Hernias Flashcards
define hernia
abnormal protrusion of a viscus through the walls of the containing cavity
define fistula
abnormal communication between two epithelial surfaces
define sinus
blind-ended tract between an epithelial surface and a cavity lined with granulation tissue
define stoma
artificial opening of an internal tube that has been brought to the surface
what is the most common type of hernia?
indirect inguinal hernia
what is the most common type of hernia in women?
indirect inguinal hernia
NOT femoral
what could be the cause of an irreducible hernia?
incarceration
obstruction
strangulation
what are the contents of the inguinal canal?
ilio-inguinal nerve
spermatic cord in men
round ligament of the uterus in women
what are the contents of the spermatic cord?
3 layers of fascia: external spermatic, internal spermatic, cremasteric
3 arteries: gonadal, cremasteric, artery to vas deferens
3 nerves: ilioinguinal nerve, sympathetic branches, genital branch of the genitofemoral nervee
3 other things: pampiniform plexus, vas deferens, lymphatics
what are the boundaries of hesselbachs triangle?
medially: rectus sheath
inferiorly: inguinal ligament
superiorly: inferior epigastric artery
what is the clinical significance of hesselbach’s triangle?
inguinal hernia arising within the traiangle is direct
lateral to the triangle = indirect
what are the boundaries of the inguinal canal?
anterior: aponeurosis of external oblique, internal oblique for lateral 1/3
roof: internal oblique and transversus abdominis fibres
posterior: transversalis fascia laterally, conjoint tendon medially
floor: inguinal ligament
what are the boundaries of the femoral canal?
anterior: inguinal ligament
posterior: pectineus and pectineal ligament
medial: lacunar ligament
lateral: femoral vein
what are the complications of a surgical hernia repair?
general: bleeding, infection, VTE, anaesthetic complications
specific: recurrence of hernia, ischaemic orchitis
what is the difference between the mid inguinal point and the midpoint of the inguinal ligament?
mid-inguinal point = between ASIS and pubic symphisis. surface marking of femoral artery
midpoint of inguinal ligament = between ASIS and pubic tubercle. surface marking for deep inguinal ring
what features of a lump should you try to elicit during examination?
site size tenderness warmth consistency cough impulse is it reducible
where is the sapheno-femoral junction?
2-3cm inferolateral to the pubic tubercle, or just medial to the femoral artery
where in relation to the pubic tubercle will an inguinal hernia arise?
superior and medial
where in relation to the pubic tubercle will a femoral hernia arise?
inferior and lateral
why should you examine the whole abdomen if a patient has a hernia?
check for:
abdominal masses e.g. tumour
ascites
bowel obstruction
which would increase intra-abdo pressure and increase risk of hernia
how could you distinguish between an indirect and direct inguinal hernia on examination?
reduce the hernia
apply pressure over the deep inguinal ring
ask pt to cough
if hernia reappears = direct
if hernia only reappears once pressure over deep ring is removed = indirect
what is the anatomical difference between indirect and direct inguinal hernias?
direct - protrudes through a weakness in the transversalis fascia. arises medial to the inferior epigastric artery.
indirect - goes through the inguinal canal and protrudes through the deep inguinal ring. arises lateral to the inferior epigastric artery
what are the differentials for a groin lump?
hernia lymphadenopathy psoas abcess femoral nerve neuroma saphena varix femoral artery aneurysm/pseudoaneurysm lipoma sebaceous cyst hydrocele ectopic testes
what could cause a hernia?
bowel obstruction
bowel strangulation
increased intra abdominal pressure
surgery
