Hernias Flashcards
Define a hernia
A protrusion of an organ or part of an organ though a deficit in the walls of its containing cavity into an abnormal position
Give some features which help define a lump as a hernia
Occur at weak spots
Reduce on lying down or with manipulation
Have an expansile cough impulse
What can occur if a hernia is not treated?
Strangulation
Incarceration
Describe strangulation
Bload vessels become constricted, preventing blood flow into the tissue. This leads to construction and necrosis.
What symptoms occur with strangulation?
Red and painful lump which is tense an irreducible Associated with: - vomiting - abdo distention - colicky abdominal pain - constipation
Define incarceration
Hernia cannot be reduced unless there is significant external effort.
Describe the inguinal canal
4cm passage lying between the muscles of the anterior abdominal wall.
Runs parallel and superior to the inguinal ligament
What is the inguinal ligament?
The inferior border of the aponeurosis of the external oblique muscle.
Where does the inguinal ligament attach?
ASIS to pubic tubercle
What are the contents of the inguinal canal in males?
Ilioinguinal nerve Spermatic cord Ext. spermatic fascia Cremasteric fascia Transversus abdominus and internal spermatic fascia
What is found in the spermatic cord?
3 arteries: testicular, ductus deferens, cremasteric
3 nerves: genital branch of the genitofemoral nerve, cremasteric, autonomic
3 others: pampiniform plexus, lymphatics, ductus deferens
What are the borders of the inguinal canal?
MALT
Roof = transverses abdomens and internal oblique fibres
Ant = aponeurosis of ext and int oblique
Floor = ilioinguinal ligament and lacunar ligament
Post = transcersalis fascia and medially conjoint tendon
How can you distinguish between a direct and indirect inguinal hernia clinically?
Occlude the deep inguinal ring with two fingers and ask the pt to cough or stand.
Indirect = hernia cannot protrude
Direct = hernia can protrude
Define a direct inguinal hernia
Hernia protrudes into the inguinal canal through a weakened patch in the transversalis fascia (Hasselbach’s Triangle).
What are the borders of hasselbach triengle?
Inferior = medial half of inguinal ligament Medially = lateral border of rectus abdomens Laterally = medial border of inferior epigastric artery
Describe an indirect inguinal hernia
Hernia protrudes through the deep inguinal ring within the diverging arm the transversalis fascial sling.
What is the main reason that indirect inguinal hernias arise?
There is a failure of embryonic closure of the deep inguinal ring after the testicle has passed through it
Where can you find the deep inguinal ring?
Mid point of the inguinal ligament which is 1.5cm above the femoral pulse
What will be the difference in coverings between direct and indirect inguinal hernias?
Indirect will be covered by internal spermatic fasciaDirect will not.
Describe a femoral hernia
Protrusion of abdominal viscera into the femoral canal, appearing as a mass in the femoral triangle.
Give the borders of the femoral canal
Medial = lacunar ligament Lateral = femoral vein Anterior = inguinal ligament Posterior = pubic ramus and pectineus
Give the borders of the femoral triangle
Superior = inguinal ligament Medial = lat border of adductor longus Lateral = med border of sartorius Roof = fascia lata Floor = pectinous, iliopsoas, adductor longus
What are the contents of the femoral triangle?
Femoral nerve
Femoral artery
Femoral vein
Femoral canal
What is contained in the femoral sheath?
Artery, vein and canal
What does the femoral canal contain?
Lymphatic vessels and lymph nodes
Describe epigastric hernias
Hernias that occur in the epigastric region.
What are the main risk factors for epigastric hernias?
Pregnancy
Obesity
Describe umbilical hernias
Occur though the umbilical ring
Why do umbilical hernias occur?
- Increased intra-abdominal pressure
- Weakness and incomplete closure of the anterior abdominal wall after ligation of the umbilical cord at birth
What is the epigastric region?
The midline between the xiphoid process and the umbilicus, through the linea alba
