Hernias Flashcards
What is a hernia?
protrusion of abdominal contents through congenital/acquired areas of weakness in the wall
What are the main types of hernia?
- inguinal (more common)
2. femoral
What are hernias due to?
increase in intra-abdominal pressure
What can cause an increase in intra-abdominal pressure?
- Chronic cough
- Smoking causing cough
- Constipation
- Pregnancy
- Weight-lifting
- Weakened abdominal muscles
What is irreducible mean?
if they cannot be pushed back into the right place
What does incarceration mean?
contents of the hernia sac are stuck inside by adhesions
What does obstruction mean?
when bowel contents can’t pass through GI hernia
What does strangulated mean?
blood supply cut-off, so you get ischaemia of the hernia
Where are femoral hernias?
inferolateral to the pubic tubercle
Where are inguinal hernias?
superomedial to the pubic tubercle
What are inguinal hernias?
Abnormal protrusion of a peritoneal sac through a weakness of the abdominal wall in the inguinal region
What are the two types of inguinal hernias and what do they have in common?
- direct and indirect
2. both emerge at the superifical inguinal ring
What is a direct inguinal hernia?
- Protrusion of the hernial sac directly through a weakness in the posterior wall of the inguinal canal
- Through Hesselbach’s triangle
What is an indirect inguinal hernia?
Protrusion of the hernial sac through the deep inguinal ring, following the path of the inguinal canal
What are the borders of hesselbach’s triangle?
- Lateral border of rectus abdominis
- Inferior epigastric vessels
- Inguinal ligament
What is the aeitology of inguinal hernias?
- Congenital
2. Acquired - due to increased intra-abdominal pressure along with muscle and transversalis fascia weakness
What is the epid of inguinal hernias?
- Common
* x9 more common in M
What are femoral hernias?
Abdominal contents pass through a naturally occurring weakness called the femoral canal
What is the epid of femoral hernias?
- Far less common than inguinal
* More common in F
What are symptoms and signs of both hernias?
- Typically ASx, other than presence of lump in the groin
- Ask pt to cough if the hernia is not visible at first
- Check if it is irreducible
- Pain if incarcerated/strangulated
What is the placement of both types of hernias?
- Inguinal: lump extends towards genitalia (medially)
2. Femoral: lump is more lateral
What are the Ix for hernias if painful and irreducible?
- bloods (FBC, CRP, WBC)
2. imaging (CXR to check perforation), USS)
What is important with examination of hernias?
examination of hernia whilst pt is supine and then when standing
Which type of hernia is more likely to become incarcerated?
femoral are more likely to become incarcerated as they are situated in a tighter place
What is the conservative managment of hernias?
Lifestyle changes: diet if overweight, limit increase in abdo pressure
What is the management of uncomplicated hernias?
- elective repair
1. mesh repair
2. laparoscopic
What happens in a mesh repair?
hernia is surgically reduced and a mesh is inserted to reinforce the defect where the hernia protruded through
What is the management of hernias if obstructed/strangulated?
emergency laparotomy
What are possible complications of hernias?
- Incarceration
- Strangulation
- Bowel obstruction
- Surgical complications
