Hernias

Question 1

Definition

Answer 1

Protrusion of an organ through defect in its containing cavity = TYPICALLY BOWEL

Question 2

Types of hernias

Answer 2

Reducible = manually push back into space
Irreducible =
- Obstructed
- Strangulated = gangrene, infarction, death of tissue
- Incarcerated = contents are fixed in sac due to size of adhesions, no bowel obstruction or strangulation

Question 3

Inguinal

Answer 3

Definition: spermatic cord herniates through inguinal canal
Epidemiology: Male, Age
Risk factors: Raised intra-abdominal pressure, obesity
Patho:
- Direct = Hasselbecks’ triangle which is medial to inferior epigastric
- Indirect = lateral to inferior epigastric
Sx: painful swelling in groin, POINTS ALONG GROIN MARGIN +/- reducible
Dx: usually clinical, unsure = AUSS/CT/MRI
Tx: Surgical intervention

Question 4

Femoral

Answer 4

Definition: bowel comes though femoral canal
Epidemiology: Female, middle aged
Risk factors: Pregnancy, raised intra-abdominal pressure (heavy lifting, chronic constipation), increasing age
Pathophysiology: v. likely to be irreducible + strangulate due to rigid femoral canal borders
S+S: swelling in upper thigh POINTING DOWN, 30% present as emergency obstruction or strangulation
DX: Clinical + USS if unsure
Tx: Surgery

Question 5

Hiatal

Answer 5

Definition: Herniation of stomach through oesophageal aperture of diaphragm
Epidemiology: Female, Advancing age (50+)
Risk factors: Obesity, Pregnancy, Ascites, Skeletal deformities
Pathophysiology:
- Rolling = Gastro-oesophageal junction remains in abdo, part of FUNDUS ROLLS INTO THORAX
- Sliding = GOJ slides into abdo
Sx: GORD, Dysphagia, Hiccups, Vomiting and Wt loss (RARE)
Dx: CXR, Barium swallow (GS), OGD
Tx: FL = PPI, Surgical intervention

Question 6

Umbilical

Answer 6

Definition: defect in anterior abdominal wall fascia when umbilical ring fails to close = protrusion of peritoneal sac
Epidemiology: low birth weight, African, American, Trisomy 21,18,13
Sx: present since birth, bulge at umbilicus, change in size/tension during movement, intermittent discomfort
Dx: Clinical
Tx: Most will close by 4-5 years spontaneously, in case of strangulation = surgical repair

Question 7

Incisional

Answer 7

Definition: Herniation through surgical scar
Epidemiology: BMI > 25, Midline incision, emergency surgery, DM, Advanced age
Sx: reducible soft, non-tender swelling near site of surgical wound, if incarcerate will become painful, tender and erythematous
Dx: Clinical, CT (GS)
Tx: Surgery

Question 8

Epigastric

Answer 8

Definition: protrusion through linea alba above umbilical at the bottom of the sternal bone
Epidemiology: Men, Age, Increased abdo pressure: weight lifting, chronic cough
Sx: bulge in skin in the upper abdomen, pain when lifting heavy objects
Dx: Clinical
Tx: Surgery