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
What is an incisional hernia?
Site of incision from previous surgery due to weakness of muscles and tissues closed after surgery
Bigger the incision, the higher the risk of a hernia forming
What is a spigelian hernia?
Occurs between the lateral border of the rectus abdominis and the linea semilunaris
This is the site of the spigelian fascia (an aponeurosis between the muscles of the abdominal wall)
Narrower base, higher risk of strangulation
What is a diastasis recti?
Widening of the linea alba forming a larger gap between rectus muscles
Most prominent when patient lies on their back and lifts their head
Protruding bulge along middle of abdomen
What is an obturator hernia?
Abdominal or pelvic contents herniate through the obturator foramen
More common in
- Women
- Older age
- Multiparity and vaginal delivery
Can irritate the obturator nerve
What is a Howship-Romberg sign?
Pain extending the inner thigh to the knee when the hip is internally rotated due to obturator nerve compression
What is a hiatus hernia?
Herniation of the stomach through the hiatus of the diaphragm
What are the 4 types of hiatus hernia?
Type 1
Sliding
Type 2
Rolling
Type 3
Combination of sliding and rolling
Type 4
Large opening with additional abdominal contents entering thorax
What is a sliding hiatus hernia?
Stomach slides up through diaphragm into thorax
What is a rolling hiatus hernia?
Separate portion of stomach e.g. fundus folds around enters hiatus alongside oesophagus
What is a type 4 hiatus hernia?
Large hernia that lets other organs through e.g. pancreas or omentum
What are the key risk factors of hiatus hernias?
Increasing age
Obesity
Pregnancy
What symptoms do patients with hiatus hernias present with?
Heartburn
Reflux
Food reflux
Burping
Bloating
Halitosis
What may hiatus hernias be seen on?
CXR
CT scans
GI endoscopy
Barium swallow testing
What is the surgical management of hiatus hernias?
Fundoplication
