Hernias Flashcards
What is a hernia?
An abnormal protrusion of a viscus outwit its normal body cavity
What is the most common hernia type?
Inguinal
In which group are femoral hernias most common?
Women
Men almost never get femoral hernias
What are natural hernias?
These go through what are effectively natural holes:
Inguinal, femoral, umbilicus, oesophageal hiatus, obturator
What hernias can arise from a “weak area”?
Mostly iatrogenic causes
Incisional, parastomal, epigastric, paraumbilical
What are the predisposing factors for abdominal hernias?
Type II collagen disorder +
Heavy lifting, coughing, constipation prostatism, pregnancy or obesity
What is a reducible hernia?
A hernia which can be pushed back in
Should not need surgical intervention
What is an irreducible hernia, and how might this be further classified?
A hernia which cannot be pushed back in
Obstructed (strangulated) or incarcerated
What will occur in strangulation due to a hernia?
Compromise of blood supply
Low pressure venous system is occluded first, then arterial supply
Gangrene develops
Will be friable to touch and easily bleed
What is the cause of an incisional hernia?
Forms in a previous scar, usually from surgery
Which group of patients will get paraumbilical hernias?
Adults, commonly obese
What causes an epigastric hernia?
Congenital weakness the line alba
In which group are epigastric hernias most likely to present?
Males
Usually late teens or early adulthood
In which group do umbilical hernias present?
Children
Usually within the first year of life
At what age would you consider operating on an umbilical hernia?
3 years
Most will have resolved by this stage
Why are paediatric inguinal hernias particularly worrying?
The inguinal canal in children is much smaller, and so there is a much higher chance of obstruction and strangulation
In which group are paediatric inguinal hernias most likely to present?
Male
Less than 1 year old
More common in pre-term and LBW infants
Where are femoral hernias found?
Below and lateral to the pubic tubercle
Usually flatten the groin crease
Where are inguinal hernias found?
Above the pubic tubercle
Usually increase the groin crease
What are the causes of scrotal swelling?
Inguino-scrotal hernia
Hydrocele
Epididymal cyst
Testicular swelling
Where would a direct inguinal hernia be found at operation?
Medial to the inferior epigastric vessels
Where would an indirect inguinal hernia be found at operation?
Lateral to the inferior epigastric vessels
In which group are indirect inguinal hernias more likely to present?
Young men
In which group are direct inguinal hernias more likely to present?
Older men
With which type of inguinal hernia is there more likely to be complications?
Indirect
When would you operate on an inguinal hernia?
Hernia at risk of complications, even if asymptomatic
Hernia with previous symptoms of obstruction
Hernia interfering with lifestyle
What are the complications of an inguinal hernia?
Haematoma Acute urinary retention Wound infection Chronic neurogenic pain Hernia recurrence Testicular pain and atrophy
What types of operations can be carried out on inguinal hernias?
Suture
Open mesh
Laparoscopic (Intraperitoneal or extraperitoneal)
What is a herniotomy, and with which type off hernia would you always chose this type of surgical repair?
Excision of peritoneal sac
Congenital hernias
What s a herniorraphy?
Repair of the defect of the wall
What is the importance of the processus vaginalis in the development of paediatric inguinal hernias?
The processus vaginalis is an outputting from the peritoneum into which the testes descend
If the processes vaginalis fails to fuse, there is an opening for fluid and hernias to enter
What are the possible outcomes from a patient processus vaginalis?
Scrotal hernia Inguinal hernia Hydrocele of the cord Hydrocele of the tunica vaginalis Communicating hydrocele
