Hernias Flashcards
What is a hernia?
A hernia is a protrusion of an organ through a hole in the wall of the cavity that usually contains it.
What is an irreducible hernia?
The hernia can’t be pushed back to where its supposed to be
What do we mean by the term ‘incarcerated’ hernia?
The contents of the hernia sac are stuck inside it by adhesions
What is meant by the term ‘obstructed’?
The contents of the bowel is prevented from passing along the bowel as an obstruction has occurred as a result of the hernia
What do we mean by ‘strangulated’ hernia? What are the consequences of this type of herniation?
Ischaemia of the tissue inside the hernia occurs. This patient will become toxic and requires urgent surgery. Strangulation can lead to herniation!
Note that with a strangulated hernia, it is possible to push the strangulation back inside where it has come from, and thus give the appearance of a successful reduction, but in actual fact, you have not de-strangulated the hernia.
What are inguinal hernias more common in men?
In men, the deep and superficial inguinal rings and the canal are larger.
Indirect inguinal hernias account for 80% of inguinal hernias. What is the difference between a direct and indirect one?
Indirect inguinal hernias come through the deep inguinal ring, and if large enough, out of the superficial inguinal ring.
Direct inguinal hernias – these come into the inguinal canal through a defect in the posterior wall of the canal. These are easier to reduce – they should just pop straight back in! these account for 20% of inguinal hernias. They are generally easy to reduce and do not strangulate.
Who do femoral hernias tend to occur in more? Describe their character.
These tend to occur more in females (due to their wider pelvis).
They tend to be irreducible and strangulate.
These go down the femoral canal (not the inguinal canal).
They are usually found below and lateral to the inguinal ligament – this is the opposite of inguinal hernias!
However, remember they can present above the inguinal ligament as well – but when they do, they will point along the femoral canal, and down the leg, as opposed to towards the groin (like inguinal ones do).
Where to para umbilical hernias occur? Name two risk factors.
These are found just above or just below the umbilicus. Omentum or bowel can herniated through them. Risk factors include ascites or obesity
Where do epigastric hernias arise?
These pass through the linea alba above the umbilicus.
What are the two types of hiatus hernias? Which is most common?
Sliding and rolling. Sliding hernias account for up to 95% of all hiatus hernias.
Describe what a sliding hiatus hernia is.
Sliding - in this, part of stomach at the oesophageal gastric junction is pulled upwards through the diaphragm. This reduces the angle between the oesophagus and the stomach, and thus removes one of the natural anatomical barriers to reflux.
However, it is unlikely that this is the sole cause for reflux, as many people have a hiatus hernia and suffer no reflux symptoms. The hernia itself never causes any symptoms – it may however contribute to reflux which will produce symptoms.
Describe what a rolling hiatus hernia is and how it might present.
Rolling (aka para-oesophageal hernia)– this is where part of the fundus of the stomach will extend through the diaphragm at a separate site to the oesophagus. They can sometimes be huge, with almost the whole stomach becoming herniated, leaving the gastro-oesophageal junction lying right alongside the pylorus.
•Symptoms develop very rarely, and often the hernia is discovered by accident on a CXR, indicated by a fluid level behind the mediastinum. When it does cause problems, then it may cause pain (due to stomach twisting), pain and discomfort after eating, and vomiting. It may present acutely if the hernia is strangulated.
Borders of Hesselbach’s triangle aka inguinal triangle?
- RIP
R = lateral border of the rectus abdominis makes the medial border of the triangle
I = Inferior epigastric vessels making the superolateral border of the triangle
P = Inguinal ligament (also called Poupart’s ligament)
