Hernias Flashcards
Definiteion of a hernia
An abnormal protrusion of a viscus outwith its normal body cavity
What is the most common type of hernia
Inguinal
How might abdoninal wall hernias arise?
From natural opening or weak areas, caused by stretching or sirgical incision
Name some predisposing factors for abdominal hernias?
Heavy lifting Coughing Constipation Prostatism – commonly bilateral inguinal Pregnancy Obesity
What do predispising factors for abdominal hernias all have in common?
They raise the intraabdominal pressure
How can we classify hernias?
Reducible (going back in and flatten) or irreducible (may obstruct)
What happens to the contents of an irreducible hernia?
May become incarcerated or strangulated
What is strangulation and describe the appearance
It denotes compromiseof the blood supply of the contents
and its development increase morbidity and mortality
Purple looks like its going to burst
Name some of the causes of incisional hernias
Age Obesity general debiliility Post op wound infection post op haematoma raised intra abdominal pressure
What type of hernias do children get
True umbilical hernias
What type of hernias do adults get?
Para - umbilical hernia
What treatment do we give for umbilical hernias
If the defect is very small, we can put some stitches in it
More than 2cm then we need some mesh in place to firm up the area
What age group of people are prone to epigastric hernia
Teenagers - mid 20s usually males
What do we do for umbilical hernias for under 3 year olds
Leave them - they usually resolve themselves
If the child is more than 3 and the hernia has not resolved, what do we do?
Operate
What is the risk of an inguinal hernia in a child
What do we do for inguinal hernias
Obstructing or strangling the bowel
Operate in the next couple of months unless obstructing or strangling the bowel
What causes hernias in kids?
Potent Processus Vaginalis
What side is a hernia more common in?
Right
What is a Herniotomy
Where you cut off the hernia
Who is most likely to get a femoral hernia
Thin elderly female
What is the main symptom for a femoral hernia?
Loss of groin crease
Describe the anatomy of the femoral hernia
Defect through the femoral canal
below and lateral to the pubic tubercle
Usually flatten the groin crease
How much more likely is it that a female wil develop a femoral hernia?
10 times more likely
Describe the anatomy of an inguinal hernia
Above pubic tubercle - increases the groin crease
If you can feel above the scrotal swelling? what is the most likely diagnosis?
epididymal cyst
ie. not a hernia
Name 4 causes of scrotal swellings
Inguino-scrotal hernia (indirect)
hydrocoele
Epididymal cyst
Testicular swelling
How do you examine a patient for an inguinal hernia?
Examine the patient upright
Find the pubic tubercle - above and medial = inguinal.
below and lateral = femoral
Ask the patient to cough
how do you differentiate clinically between indirect and direct inguinal hernias?
Pressure over the deep inguinal ring get patient to cough
Place the little finger in the canal
How do you differentiate at operation between direct and indirect inguinal hernias?
Medial to inferior epigastric vessels = direct
Lateral to inferior epigastric vessels = indirect
Describe an indirect inguinal hernia
Lateral to the inferior epigastric vessels and with the cord
May reach to the scrotum
Congenital hernias are indirect
10 times more likely in males
Describe a direct inguinal hernia
Posterior bulge through transversalis fascia
Medial to the inferior epigastric (branch of external iliac)
Often bilateral
What type of hernia is often bilateral?
Direct inguinal hernia
Who is most likely to develop an indirect inguinal hernia?
Young men
who is most likely to develop a direct inguinal hernia
Older men
Describe digital pressure in both types of ingiunal hernias
Indirect - controlled by digital pressure over the internal ring
Direct - poorly controlled by digital pressure
When should we operate on inguinal hernias?
If there are risks of complications even with no symptoms (femoral)
previous symptoms of obstruction
If it interferes with lifestyle
Name some of the complications with inguinal hernias
Haematoma
Acute urinary retention
Wound infection
Testicular pain and atrophy
What 3 types of operations can be performed on inguinal hernias?
Suture (eg. Bassini) Open mesh (Lichtenstein) Laparoscopic (intra or extra)
When can a post op hernia patient drive again?
1 week after
When can a post op hernia patient heavy lift again?
1 month (1 hand only)
What surgical procedures can be carried out to repair a hernia
Hernioctomy (excision of peritoneal sac)
Herniorraphy (repair of the defect of the wall)
Congenital - Herniotomy
How do you consent a patient for an inguinal hernia operation
Warn them of wound infection
Placing a mesh
Recurrence rate of <5%
15% chance of neurogenic pain post op
