Hernias Flashcards
What is a hernia?
A protrusion of a viscus or part of a viscus through the wall which is designed to contain it.
What are the 3 layers of a hernis?
The Covering of the sac (skin, fascia)
The sac- peritoneum
The contents.
What is the most common groin hernia?
Inguinal
What are the risk factors for inguinal hernias?
Male
Obesity,
Age,
open appendix surgery
Which side is more common for inguinal hernias?
Right side
What makes up the anterior, posterior and floor of the inguinal canal?
Anterior is the external oblique
Floor is the inguial ligament
Posterior wall is transverse fascia
What is contained within the inguinal canal in men?
Anatomy (spermatic cord and ilio-inguinal nerve)
3 arteries: testicular artery, artery to vas deferans and cremasteric artery
3 nerves: ilioinguinal nerve, genital branch of genitofemoral nerve, Sympathetics (technically outside)
3 others: Panpiniform venous plexus, Vas deference, lymphatics
Are most inguinal hernais direct or indirect?
Indirect
Anatomically what is the difference between direct and indirect hernias?
Indirect: Enters the deep ring laterally and emerges through the superficially medially. Originates lateral to inferior epigastric artery
Direct: Emerges through the transverse facia of the posterior wall. Originals medial to inferior epigastric artery
How can you clinically determine the difference between direct and indirect hernias?
Reduce hernia
Cover the deep inguinal ring and ask patient to cough.
Returns => direct
Remains reduced => indirect
Do all inguinal hernias need to be fixed?
No if small and asymptomatic you can watchfully wait incase they grow or become symptomatic.
Is incarceration of inguinal hernias common?
No- low risk
25-75% of patients chose to get inguinal hernias repaired. How is this done?
1) Open lichtenstein method. GA, spinal or local. Mesh inserted near cord
2) Laproscopic: less pain, faster recovery, needs GA. More difficult op and takes longer. Reduced risk of infection or chronic pain
What are the complications of inguinal hernia repair?
4% recure
Urinary retention
Bleeding/haematoma
Chronic pain-30% of patients get chronic groin pain
Numbness in groin
Testicular atrophy due to damage to testicular artery
Wound infection- infected mesh must be removed.
What are the emergency presentations of any hernia?
Incarcerated hernia-stuck hernia (irreducible) => strangulation, obstruction
How is an incarcerated hernia treated?
Try to reduce it under anasthetic- easier to operate if reduced
Operative repair after resuscitation.
Which group of people get femoral hernias?
Older women
Multi-parous (children)
How commonly do these present as emergency?
40%
What surrounds the femoral canal?
Superior = inguinal ligament Inferior = Pectoneal ligament Medial = Lacunar ligament Lateral is the femoral Vein (Femoral artery and nerve are more lateral)
How is a femoral hernia repaired in an emergency or elective?
Emergency = high approach Elective = low approach (laproscopic)
How should you assess a hernia?
Assess both standing and sitting. Get the patient to cough.
Is it reducible?
Yes- elective
No- Emergency
How can you tell the difference between inguinal and femoral hernias?
Femoral = below and lateral to pubic tubercle Inguinal = above and medial to pubic tubercle
Why do epigastric hernias occur?
Men usually due to a defect in the linea alba
What are the risk factors for paraumbilical hernias in adults?
Obesity, pregnancy, ascites
How are para umbilical hernias repaired?
Reduction and inserting mesh behind abdominal wall to reinforce it.
How commonly do incisional hernias occur and what are the risk factors?
10-15% of abdominal incisions
Risk factors: Obease, chest infection, smoking, old, steroid, malnutrition
What are the 2 common paediatric hernias?
Umbilical
Inguinal
How are paediatric umbilical hernias treated?
Usually resolve spontaneously by aged 4. If not operated to reduce- no mesh used.
How are paediatric inguinal hernias treated and what are the risk factors?
Mostly indirect and in boys. More common in pre term.
Silk skin sign, crying and groin swelling- difficult to see.
Needs surgical repair- no mesh used
