Hernias Flashcards
What causes visceral pain?
Visceral stretching
Visceral inflammation
Visceral ischaemia
Describe visceral pain
What often accompanies it?
- vague/poorly defined
- often midline
- nausea, vomiting + sweating
Where is foregut visceral pain often localised to?
What dermatomes?
What nerve is it associated with?
- epigastric area
- T5-T9
- greater splanchnic nerve
Where is midgut visceral pain often localised to?
What dermatomes?
What nerve is associated with it?
- peri umbilical
- T10-T11
- lesser splanchnic nerve
Where is hindgut visceral pain often localised to?
What dermatomes?
What nerve is it associated with?
- Supra-pubic
- T12-L1/2
- least splanchnic nerve
What is a hernia?
A protrusion of a part of the abdominal contents beyond the normal confines of the abdominal wall
Signs and symptoms of hernias that are not stuck
- fullness or swelling
- gets larger when intra abdominal pressure increases
- aches
Signs and symptoms of hernias that are stuck
- pain
- cannot be moved
- nausea + vomiting
- systemic problems if bowels become ischaemic
Causes of a hernia
Weakness in the containing cavity:
- congenitally related
- post surgery with inadequately healed wounds
- normal points of weakness
Anything that increases intra-abdominal pressure:
- obesity
- weightlifting
- chronic constipation or coughing
What are the three parts of a hernia?
- the sac
- contents of the sac
- coverings of the sac
What is the inguinal canal?
Oblique passage through lower part of the abdominal wall
What happens if processus vaginalis doesn’t obliterate?
- inguinal hernia if partial obliteration
- scrotal hernias if no obliteration
What makes an inguinal hernia in the scrotum more likely?
If the processus vaginalis doesnt obliterate
What are the borders of the inguinal canal?
- anterior wall: aponeurosis of external oblique
- posterior wall: transversalis fascia (+conjoint tendon medially)
- floor: inguinal ligament (+lacunar ligament medially)
- roof: internal oblique + transverse abdominus
Borders of Hesselbachs triangle
- lateral: inferior epigastric vessels
- medial: lateral border of rectus abdominis
- inferior: inguinal ligament
