Hernias Flashcards
what is the definition of a hernia?
the protrusion of an organ or part of an organ through a defect in the wall of the cavity containing it, into an abnormal position.
what is the structure of a hernia?
sac, contents, covering of sac
what are common contents of hernias?
o Omentum – omentocoel, epiplocele o Intestine - enterocoel o Bladder - cystocoel o Part of intestine – richters hernia o W type intestine – maydls hernia o Meckels diverticulum – littres hernia
what are the causes of hernias?
increased abdo pressure weakness of abdominal muscles excess fat muscle weakness following pregnancy surgical incisions familial
what are causes of increased abdominal pressure?
smoking, chronic cough, obesity, constipation with straining, pregnancy, prostatic enlargement, heavy lifting (precipitating factors)
what are the different types of hernias?
Inguinal Femoral Umbilical Incisional Epigastric Rare Hernias: Lumbar, Spegilian, Obturator
what are the two types of inguinal hernia?
indirect and direct?
where do indirect inguinal hernias occur?
at the opening of the inguinal canal
where do direct inguinal hernias occur?
near the opening of the inguinal canal
where do femoral hernias occur?
in femoral canal
where do umbilical hernias occur?
at the naval
where do incisional hernias occur?
site of previous surgical incision
where do epigastric hernias occur?
upper abdomen at the midline
what are reducible hernias?
contents can be replaced completely into the peritoneal cavity
why might a hernia be irreducible?
o adhesions of content to each other
o adhesions of content with the sac
o adhesions of one part of sac to other part
o narrowed neck of sac
o Occasionally, inspissated faeces within the loops of bowel in the hernia prevent reduction
what are obstructed hernias?
irreducibility + intestinal obstruction
what are the clinical features of a reducible hernia?
cough impulse
Lump that may disappear on lying down and is usually not painful, discomfort
what are the clinical features of an irreducible hernia?
painless?
what are the clinical features of obstructed hernias?
Vomiting/pain/distension/bowel movement/dehydration
what are strangulated hernias?
irreducibility + obstruction + arrest of blood supply
what is the pathophysiology of strangulated hernias?
contents of the hernia are constricted by the neck of the sac causing cut off of circulation. Can cause gangrene and bowel perforation.
what are the clinical features of strangulated hernias?
o Tender, tense hernia, non reducible, no cough impulse, overlying skin is inflamed and oedematous
o Signs of intestinal obstruction – abdominal tenderness, noisy bowel sounds
inguinal hernias tend to occur in
males
indirect inguinal hernias are
most common in women