Hernias Flashcards
(34 cards)
Definition of hernias?
An abnormal protrusion of a viscous outwith its normal body cavity
4 of the most common hernias?
Inguinal
Umbilical
Incisional
Femoral
Causes of abdominal wall hernias?
May arise from natural openings OR weak areas, caused by stretching or surgical incisions
5 natural abdominal wall hernias?
Inguinal Femoral Umbilical Oesophageal hiatus hernia Obturator
4 weak area hernias?
Incisional
Parastomal (around a stoma)
Epigastric
Paraumbilical
6 factors that predispose to abdominal hernias?
Increase in intra-abdominal pressure: Heavy lifting Coughing Constipation Prostatism Pregnancy Obesity
Classification of hernias?
Reducible
Irreducible:
Obstructed (can progress to strangulation)
Incarcerated
What does strangulation mean, in relation to hernias?
Compromise of blood supply of the contents of the hernia; strangulation increases morbidity and mortality
Initially, the low pressure venous system is occluded and then the arterial supply; this leads to ischaemia and then gangrene (coagulative necrosis)
What are incisional hernias?
Incompletely-healed surgical wound can cause a hernia
Aetiology of incisional hernias?
Age and general debility, e.g: malignancy
Steroids
Obesity
Post-operative wound infection or haematoma
Raised intra-abdominal pressure, e.g: ileus
Type of incision; vertical incisions have greater incidence of hernia than transverse
Prevention of incisional hernia?
In predisposed patients, use tension sutures + “mass closure” of the linea alba
What is a para-umbilical hernia?
Around the umbilicus and occur in ADULTS, usually in obese individuals
Causes of epigastric hernias?
Arise from a CONGENITAL weakness of the linea alba, between the umbilicus and xiphisternum
They usually contain extra-peritoneal fat
Occurrence of epigastric hernias?
More common in males, usually in late teens or early adulthood
Symptoms of epigastric hernia?
Usually asymptomatic or there are local symptoms
Treatment of epigastric hernia?
Repair with sutures or mesh
Cause of umbilical hernias?
Congenital problem; occurs in CHILDREN, within 1st year of life or when they are born
They can occur alongside pediatric inguinal hernias
Treatment of umbilical hernias?
Usually resolve by the age of 3; if >3 years of age, operate
What is the processus vaginalis?
Tunica vaginalis is the embryological remnant of the processus vaginalis; in males, the processus vaginalis proceeds down the gubernaculum and forms a small pouch next to the testes and the neck closes off, called fusion, to form the tunica vaginalis
What problems can occur with fusion?
If fusion does not occur completely and the neck remains open, a scrotal or inguinal hernia can form
Also, hydroceles can form, as fluid enters the processus vaginalis from the peritoneal cavity
Occurrence of pediatric inguinal hernia?
30% present before the age of 1; they are far more common in males and also in premature and low birth weight infants
Right-sided hernias are more common and there is a risk of developing a contralateral hernia
When does the risk of strangulation, with a pediatric inguinal hernial, occur?
Increased risk of strangulation if aged less than 1; urgent surgery required
What are femoral hernias?
Form due to a defect in the femoral canal
Boundaries of the inguinal canal?
Anterior - inguinal ligament
Medial - lacunar ligament
Lateral - femoral vein
Posterior - pectinate ligament
