Hernias Flashcards
What is a hernia?
A protrusion of a viscus or part of a viscus through the wall designed to contain it
What three layes is a hernia composed of?
- A sac (of peritoneum)
- Coverings of the sac
- Contents
What may be common contents for a hernia, especially in relation to the gastro-intestinal system?
- Small bowel
- Omentum
Name some regions where adult hernias may originate from
- Inguinal
- Femoral
- Epigastric
- Paraumbilical
- Incisional
Groin hernias can be which two main types of hernia?
- Inguinal
- Femoral
Most grouin hernias are _________ hernias
Inguinal
Why are inguinal hernias more common in males?
The testicles must pass through the inguinal canal during development meaning this canal is wider in females and therefore susceptible to herniation
In which gender and age profile are femoral hernias most common?
Old women
The inguinal canal has a posterior wall, anterior wall, roof and floor, what are each of these areas composed of?
- Posterior wall - Transversalis fascia
- Floor - inguinal and lacunar ligaments
- Anterior wall - aponeurosis of external oblique, internal oblique
- Roof - transversalis fascia, internal oblique, transversus abdominus
The muscles of the abdominal wall are supplied by which artery?
Inferior epigastric artery
Where can the location of the inguinal ring be located on the surface of the skin?
2cm up from the mid-point of the inguinal ligament
What are the components of the spermatic cord?
- 3 arteries - testicular artery, artery to vas deferens (deferential artery), cremasteric artery
- 3 nerves - nerve to cremaster, testicular nerves (sympathetics), ilioinguinal nerve (technically outside cord)
- 3 other things - vas deferens (ductus deferens), pampiniform plexus, lymphatic vessels
What are the risk factors for inguinal hernias?
- Male
- Obesity
- Age (increasing)
- Chronic cough
- A previous hernia
What are the two types of inguinal hernia?
- Direct
- Indirect
What is a direct inguinal hernia?
Occurs medially to inferior epigastric vessels
The abdominal contents herniate through a weak spot in fascia of the posterior wall of the inguinal canal
Which gender and age group are likely to get a direct hernia?
Older men
What is an indirect inguinal hernia?
They occur laterally to the inferior epigastric vessels
They will protrude through the deep inguinal ring and into the scrotum via the inguinal canal
Which developmental process may have failed to result in the development of an inguinal hernia?
Failure of embryonic closure of the processus vaginalis
Of the two inguinal hernias, which will take the same path as the spermatic cord?
Indirect
In relation to a hernia, what does the term “incarceration” mean?
Something becoming stuck
An incarcerated hernia cannot be put back in place with manual force alone
Which surgical procedure will often be used for emergencies involving inguinal hernias?
Open hernia surgery
Lichtenstein method
The content are put back in place and mesh is insterted to prevent re-protrusion
Which surgical procedure is more likely to be used for elective hernia repair?
Laparoscopic surgery
There is less short and long term pain and the rate of infection is lower than open surgery
Which nerve may be damaged during open hernia surgery and what may be the effect of this?
Ilioinguinal nerve
Chronic pain which may last for up to a few years
What other complications can result from hernia surgery?
- Recurrence
- Urinary retention (in men)
- Bleeding/haematoma
- Chronic pain
- Numbness
- Testicular atrophy
- Wound infection
Why would a hernia ever be the cause of bowel obstruction?
Some hernias can irreducible and may lead to strangulation of the bowel stopping blood supply
This will cause bowel obstruction
Which gender and age are most likely to get femoral hernias?
Elderly woman
(who may have had many children)
Of the two hernias, inguinal and femoral, which is more likely to have acute presentation?
Femoral
(around 40%)
The femoral canal has 4 borders, what are these?
- Anterior - Inguinal ligament
- Posterior - Pectineal line and ligament
- Medial - Lacunar ligament
- Lateral - Femoral vein
What is mainly present within the femoral canal?
Fat and lymph nodes
In relation to the anatomical borders of the femoral canal, what is it that gives rise to the development of femoral hernias?
There are three firm structures, each creating a border
(anterior, posterior and medial borders)
There is one weak structure - the femoral vein - which means that any pressure is most directed at this weaker area
Why is it hard to push a femoral hernia back in?
The three firm structure composing the rest of the femoral canal provide resistance to this
In simple terms, how can this issure be corrected in surgery?
The inguinal ligament is sutured to the pectineal ligament eliminating the weak structure and forming a femoral canal with only three borders
How can the positioning of inguina and femoral hernias be differentiated based on their locations in relation to the pubic tubercle?
- Inguinal - above and lateral to the pubic tubercle
- Femoral - below and lateral to the pubic tubercle
What gives rise to an epigastric hernia?
Any defect in the linea alba between the xiphisternum and umbilicus
A paraumbilical hernia is formed due to what?
The umbilicus being a point of weakness
What are the risk factors for a paraumbilical hernia?
- Obesity
- Ascities
- Pregnancy
Name a type of acquired hernia
Incisional hernia
(other hernias may be acquired through trauma)
What is a clinical sign of an inguinal hernia in an infant?
The silk sign
Whent he hernia is palpated over the cord structures the sensation is similar to that of rubbing two layers of silk together
Why do umbilical hernias resolve in infants (usually) by the age of 4, yet this does not happen in adults?
Children will grow allowing the hernia to resolve itself
Why are inguinal hernias always repaired in infants?
They will worsen and there will be a high rate of incarceration
Which surgical procedure is used to repair an inguinal hernia in infants?
Herniotomy
There hernia sac is ligated without any repair of the inguinal canal
This means no mesh is used
Which rare hernia is a cause of small bowel obstruction in elderly females?
Obturator hernia
Medial thigh pain may be experienced due to obturator nerve disruption
