Hernias Flashcards
what is a hernia?
protrusion of a viscous or part of a viscus through the wall which is designed to contain it
what are the 3 layers of a hernia?
sac (peritoneum)
coverings of the sac
contents
who are femoral/inguinal hernias more common in?
femoral = women inguinal = men
femoral hernias are an emergency, true or false?
true
what is the inguinal canal?
4cm long intermuscular slit to allow passage of spermatic cord
what are the components of the spermatic cord?
3 arteries - testicular artery - artery to vas cremasteric artery 3 nerves - ilioinguinal - genital branch of genito femoral - sympathetic 3 other things - pampiniform venous plexus - vas deferens - lymphatics
what are the risk factors for inguinal hernia?
male
age
chronic cough
.
what vessel runs up from femoral artery, behind inuinal canal to supply the abdominal wall?
inferior epigastric
what is the significance of the inferior epigastric vessels in terms of hernias?
lateral to vessels = indirect
medial to vessels = direct
indirect hernia = does not reappear, true or false?
true
direct will reappear if cover deep ring and ask patient to cough
how are inguinal hernias repaired?
often not fixed if small or asymptomatic
can be repaired with surgery (20-70%)
what are the 2 types of hernia repair surgery?
open - Lichtenstein method - spinal or local anaesthetic - high rate of chronic pain due to nerve damage laparoscopic - less pain, faster recovery - requires general anaesthetic
what complications can occur with inguinal hernia repair?
recurrence urinary retention bleeding chronic pain numbness testicular atrophy/ischaemic orchitis wound infection
what emergency situations can arise from an inguinal hernia?
irreducible
strangulate
obstruction (bowel)
what is done in an emergency inguinal hernia?
reduction under analgesia
operative repair after resuscitation
how do femoral hernias present?
usually elderly females who’ve had several children (multi-parous)
where is the femoral canal?
anterior border = inguinal ligament
posterior border = pectineal ligament
medial border = lacunar ligament
lateral = ileopectineal????
how can a femoral hernia be repaired?
inguinal ligament sutured to pectineal ligament
- low approach = elective
- high approach = emergency
laparoscopic repair
where do inguinal/femoral hernias originate?
inguinal = above and medial to pubic tubercle femoral = below and lateral to pubic tubercle
why are femoral hernias more of an emergency?
higher risk of incarciration
what is an epigastric hernia?
defect in linea alba between xiphisternum and umbilicus
more common in males
what in an umbilical hernia?
true umbilical = more common in children (resolve by 4)
paraumbilical = adults, obesity, pregnant, ascites
how are paraumbilical hernias repaired?
reduced and mesh inserted
what are the risks for incisional hernia?
obesity age surgical site infection smoking post chest infection . .
how do paediatric inguinal hernia present?
more common in pre-term babies 99% are indirect groin swelling on crying "silk sign" often not easy to find on examination
how are paediatric inguinal hernias repaired?
always repaired
herniotomy
what is an obturator hernia?
hernir through obturator foramen (in pelvis)
medial thigh pain
elderly women bowel obstruction
