Hernias Flashcards
What is a hernia?
A weakness and discontinuity in a cavity wall, usually of the muscle or fascia
What are the complications of hernias?
- Incarceration
- Obstruction
- Strangulation
What is the inguinal canal?
Allows the spermatic cord to travel from inside the abdominal cavity to outside within the scrotum
What is a direct inguinal hernia?
Failure of closure of the internal inguinal ring and degeneration of processus vaginalis
- Pathway from abdomen -> internal inguinal ring -> inguinal canal -> scrotum
What forms Hesselbach’s triangle?
RIP
R - Rectum Abdominis
I - Inferior epigastric vessels
P - Poupart’s ligament/inguinal ligament
What is an indirect inguinal hernia?
Weakness in the abdominal wall around Hesselbach’s triangle
- Hernia protrudes directly through abdominal wall
How do you differentiate between direct and indirect inguinal hernia?
Direct inguinal hernia will remain reduced
Indirect inguinal hernia will not be reduced
Where can inguinal hernias extend into?
Scrotum
What is a femoral hernia?
Weakness around the opening of the femoral canal, below the inguinal ligament
Why is a femoral hernia more at risk of incarceration, obstruction and strangulation?
Has a narrow base to the hernia
What is the difference in positioning of inguinal and femoral hernias?
- Inguinal hernias are located above and medial to pubic tubercle
- Femoral hernias are located below and lateral to pubic tubercle
What is an incisional hernia?
Occurs at the site of incision from a previous surgery
- Due to inadequate closure of the muscle and tissues after an incision
What causes an umbilical hernia?
Defect in the muscle around the umbilicus
Who are epigastric hernias common in?
Men aged 20-30yrs
What is a spigelian hernia?
Herniation through the abdominal wall between the lateral border of rectus abdominis and linea semilunaris
What is hiatus hernia?
Herniation of the stomach through the diaphragm
What is a type 1/sliding hiatus hernia?
Stomach slides up along with the oesophagus through the diaphragm
What is a type 2/rolling hiatus hernia?
A separate portion of the stomach (e.g. fundus) folds around and enters through the diaphragm opening with the oesophagus
What is an obturator hernia?
Abdominal/pelvic contents herniate through the obturator foramen through a defect in the pelvic floor
What are clinical features of an obturator hernia?
Howship-Rhomberg sign
- Pain extending from the inner thigh to the knee when the hip is internally rotated due to compression of the obturator nerve
Bowel obstruction
What is diastasis recti?
Gap between the rectus abdominis muscle
- Linea alba is strecthed and broad
What is a richter’s hernia?
Portion of the bowel herniates through the defect
- Can occur in any abdominal hernia
What indicates that a hernia is at risk of strangulation?
- Episodes of hernia pain that was previously asymptomatic
- Irreducible hernia
What indicates that a hernia is strangulated?
- Pain
- Fever
- Increase in size
- Erythema of overlying skin
- Peritonitic features (guarding and localised tenderness)
- Bowel obstruction (distention, nausea, vomiting)
- Bowel ischaemia (bloody stools)
