Hernias Flashcards
What are the typical features of an abdominal wall hernia?
Soft lump protruding
Reducible lump
Lump protrudes on raised intra-abdominal pressure
Aching, pulling or dragging sensation
What is incarceration of a hernia?
Hernia cannot be reduced back into proper position
Bowel is trapped in herniated position
What is obstruction of a hernia?
Hernia causes a blockage in the passage of faeces through the bowel
What is strangulation of a hernia?
Non-reducible hernia, blood supply is cut off causing ischaemia
Bowel will die quickly- emergency
What is a Richter’s hernia?
Can occur in any abdominal hernia
Only part of the bowel wall and lumen herniate through defect
Other side of bowel remains in peritoneal cavity
Can become strangulated
Why do you operate immediately on a Richter’s hernia?
Can progress very rapidly to ischaemia and necrosis
What is a Maydl’s hernia?
Two different loops of bowel contained in the same hernia
What are the general management options of abdominal wall hernias?
Conservative management
Leaving hernia alone, most appropriate with wide neck hernia
Tension-free repair
Mesh over defect in abdominal wall, mesh sutured to muscles and tissues on either side
Tension repair
Operation to suture muscles and tissue on either side of defect back together
High recurrence rate
What are the differential diagnoses for a lump in the inguinal region?
Femoral hernia
Lymph node
Saphena varix (dilation of saphenous vein at junction with femoral vein in groin)
Femoral pseudoaneurysm- not a true aneurysm
Abscess
Undescended testes
Kidney transplant
What happens in an indirect inguinal hernia?
Bowel herniates through inguinal canal
What specific finding will help you differentiate an indirect inguinal hernia from a direct?
Indirect hernia is reduced and pressure is applied to the deep inguinal ring the hernia remains reduced
What happens in a direct inguinal hernia?
Passes through Hesselbach’s triangle
Lateral rectus abdominis
Inferior epigastric vessels
Inguinal ligament
What is a femoral hernia?
Herniation of abdominal contents through the femoral canal
What is the opening between the peritoneal cavity and femoral canal called?
Femoral ring
What are the borders of the femoral canal?
Femoral vein
-laterally
Lacunar ligament
-medially
Inguinal ligament
-anteriorly
Pectineal ligament
-posteriorly