Hernias Flashcards
What is a direct inguinal hernia?
A hernia that occurs due to a weakness in the abdominal wall
Where does a direct inguinal hernia protude through?
Hasselbach’s triangle
What are the borders of hasselbach’s triangle?
Lateral edge of rectus abdominus
Inferior epigastric vessels (superiorly)
Inguinal ligament (inferiorly)
What is an indirect inguinal hernia?
An inguinal hernia that protrudes through the deep inguinal ring
What populations are indirect and direct hernias typically seen in?
Indirect - young males, as they are typically congenital
Direct - older males, due to abdominal wall laxity, or conditions that increase intra-abdominal pressure
What are the risk factors for developing an inguinal hernia?
Male
Increasing age
Raised intra-abdominal pressure (chronic cough, chronic constipation, heavy lifting)
High BMI
What are the features of an inguinal hernia?
Groin swelling
Pain
Palpable mass
What features should be assessed on examination of a groin lump?
Cough impulse
Location
Reducibility
If in the scrotum - is it separate from the testes
How can a direct hernia be differentiated from an indirect hernia?
A direct hernia is indicated by protusion despite occlusion of the deep inguinal ring
If there is no protusion on occlusion of the deep inguinal ring, it is likely an indirect hernia
Where is the deep inguinal ring found?
At the midpoint of the inguinal ligament (between ASIS and pubic symphysis)
What investiagations may be performed for a suspected inguinal hernia?
WCC - may be raised if there is strangulation
Blood gas - raised lactate
Ultrasound (first choice of imaging)
CT
Abdominal X-ray if obstruction suspected
Where would a femoral hernia be located?
Groin - below and lateral to the pubic tubercle
What is the management of a strangulated hernia?
Urgent surgical repair
IV antibiotics
