Hernias Flashcards
Upon presentation of a groin lump, what questions should you ask?
How long has it been there? Is it always there? Changed in size? Painful? Any other lumps? Tender and warm? Solid or fluctuant? Pulsatile? Cough impulse? Does it reduce?
What are some NAVEL causes of groin lumps?
Saphena varix
Femoral artery pseudoaneurysm
Lymphadenopathy
What are some MSK causes of groin lumps?
Inguinal hernias
Psoas abscess
What are some other causes of groin lumps?
Undescended testes
Cord hydrocoeles
Lipoma
What is a hernia?
Protrusion of an organ through the wall of the body compartment from which it is normally contained.
What is an epigastric hernia?
Defects in the linea alba allowing bowel protrusion (usually at site where nerves and vessels puncture the linea alba).
What is an incisional hernia?
Protrusion of the bowel through old surgical incisions that have created a weakness in the abdominal wall.
What can incisional hernias be a result of?
Poor surgical technique, wound infection, steroid use, malnutrition, anaemia - all of which impair healing of the abdominal wall.
What is an umbilical hernia?
Can be a true umbilical hernia where there is protrusion through the umbilicus (usually congenital or present early) or paraumbilical where there is weakness in abdominal wall structures.
The omentum or bowel can pass through hence the rectus sheath needs to be repaired.
What is a direct inguinal hernia?
Enters through HESSELBACH’S TRIANGLE.
Due to a weakness in the abdominal wall - presents in adults.
MEDIAL TO INFERIOR EPIGASTRIC ARTERY.
Strangulation is rare.
What is an indirect inguinal hernia?
Herniation of bowel into inguinal canal through the deep inguinal ring.
LATERAL TO INFERIOR EPIGATRIC ARTERY.
Due to congenital patent processus vaginalis so often present young.
Strangulation likely.
Is a direct or an indirect inguinal hernia more likely to strangulate?
Indirect.
What is a femoral hernia?
Herniation of bowel into the femoral canal (in femoral sheath medial to femoral vein) through the femoral ring.
Occur more often in females.
More prone to complications - often strangulated and irreducible.
How can you identify between femoral and inguinal hernias?
Inguinal hernias are superior and lateral to pubic tubercle.
Femoral hernias are inferior and lateral to pubic tubercle.
What are some risk factors for hernias?
Jobs involving heavy lifting. Previous abdo surgery. Obesity. Lack of exercise. Chronic cough. Chronic constipation.
