Hernias Flashcards
What is an inguinal hernia
Protrusion of abdominal contents through the inguinal canal
What arteries run through the spermatic cord
- Testicular artery
- Cremasteric artery
- Artery of Vas
What veins run though the spermatic cord
- Pampiniform plexus of testicular veins
- Cremasteric vein
- Vas vein
What does the ilii-inguinal nerve supply
Skin sensation to anterior 1/3 of external genitalia
What does the genitofemoral nerve supply
Cremasteric muscle
What does the sympathetic nerve supply
Vas and testicular pain
Role of vas deferens
Duct that transports sperm from the epididymis to the ejaculatory ducts
What is the tunica vaginalis
Serous membrane that covers the testes
Is a direct or indirect inguinal hernia more common
Indirect
What people do inguinal hernias effect
Men over 40
Risk factors for an inguinal hernia
- Male
- Chronic cough
- Constipation
- Urinary obstruction
- Heavy lifting
- Ascites
- Past abdominal surgery
What is the inguinal canal
A short passage that extends through inferior abdominal wall
Extent of inguinal canal
From deep inguinal ring to superficial ring
Role of the inguinal canal
Allows structures to pass from abdominal wall to the external genitalia
Where is the inguinal canal weakest
Aldo wall
Length of inguinal canal
5cm
Where does the direct hernia occur
- Where peritoneal sac enters the inguinal canal through posterior wall of the inguinal canal (medial to the inferior epigastric vessels)
Why are direct hernias not very common
Rarely strangulate
Where are indirect hernias located
Where peritoneal sac enters inguinal canal through deep inguinal ring
Lateral to inferior epigastric artery
Clinical presentation of an inguinal hernia
- Bulges when you cough or strain
- Rarely painful
- Painful = strangulation
Differential diagnosis of an inguinal hernia
- Femoral hernia
- Epididymitis
- Testicular torsion
- Groin abscess
- Aneurysm
- Hydrocele
- Undescended testes
How is a inguinal hernia treated
- Use of truss to contain and prevent further progression
- Prosthetic mesh/open repair/ laparoscopy
- Pre-op: diet and stop smoking
- May reoccur
What is a femoral hernia
Bowel comes through the femoral canal blow the inguinal ligament
In what gender are femoral hernias common
FEMALES
Pathophysiology of femoral hernias
- Bowel meters femoral canal presenting as a mass
Where is the femoral hernia mass felt
- upper medial thigh
2. Above inguinal ligament where it points down the leg
Where do inguinal hernias point to
Groin
Characteristic of femoral hernias
Irreducible and easily strangulated
Why is the femoral hernia easy to strangulate
Due to rigidity of the canal’s borders
Where is the neck of the femoral hernia felt
- Inferior and lateral to pubic tubercle (inguinal hernias are superior and medial to this point)
Differential diagnosis of femoral hernias
- Inguinal hernia
- Lipoma
- Femoral aneurysm
- Psoas abscess
- Saphena varix
What is the saphena varies
Dilation of saphenous vein at junction of femoral vein in groin
How are femoral hernias treated
- Surgical repairs
- Heriotomy (ligation and excision of sac)
- Herniorrhaphy (repair of hernial defect)
What is ligation
Stopping bleeding once sac is removed
What is an incisional hernia
- Occurs when tissue protrudes through surgical scar that is weak
Where can incisional hernias occur
Anywhere there is an incision and follows breakdown of muscle closure after surgery
What factor makes repairing an incisional hernia more difficult
Obesity
Risk factors for incisional hernias
- Emergency surgery
- Wound infection post-op
- Persistent coughing and heavy lifting
- Poor nutrition
Who do hiatus hernias tend to effect
Over 50 aged women
What is a sliding hiatus hernia
- Where gastro-oesophageal junction part of the stomach slides up to the chest via the hiatus so that it lies above the diaphragm
Why does acid reflux happen in hiatus hernias
As lower oesophageal sphincter becomes less competent in many cases
What is a rolling or para-oesophageal hiatus
Where the gastro-oesophageal junction remains in the abdomen but part of the funds of the stomach prolapses through the hiatus alongside the oesophagus
When is reflux uncommon in para-oesophageal hiatus
When the gastro-oesophageal junction remains intact
Clinical feature of hiatus hernias
GORD (50% of patients)
How is hiatus hernias diagonsed
- Barium swallow and Upper GI endoscopy
Why is an upper GI endoscopy beneficial in hiatus hernias
Visualises the mucosa (can’t exclude hiatus hernia)
How are hiatus hernias treated
- Lose weight
- Treat reflux symptoms
- Surgically treat to prevent strangulation
