Hernias Flashcards
What is a hernia?
A protrusion of a viscus or part of a viscus through a weakness in its containing cavity into somewhere it shouldn’t be
What is meant by an irreducible hernia?
When the hernia can’t be pushed back to where it should be
Where in the body are hernia’s most common?
Abdomen
What is an inguinal hernia?
A protrusion of abdominal cavity contents through the inguinal canal
What is the inguinal canal?
A passage that goes through the anterior abdominal wall
Conveys the spermatic cord in men and the round ligament in women
There is one either side of the midline
What 2 types of inguinal hernia are there?
Direct
Indirect
Describe a direct inguinal hernia?
When the abdominal contents come through into the inguinal canal through a defect in its posterior wall
Describe an indirect inguinal hernia?
The abdominal contents come through the deep inguinal ring (the entrance to the inguinal canal)
In which type of inguinal hernia is there a risk of strangulation of the bowel that has come through?
Indirect
What causes an indirect inguinal hernia?
The deep inguinal ring never closed properly during embryonic development.
It should do this after the testicle passes through it
Clinical features of inguinal hernia?
Bulges in the groin area that become more prominent when coughing and straining
Rarely painful, if so suspect strangulated bowel
What should you do if you find you’re unable to reduce the bulge back into the abdomen?
The hernia is likely incarcerated
Emergency surgery!
What is meant by an incarcerated hernia?
The contents of the hernia are stuck inside it by adhesions
They must be moved back by prompt surgery
How do you manage inguinal hernia?
Watchful waiting if they are asymptomatic
If not, elective surgery to move bowel back into right place and strengthen the weakness
If suspected incarcerated or strangulated hernia emergency surgery
Advise weight loss and avoid heavy lifting/exercise
Which is more common, indirect or direct inguinal hernias?
Indirect
Which sex gets inguinal hernias more?
Men
What is a femoral hernia?
When abdominal contents go down the femoral canal
What/where is the femoral canal?
AKA the femoral sheath
A canal containing femoral artery, vein and nerve that goes from the lower abdomen area down along the femur
Which sex gets femoral hernias more?
Females
FEMoral - FEMale
How do femoral hernias present?
A mass in the upper thigh
How do you distinguish femoral hernias from inguinal hernias?
The direction they point in:
Inguinal: towards the groin
Femoral: away from the groin
Femoral hernias are unlikely to be irreducible or to become strangulated.
True or false?
False!
Most femoral hernias do just that, they need surgical intervention
What is an incisional hernia?
Hernias that occur along lines of previous surgical incisions
The incision creates a weakness in the muscle
What is an epigastric hernia?
When the abdominal contents pass through the linea alba above the umbilicus
What is a hiatus hernia?
When part of the stomach herniates through the oesophageal hiatus in the diaphragm
What are the 2 types of hiatus hernia?
Sliding
Rolling (para-oesophageal)
What is a sliding hiatus hernia?
The gastro-oesophageal junction slides through the hiatus into the area above the diaphragm
What are the symptoms of a sliding hiatus hernia?
Why do these occur?
Acid reflux, because the gastro-oesophageal sphincter becomes incompetent
What is a rolling hiatus hernia?
The gastric fundus rolls up through the hiatus so it is alongside the oesophagus
The gastro-oesophageal junction remains below the diaphragm
What are the symptoms + complications of a rolling hiatus hernia?
Gastric volvulus: rotating and strangulation of the fundus of the stomach
Also, bleeding, obstruction and even respiratory problems
Investigations of hiatus hernia?
Endoscopy
Barium swallow is the best test
Treatment of hiatus hernia?
Advise weight loss
Treat reflux symptoms in sliding hiatus hernia
Surgery is advised in rolling hiatus hernia, even if asymptomatic to prevent it getting strangulated in the future
Surgery in sliding hiatus hernia if symptoms become uncontrollable
