Hernias Flashcards
Define a hernia
An abnormal protrusion of a viscus outwith its normal body cavity
Predisposing factors to abdominal hernias
heavy lifting coughing constipation pregnancy obesity type 2 collagen deficiency prostatism (bilateral direct inguinal hernia)
Hernias can be…
reducible or irreducible
What is an incarcerated irreducible hernia?
useless but not affecting bowel within hernial sac
A hernia described as strangulated, means what?
denotes compromise of the blood supply of the contents of the hernial sac
It’s development increases morbidity and mortality
low pressure venous system is occluded first, then the arterial supply becomes occluded and gengrene develops
An obstructed irreducible hernia gives what?
Pain
Causes of an incisional hernia
created as a result of an incision
age, obesity, genral debility, post-op wound infection or haemotoma and increased intra-abdominal pressure can lead to an incisional hernia
If a pt is predisposed to an incisional hernia, what should be used?
tension sutures and “mass closure” of the linea alba
How do umbilical and paraumbilical hernias differ?
umbilical - kids outty belly button, usually resolves by 3years - if not then surgery
paraumbilical - adult and obese
What does an epigastric hernia arise from?
congenital weakness in the linea alba
What does an epigastric hernia usually contain?
extraperitoneal fat
Are epigastric hernias more common in males or females? What is the ratio?
Males: females 3:1
How are epigastric hernias repaired?
sutures or mesh
What predisposes a child to a paediatric inguinal hernia?
patent processus vaginalis (PPV) [normally closes off when testicles drop]
more common in pre-term and LBW babies
Are paediatric inguinal hernias more common in males or females? ratio?
Males, 9:1
Does having a paediatric inguinal hernia increase the chance of anything?
20% chance of developing a conralateral hernia
Can paediatric inguinal hernia become strangulated?
Yes, high risk of strangulation and must be operated on urgently (<24hours) if this develops
What is a femoral hernia?
Defect though the femoral canal
Where is a femoral hernia?
Below and lateral to pubic tubercle
usually flattens the groin crease
Are femoral hernias more common in males or females?
females, 10:1
Where are inguinal hernias?
Above and medial to the pubic tubercle
increase groin crease
Could be Inguino-scrotal – goes into scrotum - indirect
How can you determine if an inguinal hernia is direct or indirect?
pressure over deep inguinal ring and ask patient to cough
if pops out then direct inguinal hernia
What is a direct inguinal hernia?
- posterior buldge through the transversalis fascia
- it is medial to inferior epigastric vessels
- often bilateral
- more common in older men
Who is most likely to suffer a femoral hernia? (obstructing irreducible)
Thin elderly female with small bowel obstruction
Scrotal swellings - can you get above the swelling?
yes - primary swelling from scrotum
no - hernia
Scrotal swellings - can you feel the testes separate?
Yes - epididimal cyst
No - hydrocele
What is an indirect inguinal hernia?
- Lateral to inferior epigastric vessels and with the cord
- May reach to the scrotum (inguino-scrotal)
- Congenital hernias are indirect (ppv)
- M/F ratio 10/1 (esp young men)
Inguinal hernias should be operated when..?
- hernia at risk of complications
- hernia with previous symptoms of obstruction
- hernia interfering with lifestyle
Complications of an inguinal hernia
- Haematoma (wound or scrotum)
- Acute urinary retention
- Wound infection (~5%)
- Chronic neurogenic pain (15-30%)
- Hernia Recurrence (ideal <5%)
- Testicular pain and atrophy
Types of operations for inguinal hernias
- Suture
- Open Mesh
- Laparoscopic: Intraperitoneal (TAPS)
Extraperitoneal (TEPS)
What shouldn’t a patient post-op inguinal hernia do?
drive for about a week
heavy lift for one month (1 hand lift only)
to let mesh get fibrosed in
When consenting a patient for inguinal hernia repair, what should they be told about?
- Wound infection/haematoma (<5%
- 15% chance of neurogenic pain post-op
