Hernias Flashcards
Risk factors for hernias
Protein deficiencies Males Increasing age Obesity Chronic couging Constipation Lifting
Contents of inguinal Canal
Spermatic cord
Round ligament
Nerves
Anterior wall of inguinal canal
Aponeurosis of external oblique
Internal oblique
Floor of inguinal canal
Inguinal ligament
Lacunar ligament
Posterior wall of inguinal canal
Transversalis fascia
Roof of inguinal canal
Transversalis fascia
Internal oblique
Transversus abdominus
where does the deep inguinal ring lie
Just above midpoint of inguinal ligament
Where does inguinal canal lie in relation to inferior epigastric vessels
Lateral
Weakest wall in inguinal canal
Transversalis fascia
Where does the inguinal canal end
Pubic tubercle
Most common type of inguinal hernia
Indirect
fact file of direct inguinal hernias
Bowel enters inguinal canal through weakness in posterior wall (Hesselbach’s triangle)
Easily reduce and rarely strangulate
Fact file of indirect inguinal hernias
Bowel passing through the deep ring of inguinal canal due to an incomplete closure of processus vaginalis
Which inguinal hernias are more likely to strangulate
Indirect
Which inguinal hernia has more likely to exit superficial ring and pass into scrotum
Indirect
How to distinguish between indirect vs direct
Press over deep ring (just above midpoint of inguinal ligament)
Ask patient to cough
If hernia reappears it is direct
How do we know if its direct vs indirect hernia during surgery
Indirect hernias are lateral to inferior epigastric vessels
Direct hernias are medial to inferior epigastric vessels
femoral canal contents and purpose
Fatty tissue and lymph nodes
Lies medial to the femoral vein and allows it space for it to expand
What are femoral hernias
Abdominal viscera or momentum pass through femoral ring into the potential space of the femoral canal
Risk factors for femoral hernias
Female (wider pelvis)
Pregnancy
Raised intra-abdominal pressure
Age
Problem with femoral hernias
High risk of strangulation so require urgent surgical intervention
Femoral vs inguinal hernias
Inguinal- superiomedial to pubic tubercle
Femoral- Inferolateral
Why do femoral hernias pose a high strangulation risk
Due to narrow neck of the femoral canal
Epidemiology of direct vs indirect inguinal hernias
Direct- older men
Indirect- Younger men
Cause of ubilical hernia
Defect in transversalis fascia or umbilical ring
Factfile of umbilical hernia
More common in children
Low strangulation risk
Occur in adults due to pregnancy or gross ascites
Cause of paraumbilical hernia
Weakness in linea alba
More common in 25-50yo women
Usually caused by obesity or gross ascites
High risk of strangulation
What is an epigastric hernia caused by
Herniation of fat which overlies the bowel through the linea alba above the umbilicus
Who do epigastric hernias most occur in and what are the symptoms
Young males
Discomfort on exercise or eating
Relieved by reclining
What are small epigastric hernias prone to
Incarceration and strangulation
What do small epigastric hernias contain
Extraperitoneal fat
What do large epigastric hernias contain
omentum
What is divarication of recti
Separation of rectus abdomens due to linea alba laxity
Risk factors of divarication fo recti
Truncal obesity
Pregnancy
Repeated midline operations and chronically raised intra abdominal pressure
How to diagnose divarication of recti
ultrasound
When do you not have to intervene in incisional hernias
If patient is asymptomatic
