Hernias Flashcards
what is a hernia?
an abnormal protrusion of a viscus outwith its normal body cavity
what hernias arise from natural openings?
inguinal femoral umbilicus oesophageal hiatus obturator
what hernias arise from weak areas?
incisional (caused by surgery)
parastomal
epigastric
paraumbilical
what are the 6 predisposing factors to abdominal hernias?
heavy lifting coughing constipation prostatism pregnancy obesity (all cause raised intrabdominal pressure)
what is prostatism a symptom of?
compression/obstruction of the urethra
what is the main way that hernias are classified?
reducible or irreducible
what is a reducible hernia?
a hernia that can easily be pushed back into place
what is an irreducible hernia?
a hernia that won’t push back into place
what is the 2 subgroups of irreducible hernias?
obstructed hernias
incarcerated hernias
what is the difference between obstructed and incarcerated hernias?
obstructed hernia: neck is narrow enough to occlude bowel lumen
incarcerated: bowel isn’t affected
if an obstructed hernia isn’t treated quickly enough what can happen?
strangulated hernia can form
what is a strangulated hernia?
the neck has compromised the bowel blood supply
in a strangulated hernia which supply is usually compromised first?
(arterial or venous)
venous usually compromised first because of it’s lower pressure
(venous congestion causes purple appearance)
who gets paraumbilical hernias and who gets true umbilical hernias?
adults (and obese)- paraumbilical
children-umbilical
what does an epigastric hernia usually arise from?
congenital weakness of the linea alba
when do epigastric hernias usually present?
late teens/early adult
what age do congenital umbilical hernias usually resolve by?
age 3
if a congenital umbilical hernia hasn’t resolved by the age of 3 what should be done?
surgery
what is the processus vaginalis?
a bit of peritoneum that that descends with the testes during fetal development
what usually happens to the processus vaginalis?
communication between processus vaginalis and peritoneal cavity close and the processus vaginalis becomes the tunica vaginalis
what is it called when communication between the processus vaginalis and peritoneal cavity doesn’t close? (and what can this lead to)
patent processus vaginalis
can lead to hernias
what is the difference between a scrotal hernia and an inguinal hernia in infants?
(caused by patent processus vaginalis)
scrotum hernia- peritoneum comes all the way to the bottom of the scrotum
inguinal hernia- similar but peritoneum only goes half way to the bottom of the scrotum
what is hydrocele of the spermatic cord in infants?
presence of a non-communicating pocket of peritoneal fluid that failed to be obliterated, in the testes close to the spermatic cord
what is a communicating hydrocele in infants?
a pocket of fluid within the scrotum sac that can communicate with the peritoneal cavity
what is hydrocele of the tunica vaginalis in infants?
presence of a non-communicating pocket of peritoneal fluid that failed to be obliterated, in the testes in the area of the tunica vaginalis
what is the typical patient of a femoral hernia?
thin elderly female
what can you see on inspection of a femoral hernia?
loss of groin crease
what natural opening does peritoneum protrude into in a femoral hernia?
defect through femoral canal
what are the anterior, medial, lateral and posterior boundaries of the femoral canal?
anterior- inguinal ligament
medial- lacunar ligament
lateral- femoral vein
posterior- pectinate ligament
what does the inguinal ligament run from?
anterior superior iliac spine
pubic tubercle
where is the femoral hernia in relation to the pubic tubercle?
inferior and lateral to the pubic tubercle
what do you usually see on inspection of an inguinal hernia?
increased groin crease
where is an inguinal hernia in relation to the pubic tubercle?
superior and medial to the pubic tubercle
what are the 4 major causes of scrotal swellings?
inguino-scrotal hernia
hydrocele
epidydymal cyst
testicular swelling
what is a direct inguinal hernia?
occurs medial to the inferior epigastric vessels, abdominal contents herniate through weak spot in fascia of the posterior wall of the inguinal canal
what is an indirect inguinal hernia?
occurs laterally o the inferior epigastric vessels, abdominal contents protrude through deep inguinal ring
what type of inguinal hernia goes into the scrotum?
indirect
what type of hernias are congenital inguinal hernias?
indirect hernias
where does the inguinal canal run from?
deep ring to superficial ring
where is the deep inguinal ring?
mid-inguinal point
where is the superficial ring?
superior and medial to pubic tubercle
what make up the anterior, the floor, the roof and the posterior boundaries of the inguinal canal?
anterior- external oblique aponeurosis
floor- inguinal and lacunar ligament
roof- conjoint tendon
posterior- transversalis fascia and conjoint tendon
what are the boundaries of Hesselbach’s triangle?
inferior- inguinal ligament
lateral- inferior epigatric vessels
medial- lateral border of rectus sheath
how are indirect hernias controlled?
controlled by digital pressure over the internal ring
when do you operate on a hernia?
- if hernia is at risk of complications even if no symptoms
- hernia with previous symptoms of obstruction
- hernia interfering with lifestyle
what surgical repair technique is use on congenital hernias?
herniotomy
what is the surgical technique which repairs the defect of the wall?
herniorrhaphy
