
General Mx options - conservative management
leaving hernia alone
most appropriate when hernia has a wide neck and in patients which are not good surgical candidates
General Mx options - tension free repair
place mesh over defect and suture it to muscles and tissue on either side of defects
General Mx options - tension repair
suture muscles and tissue on either side of defect back together
rarely done - been largely replaced by tension free repairs
indirect inguinal hernia
bowel herniates through inguinal canal
differential diagnoses for lump in inguinal region
inguinal hernia femoral hernia lymph node saphena varix femoral aneurysm abscess undescended testis
how can indirect inguinal hernias be differentiated from direct inguinal hernia
when indirect hernia is reduced and pressure applied to deep inguinal ring the hernia will remain reduced
direct inguinal hernia
due to weakness in abdo wall at Hesselbach’s triangle
hernia protrudes directly through abdo wall
pressure over deep inguinal ring will not stop herniation
Hesselbach’s triangle boundaries
rectus abdominis muscle
inferior epigastric vessels
inguinal ligament
femoral hernias
herniation of abdo contents through femoral canal
occurs below inguinal ligamant
femoral hernias are at high risk of
incarceration
obsctruction
strangulation
due to narrow femoral ring
incisional hernias
occur at site of incision from prev surgery
due to weakness where muscles and tissues were closed after surgical incision
Spigelian Hernia
occurs between lateral border of rectus abdominis and linea semilunaris
USS for diagnosis
Obturator hernias
where abdo or pelvic contents herniate through obturator foramen
due to defect in pelvic floor
Obturator hernias presentation
irritation to obturator nerve: pain in groin or medial thigh
Hiatus hernia
herniation of stomach up through diaphragm
hiatus hernia type 1
sliding
hiatus hernia type 2
rolling
hiatus hernia type 3
combo of sliding and rolling
hiatus hernia type 4
large with additional abdo organs entering thorax
sliding hiatus hernia
stomach slides up through diaphragm with gastro-oesophageal junction passing up into thorax
rolling hiatus hernia
separate portion of stomach e.g. fundus folds around and enters through diaphragm
hiatus hernia presenation
dyspepsia heart burn reflux burping bloating
hiatus hernia Mx
conservatie with medical Mx of GORD
surgery - Nissen fundoplication
