Hernias Flashcards
Patho of Hernia
protrusion of an organ as part of an organ through the body wall that normally contains it
Most common type of hernia
groin
Most common hernia
inguinal
Types of groin hernias
inguinal and femoral
Types of ventral hernias
umbilical, epigastric, spigelian
Incisional hernias are due to? What type of hernia?
- Due to open abdominal procedure and incision through the abdominal wall
- Ventral hernia
Reducible Hernia
tissue is easily movable and can be reduced from the sac and easily pushed back in
Incarcerated Hernia
Trapping of hernia within the sac without compromise of vasculature
Strangulated Hernia
Circulation of hernia contents is compromised
What do we worry about with strangulated hernias?
ischemia–> dead bowel–> sepsis
2 types of inguinal hernias
direct and indirect
Direct inguinal hernia
- inferior to epigastric vessels and doesn’t pass through inguinal canal
- ACQUIRED
Indirect inguinal hernia
- passes through the inguinal ring
- CONGENITAL
Femoral hernia
inferior to the inguinal ligament
Hesselbach’s triangle contains
inguinal ligament, epigastric vessel and rectus muscle
Cause of Acquired groin hernias
weakening or disruuption of fibromuscular tissue due to:
- trauma
- drugs
- connective tissue abnormality (Marfan/ DE)
- chronic overstretching of musculoaponeurotic structures
Age of groin hernias for men/women
Women get it later in life 60-80; men 50-70
Risk factor for groin hernia
- HX of hernia or repair
- old age
- male
- white
- chronic constipation
- abdominal wall injury
- smoking
- family history of hernias
Clinical Presentation/PE of groin hernia
- bulge in the groin that may be tender to palpate but generally has no pain
- heavy/discomfort in groin
- slight pelvic pain in women
- worst at end of day/ prolonged sitting
- radiating twinge of pain with sitting/standing
Who is more likely to get groin hernias?
patients who work in manual/physically active professions
Clinical presentation of reducable hernias
- some pain
- asymptomatic
Clinical presentation of incarcaerated hernias
- +/- N/V, pain, block
- tenderness, bowels may not move due to obstruction
- fever
Clinical presentation of strangulated hernias
- painful
- +/- N/V, pain, block
ischemia–> pain out of proportion
How do you examine inguinal canal?
use small finger to go into it and have patient cough.
If you feel bulge next to finger–> direct
If you feel bulge hit finger–> indirect
Dx Groin Hernias
H/PE
Use US if occult, differentiation, determining if strangulation/incarceration
Tx groin hernias
ASx- monitor Surgical: - moderate to severe sx - Urgent- incarceration - Emergency- strangulation, bowel obstruction - Laproscopic/open - Mesh: durable and longevity - Aloderm: human cadaver skin; less likely to get infected
Tx Femoral Hernia
Surgery
Pantaloon Hernia
both direct and indirect hernia on the same side
How do you see an incisional hernia?
Have ptn lay down and sit up a little–> pop out
Umbilical hernia is a protrusion through?
umbilical ring
Who gets umbilical hernias?
Adults- acquired
Children- congenital; close spontaneously by 1.5yr
RF for umbilical hernia
obesity
pregnant
ascites
Where is an epigastric hernia?
in the epigastrium (upper/central abdomen)
Where does the Spigelian hernia form?
through the spigelian fascia; ACQUIRED
Clinical Spigelian hernia
- swelling lateral to the rectus muscle
- pain is dull/ constant
Dx Spigelian hernia
US
Tx Spigelian hernia
surgical because very painful and complicated; trapped easily
Patho Richter’s Hernia
- Part of circumference of bowel becomes incarcerated
- little piece of bowel wall is stuck in hernia– weakening of the bowel wall, ischemia, or rupture
Most common site of Richter’s Hernia
femoral canal
Clinical Richter’s Hernia
- local inflammation
- overtime ischemia, gangrene, perforation
Tx Richter’s Hernia
- surgical
Parastomal hernia common in patients with?
stoma (ileostomy or colostomy)
Tx Parastomal hernia
based on sx
Clinical Parastomal hernia
- bowels and intestine protrude out of stoma
- skin is clean and normal looking
- patient comfortable
What is not a true hernia and why?
Rectus Abdominus Diastasis; not a break in the rectal wall only a seperation of the walls
Biggest RF for Rectus Abdominus Diastasis
Pregnancy
Cause Rectus Abdominus Diastasis
- weak/stretched abdominal wall fascia due to pregnancy/ obesity
- some association with aneurysmal disease
Dx Rectus Abdominus Diastasis
PE- prominent ridge between two rectus abdominous while sitting
Tx Rectus Abdominus Diastasis
conservative- weight loss, abdominal exercise
surgical- cosmetic/ severe sx
