Hernias Flashcards
What is the definition of a hernia?
protrusion of a viscus (organ) or part or a viscus through a defect of the walls of its containing cavity into an abnormal position
what is an irreducible hernia?
cannot be pushed back into right place
What is incarceration
contents of hernial sac are stuck inside by adhesions
what is reduction en masse
pushing the strangulated hernia and hernial sac back into the abdomen cavity giving the appearance of fixing it yet it is still strangulated
What is the most common type of hernia
inguinal hernia
Where do femoral hernias occur?
What sex are they more common in?
What is the treatment?
Below and lateral to the pubic tubercle
women
surgical repair
Which hernia carries a high risk of strangulation?
femoral hernia
How do paraumbilical hernias present?
What is the treatment
asymmetrical bulge of omentum or bowel directly above or below the umbilicus
more common in women
Rx: mayo repair - repair of rectus sheath
Where do epigastric hernias occur? who are they most common in?
Lump in the midline between umbilicus and the xiphisternum
Most common in men aged 20-30 years
what is an incisional hernia? what is treatment?
follow breakdown of muscle closure after surgery
mesh repair
What is a spegelian hernia
lateral ventral hernia
through linea semilunaris at lateral edge of rectus sheath below and lateral to umbilicus
What is gastroschisis?
Is it associated w congenital abnormalities?
What is the treatment?
- protrusion of abdo contents through a defect in the anterior abdomen wall to the right of the umbilicus w no covering
sac - not associated w congenital abnormalities
- urgent surgical repair
what is exomphalos?
is it associated w congenital abnormalities?
what is rx?
Abdo contents protrude through the umbilical ring, covered w a transparent sac formed by the amniotic membrane and peritoneum
ASSOCIATED w congenital abnormalities
surgical repair
What causes congenital inguinal hernias? who is at risk? what is rx?
patent processus vaginalis
premature males
surgical repair
what causes true umbilical hernias? who is at risk? what is rx?
persistent defect in transversalis fascia, umbilical ring
risk: afro-caribbean,
rx. conservative - most resolve by 3
which sex are inguinal hernia s more common in and by how much?
male, around 95% of pts are male
What are the features of inguinal hernias?
groin lump - disappears on pressure or when the pt lies down
discomfort and ache- worse w activity
strangulation (rare)
What is the management of inguinal hernias? which method provides lowest recurrence rate
Rx even if asymptomatic!
Conservative management if few sx
make sure pts are medically fit- advise on diet (weight)and stop smoking
Mesh repair (Lichtenstein) - lowest recurrence rate
Laparoscopic repair
What are the boundaries of Hasselbach’s triangle? how do they distinguish between indirect and direct inguinal hernias?
medial: rectus abdokminis
lateral: inferior epigastric vessels
inferior: inguinal ligament
hernias occurring within the triangle tend to be direct and those outside - direct
how are inguinal hernias diagnosed?
clinically w a reducible swelling at the level of the inguinal canal
or US or herniogram
how can large inguinal hernias present?
may extend down into the male scrotum
won’t transilluminate and not possible to get above the swelling
