Hernias Flashcards
What is a hernia?
A protrusion of an organ/organ fascia through the wall of the cavity in which it is contained.
What does the ‘neck’ of a hernia refer to?
Point of protrusion through the defect
- diameter of neck dictates severity & risk of strangulation
What is the difference between reducible & irreducible hernias?
Reducible - (incarcerated) no risk of ischaemia, can push back in
Irreducible - (strangulated) far more serious, strangled by neck, blood supply threatened = ischaemic bowel
What is the typical profile of an inguinal hernia?
- elderly M; hx heavy lifting
- reducible lump
- above & medial to PT
Differentiate between a direct & indirect inguinal hernia.
Direct - medial to inferior epigastric artery
- through abdominal wall
Indirect - lateral to IEA
- through superficial to deep inguinal ring
What is a patent processus vaginalis?
PPV - communication between peritoneum & scrotum (congenital defect)
- felt as a scrotal lump like an indirect hernia but cannot get above it as connected into abdomen
What is the cough impulse?
Reduce hernia, ask patient to cough.
- reduced at MPIL, will reappear elsewhere (+)
+ve = indirect hernia
How would a femoral hernia present?
- multiparous F
- below & lateral to PT
- painful, irreducible (sequelae common)
- narrow neck req emergency surgery
What is a differential of a femoral hernia?
Sapheno varix
What is an incisional hernia?
Protrusion through iatrogenic weakness - 10% abdominal ops
Risk - nutritional, obesity, steroids, cough
- oft have wide neck so strangulation rare
What is a hernia truss?
Conservative alternative to hernia surgery - belt worn over hernia to keep it reduced & to relieve discomfort
(especially with incisional as healing & while strengthening abdo wall muscles)
What is Littré’s hernia?
Herniation of Meckle’s diverticulum
What is Maydl’s hernia?
A W-shaped herniation (2 protrusions)
Richter’s hernia?
Rare: ante-mesenteric bowel border protrudes through fascial defect
- little risk strangulation
Difference between umbilical & paraumbilical hernias?
Umbilical - central, symmetrical
Paraumbilical - asymmetric
Where would you find an epigastric hernia?
Midline between XSP & umbilicus
Why would a COPD patient be at risk of a hernia?
Persistent cough
Spigelian hernia?
Protrusion through spigelian fascia (btw rectus abdominis & transversus abdominis)
How might an obturator hernia present?
Median paresthesia of the LL
What is Hesselbach’s triangle?
Natural weakness in groin area predisposed to herniation.
Borders:
1. Inferior epigastric vessels
2. Inguinal ligament
3. Rectus abdominis
What is the arcuate line?
Site of weakness in abdominal wall (spigelian hernias common)
IEAs perforate to supply ant abdo wall.
Above - abdominis sandwiched in internal oblique aponeurosis
Below - abdominis sandwiched btw tranversalis fascia & aponeurosis of the 3 flat side muscles
