Hernias Flashcards
What is the classical surgical definition of a hernia?
The protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it.
What are the risk factors for abdominal wall hernias?
Obesity, ascites, increasing age, surgical wounds.
What are the common features of abdominal wall hernias?
Palpable lump, cough impulse, pain, obstruction, strangulation.
Which type of hernia accounts for 75% of abdominal wall hernias?
Inguinal hernia
Around 95% of patients are male; men have around a 25% lifetime risk of developing an inguinal hernia.
Where is an inguinal hernia located?
Above and medial to the pubic tubercle.
What is the risk of strangulation in inguinal hernias?
Strangulation is rare.
Where is a femoral hernia located?
Below and lateral to the pubic tubercle.
Who is more likely to develop a femoral hernia?
More common in women, particularly multiparous ones.
What is the risk associated with femoral hernias?
High risk of obstruction and strangulation.
What characterizes an umbilical hernia?
Symmetrical bulge under the umbilicus.
What characterizes a paraumbilical hernia?
Asymmetrical bulge - half the sac is covered by skin of the abdomen directly above or below the umbilicus.
What is an epigastric hernia?
Lump in the midline between umbilicus and the xiphisternum.
What are the risk factors for an epigastric hernia?
Extensive physical training or coughing (from lung diseases), obesity.
What is an incisional hernia?
May occur in up to 10% of abdominal operations.
What is a Spigelian hernia?
Also known as lateral ventral hernia, rare and seen in older patients.
What characterizes an obturator hernia?
A hernia which passes through the obturator foramen, more common in females.
What is a Richter hernia?
A rare type of hernia where only the antimesenteric border of the bowel herniates through the fascial defect.
How can Richter’s hernia present?
Can present with strangulation without symptoms of obstruction.
What is a congenital inguinal hernia?
Indirect hernias resulting from a patent processus vaginalis.
How common are congenital inguinal hernias in term babies?
Occur in around 1% of term babies, more common in premature babies and boys.
What is the typical presentation of infantile umbilical hernia?
Symmetrical bulge under the umbilicus.
What is the prognosis for infantile umbilical hernias?
The vast majority resolve without intervention before the age of 4-5 years.
What is a femoral hernia?
A femoral hernia occurs when a section of the bowel or any other part of the abdominal viscera passes into the femoral canal.
Where is the femoral canal located?
The femoral canal is usually a densely packed area of the anterior thigh, but it is a potential space that can become occupied by herniated contents via the femoral ring.
What are the key features of a femoral hernia?
A lump within the groin that is usually mildly painful; it is inferolateral to the pubic tubercle and typically non-reducible.
How does a femoral hernia differ from an inguinal hernia?
Femoral hernias are inferolateral to the pubic tubercle, while inguinal hernias are supermedial to the pubic tubercle.
What is the epidemiology of femoral hernias?
Femoral hernias are much less common than inguinal hernias (only 5% of abdominal hernias) and are more common in women (M:F 1:3).
Why are femoral hernias more common in multiparous women?
The effects of increased abdominal pressure in pregnancy mean that femoral hernias are more common in multiparous women compared to nulliparous women.
How is a femoral hernia diagnosed?
Diagnosis is usually clinical, although ultrasound is an option.
What are important differentials to exclude for femoral hernias?
Lymphadenopathy, abscess, femoral artery aneurysm, hydrocoele or varicocele in males, lipoma, inguinal hernia.
What are the complications of femoral hernias?
Complications include incarceration, strangulation, bowel obstruction, and bowel ischaemia.
What is the risk associated with femoral hernias?
The risk of strangulation is much higher with femoral hernias than inguinal hernias and increases with time from diagnosis.
What is the management for femoral hernias?
Surgical repair is necessary, either laparoscopically or via laparotomy; hernia support belts/trusses should not be used.
What should be done in an emergency situation for femoral hernias?
In an emergency situation, a laparotomy may be the only option.
What percentage of abdominal wall hernias are inguinal hernias?
Inguinal hernias account for 75% of abdominal wall hernias.
What is the lifetime risk of developing an inguinal hernia in men?
Men have around a 25% lifetime risk of developing an inguinal hernia.
What are the common features of an inguinal hernia?
Common features include a groin lump, superior and medial to the pubic tubercle, which disappears on pressure or when the patient lies down, and discomfort or ache that is often worse with activity.
Is severe pain common in inguinal hernias?
Severe pain is uncommon.
Is strangulation common in inguinal hernias?
Strangulation is rare.
What is the current clinical consensus on treating inguinal hernias?
The consensus is to treat medically fit patients even if they are asymptomatic.
What is a hernia truss?
A hernia truss may be an option for patients not fit for surgery but probably has little role in other patients.
What type of repair is associated with the lowest recurrence rate for inguinal hernias?
Mesh repair is associated with the lowest recurrence rate.
How are unilateral inguinal hernias generally repaired?
Unilateral inguinal hernias are generally repaired with an open approach.
How are bilateral and recurrent inguinal hernias generally repaired?
Bilateral and recurrent inguinal hernias are generally repaired laparoscopically.
What is the recommended return to work time after an open repair of an inguinal hernia?
Patients are recommended to return to non-manual work after 2-3 weeks.
What is the recommended return to work time after a laparoscopic repair of an inguinal hernia?
Patients are recommended to return to non-manual work after 1-2 weeks.
What are early complications of inguinal hernia repair?
Early complications include bruising and wound infection.
What are late complications of inguinal hernia repair?
Late complications include chronic pain and recurrence.
What is an inguinal hernia?
An inguinal hernia is the protrusion of viscera or abdominal contents through the superficial inguinal ring.
What typically makes up the viscera in an inguinal hernia?
The viscera is normally made up of some small bowel, but not always.
How can inguinal hernias enter the inguinal canal?
Inguinal hernias can enter the inguinal canal either directly through the deep inguinal ring or indirectly through the posterior wall.
What does it mean for a hernia to be reducible?
A reducible hernia means that the herniated tissue can be pushed back into place in the abdomen through the defect using a hand.
What is an incarcerated hernia?
An incarcerated hernia is one that cannot be reduced and is at risk of strangulation.
What are the characteristics of incarcerated hernias?
Incarcerated hernias are typically painless.
What is strangulation in the context of hernias?
Strangulation is a surgical emergency where the blood supply to the herniated tissue is compromised, leading to ischemia or necrosis.
What is the risk associated with strangulation of inguinal hernias?
Impaired blood flow can cause bowel tissue to be permanently lost or to perforate.
How common is strangulation in inguinal hernias?
Strangulation occurs in around 1 in 500 cases of all inguinal hernias.
What are indications that a hernia is at risk of strangulation?
Indications include episodes of pain in a hernia that was previously asymptomatic and irreducible hernias.
What are the symptoms of strangulated hernias?
Symptoms include pain, fever, increase in size of the hernia or erythema of the overlying skin, peritonitic features, bowel obstruction, and bowel ischemia.
What imaging techniques can be used for suspected strangulation?
Imaging can include abdominal X-ray or CT, especially if obstruction is suspected.
What laboratory tests can help in diagnosing strangulated hernias?
A full blood count and arterial blood gas analysis can show leukocytosis and raised lactate.
What is the recommended repair method for strangulated hernias?
Repair involves immediate surgery, either from an open or laparoscopic approach with a mesh technique.
What should not be done while waiting for surgery for strangulated hernias?
It is not recommended to manually reduce strangulated hernias, as this can cause more generalized peritonitis.
Types of abdominal wall hernias, and details
Abdominal wall hernias in children
