Hernias Flashcards
define hernia
abnormal protrusion of a body part through the wall that normally contains it
the inguinal canal runs superior/inferior and parallel to the inguinal ligament
superior and parallel
define mid-inguinal point
halfway between ASIS and pubic symphysis
define midpoint of the inguinal ligament
halfway between the ASIS and pubic tubercle
What makes up the superior border of the inguinal canal
2Ms
internal oblique Muscle
transversus abdominus Mucle
what makes up the anterior border of the inguinal canal
2As
external and internal oblique aponeuroses
What makes up the inferior border of the inguinal canal
2Ls
inguinal Ligament
Lacunar Ligament
what makes up the posterior border of the inguinal canal
2Ts
Transversalis fascia
conjoint Tendon
what is the deep inguinal ring and where is it found
found at the midpoint of the inguinal ligament, lateral to the inferior epigastric artery
opening in the transversalis fascia
what is the superficial inguinal ring and where is it found
opening in the external oblique aponeurosis
found superior and medial to pubic tubercle
what are the contents of the inguinal canal in males
spermatic cord
- 3 arteries: vas, testicular, cremasteric
- 3 nerves: GF, symp, cremasteric
- 3 fascia: external, cremasteric, internal
- 3 others: vas deferens, paminiform plexus, lymphatics
ilioinguinal nerve is found in the canal but not in the spermatic cord
what are the contents of the inguinal canal in females
ilioinguinal nerve
round ligament of the uterus
what nerve is at risk of damage in hernia surgery
ilioinguinal nerve
what are the borders of the Hesselbach triangle
medially = lateral border of rectus abdominus laterally = inferior epigastric artery inferiorly = inguinal ligament
indirect / direct inguinal hernias protrude through Hesselbach’s triangle
DIRECT
borders of the femoral canal
laterally = femoral vein medially = lacunar ligament anteriorly = inguinal ligament posteriorly = pectineus
contents of the femoral triangle from lateral to medial
NAVEL femoral Nerve femoral Artery femoral Vein Empty space - femoral canal Lymphatics
the femoral sheath encloses all structures of the femoral triangle except which structure?
femoral nerve
define irreducible hernia
unable to push hernia back into the right place, not necessarily strangulated
differential for transient scrotal swelling
hernia
define incarcerated hernia
hernial sac stuck by adhesions
define obstructed hernia
bowel contents are unable to pass
define strangulated hernia
there is ischaemia
RF for inguinal hernias
male age chronic cough - smoker constipation previous surgery heavy lifting previous hernia ascites
an in/direct inguinal hernia passes through the deep inguinal ring and superficial inguinal ring
INDIRECT hernia
in/direct inguinal hernias are lateral to the inferior epigastric artery
INDIRECT
which is more likely to strangulate, an in/direct hernia
indirect
what is the pathology behind a direct hernia
it protrudes through a weakness in the posterior wall of the inguinal canal
in/direct inguinal hernias are medial to the inferior epigastric artery
DIRECT
when a patient is standing and you have reduced the hernia and asked the patient to cough, what would happen if it was an indirect hernia
it would not reappear
when a patient is standing and you have reduced the hernia and asked the patient to cough, what would happen if it was a direct hernia
it would reappear
management of inguinal hernias
conservative - smoking cessation, weight loss
operative - open mesh repair, laparoscopic
what is a femoral hernia
bowel passes through the femoral canal resulting in a mass
RF for femoral hernias
female
middle aged - elderly
present with SBO having had no previous surgery
what is a severe risk of femoral hernias
irreducible and can strangulate
an inguinal hernia is superior/inferior and medial/lateral to the pubic tubercle
superior and medial
a femoral hernia is superior/inferior and medial/lateral to the pubic tubercle
inferior and lateral
what should you consider in a PWID with groin pain
psoas abscess
which artery is a marker of the deep inguinal ring
inferior epigastric artery
in babies, what defect can predispose them to an inguinal hernia
patent processus vaginalis
why are inguinal hernias more common on the RHS
previous appendicectomies (historic now) right kidney is lower down because of the liver
indications for inguinal hernia repair
pain
cosmesis
impairment of everyday activities
what are patients at high risk of following hernia surgery
chronic pain
list immediate complications of hernia repair surgery
incise the femoral vein or testicular artery
list early complications of hernia repair surgery
wound infection
haematoma
wound dehiscence
list late complications of hernia repair surgery
DVT/PE
why are femoral hernias more common in females
women in their 60s generally have more fat which occupies the femoral canal
when they reach their 80s, they lose that fat which makes space for bowel to herniate
what should you do if you have an elderly lady complaining of umbilical pain and all her investigations are normal
check for femoral hernias
how should you carry out a hernia examination
ask the patient to stand and face the wall
stand to the side of the patient
ask them to show you their hernia and reduce it if they can
ask them to cough and observe if it reappears
what is palpated at the midinguinal point
femoral artery
what is found at the midpoint of the inguinal ligament
deep inguinal ring
why would you be scared of infection in a mesh repair
mesh is a foreign material which bacteria can grow on despite antibiotics
more complicated as you have to remove the mesh and then operate again in 6 months
chronic coughers are more likely to have an in/direct hernia
direct
differentials for a groin lump in PWID
groin abscess –> drain by gen surg
pseudoaneurysm –> vascular
