Hernias Flashcards
What is a femoral hernia?
Intra-abdominal contents herniate into the femoral canal through the femoral ring
List 5 risk factors for femoral hernias
Female (3:1)
Age
Obesity
Multiparity
Increased intra-abdominal pressure e.g. chronic constipation, cough, straining during micturition
Describe the epidemiology of femoral hernias
Much LESS common than inguinal
but more likely to get incarcerated as are situated in a tighter place
F > M
Account for 5% of abdominal hernias
Describe presentation of a femoral hernia
Globular lump in the groin
Enlarges with coughing
Clinical dx
Location of femoral hernias
INFEROLATERAL to pubic tubercle
What investigation may be used for femoral or inguinal hernias if there is diagnostic uncertainty?
US
(difficult to palpate in obese)
Describe the management of non-complicated femoral hernias
Refer due to high risk of strangulation (50% strangulate within a month)
Elective surgical repair with mesh hernioplasty
Describe management of complicated femoral hernias
Herniorrhaphy (non-mesh repair)
Name 4 complications of hernias
Pain
Incarceration
Strangulation
Bowel obstruction
Define hernial incarceration
Irreducible
Define hernial strangulation
Ischaemic necrosis of contents of hernial sac as blood supply compromised by incarceration
In which type of hernia is there greater risk of strangulation?
Femoral
Describe presentation of strangulated hernia
Tender, irreducible, warm hernia
Systemic Sx
Features of bowel obstruction
Severe pain
Describe management of strangulated hernias
DO NOT attempt to reduce
Laparotomy
What is the most common type of hernia?
Inguinal
How are inguinal hernias diagnosed?
CLINICAL DIAGNOSIS
What is an inguinal hernia?
Protrusion of intra-abdominal contents through inguinal canal
What is a direct inguinal hernia?
protrusion directly through the POSTERIOR WALL of the inguinal canal
ACQURIED
What is an indirect inguinal hernia?
Protrusion THROUGH the DEEP inguinal RING, following the path of the inguinal canal
usually congenital
What is the most common type of inguinal hernia?
Indirect
Describe the aetiology of inguinal hernias
Congenital: abdo contents enter the inguinal canal through a patent processus vaginalis
Acquired: increased intra-abdo pressure + weakness of abdo muscles
Describe the location of direct inguinal hernias
Within Hesselbach triangle
Medial to inferior epigastric blood vessels + lateral to the rectus
Describe the location of indirect inguinal hernias
Outside Hesselbach triangle
Lateral to inferior epigastric blood vessels
List 5 risk factors for inguinal hernias
Male
Prematurity
Age
Obesity
Heavy lifting
Describe the epidemiology of inguinal hernias
COMMON
Peak age in adults: 55-85y
M > F
How may inguinal hernias present?
Groin lump
Increases in size on coughing/ straining
Decreases when lying
Discomfort + ache (severe pain uncommon)
How do you distinguish between direct and indirect inguinal hernias?
Reduce the hernia + occlude the deep internal ring with 2 fingers.
Ask patient to cough/ stand.
If hernia is restrained= indirect.
If protrudes= direct
Describe management of uncomplicated inguinal hernias
Elective repair:
Hernioplasty (mesh repair)
Herniorrhaphy (non-mesh repair)
When is emergency surgery performed for inguinal hernias?
If obstructed or strangulated
Laparotomy with bowel resection may be indicated if bowel is gangrenous
What is the term used for presence of co-existing direct and indirect inguinal hernias?
pantaloon hernia
How do you differentiate between inguinal and femoral hernias?
Inguinal: superior + medial to pubic tubercle
Femoral: inferior + lateral to pubic tubercle (+ medial to femoral pulse)
Describe the anatomy of the inguinal ligament. What runs within the ligament?
Runs between ASIS + pubic tubercle.
Inguinal canal
What passes through the inguinal canal?
Ilioinguinal nerve
+
Males: spermatic cord
Females: round ligament
Describe the anatomy of the deep and superficial rings within the inguinal canal
Deep (entry): just above midpoint of inguinal ligament
Superficial (exit): just above + medial to pubic tubercle
What is an irreducible hernia?
Can’t be pushed back into place
What is a hernia?
protrusion of a viscus through a defect of the walls of its containing cavity into an abnormal space
What is an obstructed hernia?
Bowel contents can’t pass through the no longer patent, compressed bowel lumen
What is a strangulated hernia?
Compression around the hernia prevents blood flow into the hernial contents causing ischaemia to the tissues within
What is a reducible hernia?
Contents of hernia can be manipulated back into its original position through the defect from which it emerges
