Hernias Flashcards
Define - hernia
Protrusion of viscus or part of a viscus through the wall that was designed to contain it
What type of groin hernias are more common in men? Why?
Inguinal
- the way the testes develop leaves a weakness
What type of groin hernias are more common in women?
Femoral
What are the 3 arteries, nerves and other things of the spermatic cord?
3 arteries – testicular artery, artery to vas, cremasteric artery
3 nerves – ilio-inguinal nerve, genital branch of genito femoral, sympathetic
3 other things – pampiniform venous plexus, vas deferens, lymphatics
What are the risk factors for inguinal hernias?
- Man – right sided commoner than left
- Old – 6th decade
- Fat
- Cough
- Previous hernia
- Collagen disorder
- AAA
- Appendicectomy
What is the opening to the inguinal canal?
deep inguinal ring
What is the exit of the inguinal canal?
superficial inguinal ring
What is the route of indirect hernias?
deep inguinal ring, lateral to inferior epigastric vessels and goes down the spermatic cord
What is the route of direct hernias?
bulges through medial to the inferior epigastric vessels and straight through the transversalis fascia
What type of hernia is this?
Cover deep inguinal ring, patient coughs, if hernia comes back….
DIRECT
What is the best form of inguinal hernia repair?
Laprascopic surgery – less pain, faster recovery, needs general anaesthetic
What can occur due to open rapair?
chronic pain
What is the first treatment of an emergency hernia?
gentle reduction under analgesia
What are the characteristics of femoral hernias?
- normally present acutely
- normally women who have had lots of children
- operative mortality is high
How are femoral hernias repaired?
inguinal ligament is sutured to the pectineal ligament
- High approach – emergency
- Low approach – elective (cut on top of the inguinal ligament)
Where do inguinal hernias originate?
above and medial to pubic tubercle
Where do femoral hernias originate?
below and lateral to pubic tubercle
Describe an epigastric hernia?
Defect in linea alba between xiphisternum and umbilicus
More common in men
Describe a paraumbilical hernia?
Common in children
Adult ones are usually just next to umbilicus
Risk factors: fat, pregnant (go away when baby is delivered), ascites
Describe an incisonal hernia?
Hernia at the site of previous abdominal incision
Risk factors: obesity, age, surgical site infection, smokers, steroids, immunosuppression, chest infection
When do Paediatric umbilical hernias resolve by?
age of 4
Describe Paediatric inguinal hernias?
Normally indirect and in boys
Preterm causes higher risk
Groin swelling on crying
