Hernias Flashcards
Hernia definition
protrusion of a viscus or part of a viscus through a defect of the walls of its containing cavity into an abnormal position
Irreducible
if a bowel hernia can’t be pushed back into the right space
Incarcertaion
contents of the hernia sac are stuck inside by adhesions
Obstructed
if bowel contents cannot pass through them
strangulated
if ischamia occurs
whats the most common type of hernia?
inguinal
indirect inguinal hernias
pass through the internal (deep) inguinal ring, and, if large, out through the external (superficial) ring
direct inguinal hernias
push their way directly forward through the posterior wall of the inguinal canal, into a defect in the abd wall
predisposing conditions to an inguinal hernia
male, chronic cough, constipation, urinary obstruction, heavy lifting, ascites, past abd surgery
relations of the inguinal canal
floor: inguinal ligament
roof: fibres of transversalis, internal oblique
anterior: external oblique aponeurosis + internal oblique
posterior: laterally, transversals fascia. medially, conjoint tendon
gold standard for determining the type of inguinal hernia?
at surgery:
- (80%) direct hernias arise lateral to inferior epigastric vessels
- indirect hernias are medial
which hernias frequently strangulate and are frequently irreducible
femoral
femoral hernia
bowel enters the femoral canal, presenting as a mass in the upper medial thigh or above the inguinal ligament where it points down the leg
likely to be irreducible and to strangulate
RF for femoral hernia
female, elderly
boundaries of the femoral canal
anteriorly: inguinal ligament
medially: lacunar ligament (and pubic bone)
laterally: femoral vein
posteriorly: pectineal ligament + pectineus
treatment for femoral hernia
surgical repair
herniotomy - ligation + excision of the sac
herniorrhaphy - repair of hernial defect
incisional hernia
follow breakdown of muscle closure after surgery
repair isn’t easy if obese
hiatus hernia
part of the stomach herniates through the oesophageal hiatus of the diaphram
whats a sliding hiatus hernia?
symptoms?
accounts for more than 95% of cases
GO junction slides through hiatus + lies above diaphragm
no symptoms unless associated reflux
other type of hiatus hernia aside from sliding?
para-oesophageal hernia dangerous!!
gastric funds rolls up through the hiatus alongside oesophagus, GO junction remaining below the diaphragm
hernia repair
mesh techniques
advise to diet and stop smoking pre-op
