Hernias Flashcards
Direct hernia pathway
Protrudes from hesellbach triangle through the posterior wall of the inguinal canal
Can traverse the inguinal canal and come out of the superficial inguinal ring to cause scrotal hernia
Direct hernia in relation to inferior mesenteric vessels
Medial
Indirect hernia pathway
Protrudes through deep ring of the inguinal canal, traverses the inguinal canal, comes out of the superficial ring
Reducible
When hernial contents can be pushed back in to original position
Incarcerated
Irreducible as compressed by defect
Strangulated
Compression around hernia prevents blood flow into the hernia contents causing ischaemia and pain
- medical emergency
Risk factors
Increased intra abdominal pressure:
- obesity
- pregnancy
- weight lifting
- chronic cough
- constipation
Weakness of the abdominal muscles
- age
- previous surgery
- male
Symptoms
Lump in the groin
Comes and goes
Asymptomatic normally
Symptoms:
- RIF/LIF pain
- fever
- bowel obstruction - N+V, constipation
- bowel ischaemia - blood in stools
Signs
Ask patient to cough - Reducible lump
Signs of bowel obstruction - abdominal distension
Strangulated hernia - tenderness and irreducible
Can’t get above lump
DO NOT MANUALLY REDUCE STRANGULATED HERNIA - risk of peritonitis
How to tell if direct or indirect hernia
- Reduce hernia
- Occlude deep internal ring with 2 fingers
- Ask patient to cough
- If restrained - indirect,
- if not - direct
Investigations
Abdominal examination Obs Bloods - FBC, CRP, LFTs, U+Es (Group and save and lactate if strangulated) Urine analysis
Imaging:
AXR
USS
CT groin and abdomen
Management of asymptomatic hernia
Conservative
- lose weight
- avoid weigh lifting
- watch and wait with regular follow up
Uncomplicated, symptomatic hernia management
Elective surgery
Complicated, symptomatic hernia management
Immediate surgery
Difference between inguinal and femoral hernia
Inguinal - superior and medial to pubic tubercle
Femoral - inferior and lateral to pubic tubercle
