Hernias Flashcards
Define it
What does it consist of?
The protrusion of a viscus (organ of the body) or part of a viscus through the walls of its containing cavity into an abnormal position.
Hernial sac and neck
Define:
- Reducible
- Irreducible
- Obstructed
- Strangulated
- Incarceration
Content can be pushed back into place
Content cannot be pushed back into place
Bowel contents cannot pass - features of intestinal obstruction
Ischaemia occurs - the patient requires urgent surgery
Contents of the hernial sac are stuck inside by adhesions
Sliding hernia - define?
Sliding hiatal hernias are those in which the junction of the oesophagus and stomach, referred to as the gastro- oesophagal junction, and part of the stomach protrude into the chest. The junction may reside permanently in the chest, but often it juts into the chest only during a swallow.
Richter’s hernia - define?
Maydi’s hernia - define?
Only part of the hernia protrudes - you get strangulation without obstruction - look at pics
W-shaped loop (two adjacent loops) in the hernial sac with tight, strangulated neck - look at pics
6 types of abdominal wall hernias
Inguinal Femoral Epigastric Umbilical Paraumbilical Incisional
3 types of internal hernias
Diaphragmatic (hiatus or congenital)
Mesenteric
Omental
What is the most common?
Inguinal
Most are asymptomatic. You can get mild discomfort/pain.
What 2 ways is the pain described?
What makes the pain worse?
Heavy
Dragging
Worse on straining
What type of abdominal hernia is typically missed and should be checked in any acute abdomen case?
Femoral - 1 in 3 present with strangulation or bowel obstruction
One risk factor is increased intra-abdominal pressure. Give some causes of this?
Another risk factor is wall weakness.
Give some causes of this?
Chronic cough Constipation Urinary obstruction Ascites Heavy lifting --------- Obesity Smoking Previous surgery Connective tissue disorders
Inguinal hernias:
What sex is it commoner in?
What does the viscus pass through?
2 places it can be felt?
Male
Inguinal canal
Either medial to pubic tubercle (more common) or lateral when entering canal and not fully protruded.
Indirect inguinal hernias - commonest - effecting young as well as old:
Where does it enter into?
Cause?
What congenital problem may lead to this?
Deep inguinal ring and comes out at the superficial ring
A persistent opening that does not close during fetal development.
Patent processus vaginalis - look it up
Direct inguinal hernias:
Where does it enter into?
Cause?
What makes this better than indirect?
Protrudes through the abdo wall into the inguinal canal
Age-related stress and weakened muscles in the inguinal canal so there is a weakness in the abdo wall
They rarely extend into the scrotum so there are fewer complications
Femoral hernias:
Where is the protrusion through?
What are the canal borders?
What sex is it commoner in?
Femoral canal
Femoral vein (lat) Lacunar ligament (med) Inguinal ligament (ant) Pectineal ligament (post)
Women
Groin and scrotal lumps:
How can you distinguish between femoral and inguinal hernias and other causes of lumps? - 3
Can’t get above the lump - you can’t use a finger to sort of grasp it
Bowel sounds on auscultation
Able to reduce
