Hernias Flashcards
Cause
Raised intra abdominal pressure
Femoral hernia - aetiology
Thin, elderly females
Femoral hernia - anatomy
Below and lateral to the pubic tubercle
Femoral hernia - management
Surgery
Inguinal hernia - risk factors
Males, increasing age, chronic cough, obesity, AAA, previous hernia
Inguinal hernia - anatomy of the inguinal canal
Designed to allow the passage of the spermatic cord
The floor is composed of the inguinal ligament
Inguinal hernia - anatomy of the inguinal ligament
Goes from the ASIS -> pubic tubercle
Inguinal hernia - deep inguinal ring
Opening of the inguinal canal
Inguinal hernia - superficial inguinal ring
Exit of the inguinal canal
Inguinal hernia - anatomy
Above and medial to the pubic tubercle
Inguinal hernia - direct
Cover deep inguinal ring Get patient to stand up and cough Hernia will pop back out straight away Commoner in older men Medial to inferior epigastric vessels
Inguinal hernia - indirect
Cover deep inguinal ring Get patient to stand up and cough Hernia will not bulge back through as pressure is applied Commoner in younger men, congenital Lateral to inferior epigastric vessels
Hernia - post op requirements
No driving for 1 week
No heavy lifting for 1 month
Paediatric inguinal hernia
More likely to be indirect
More common in males
Premature babies
Operate urgently
Incisional hernia - cause
Occurs at a site of weakness (i.e. site of previous surgery)
Raised intra abdo pressure
Epigastric hernia - cause
Congenital weakness of the line alba
males
Paraumbilical hernia - cause
Defect around umbilicus
Increased intra abdominal pressure
Umbilical hernia - cause
Occurs in children
Usually resolves spontaneously
Emergency presentation of hernia
Strangulation
Irreducible
Obstruction
Which hernia is IN the inguinal canal
- indirect inguinal hernia
- direct inguinal hernia
Indirect inguinal hernia
if hernia is in the scrotum is must be direct/indirect?
Indirect
Why do femoral hernias need to be treated more urgently than inguinal hernias?
The femoral canal has very tough borders and is strong so there is not much room for expansion. If there is a femoral hernia there is therefore a higher risk of obstruction or strangulation
direct/indirect inguinal hernias strangulate more easily?
Indirect strangles more easily
Classic description of someone with a femoral hernia
Elderly thin female who was previously overweight in earlier years. This means that femoral canal was stretched when younger and now bowel falls into the femoral canal easier
If you can get above a groin lump, this means it is a hernia true or false?
False
- if you can get above a groin lump, it is coming from the scrotum
Causes of IVDU swellings (2)
Abscess
Pseudoaneurysm
