Inguinal, Femoral and other Hernias Flashcards
What is a hernia?
Weak point in a cavity wall leading to abnormal protrustion of a bodys cavity, taking its linings with it.
A hernia is a protrusion of a viscus or other structure beyond the normal coverings of the cavity in which it is contained
List 4 typical features of an abdominal wall hernia
- Soft lump protruding from the abdominal wall
- May be reducible
- May protrude on coughing or standing
- Aching, pulling or dragging sensation
List 3 key complications of a hernia
- Incarceration (cant be reduced)
- Obstruction
- Strangulation
What is meant by Incarceration?
Cannot be reduced, bowel is trapped in the herniated position
Can lead to obstruction and strangulation
What is meant by Obstruction?
How would this present?
Blockage in the passage of faeces through the bowel
Presents with vomiting, generalised abdominal pain and absolute constipation
What is meant by Strangulation?
How would this present?
Hernia is non-reducible and it cuts off the blood supply causing ischaemia
Presents with significant pain and tenderness at the hernia site
Surgical emergency
What is the hernia sac?
Hernia sac has FUNDUS, BODY and NECK
List the coverings of a hernia sac
- skin
- subcutaneous fat
- aponeurosis
- muscle
- endo-cavity fascia
- endothelial lining – peritoneum in the abdomen
List the most common contents of a hernia
Small bowel and omentum is most common
List 4 main causes of hernia
Increased intra abdo pressure
Weakness/defect
Obesity
Congenital
List 4 things which cause an increase in abdominal pressure and may precipitate a hernia
Heavy lifting
Chronic cough
Straining to pass urine/faeces
Pregnancy
Why do hernias with a wider neck has lower risk of complications?
Because the size of opening means contents can easily pass out and can also be easily put back in
Lower risk of incarceration, obstruction and strangulation
What is Richters Hernia?
When the antimesenteric wall of intestine protrudes through a defect in the abdominal wall
Results in strangulation and necrosis without obstruction
How do you examine a hernia?
Examine in SUPINE & STANDING Positions
- Lying position to help to reduce the hernia
- Standing position/gravity helps hernia to reappear
- CONTROL of hernia is the ability to prevent the hernia reappearing by digital pressure at the neck
- Remember to examine the opposite side and other common sites
- Consider features of predisposing factors like COPD, Prostatism, colonic cancer
- TENDER HERNIA indicates strangulation
- Obstructed hernia- features of intestinal obstruction (details)
How does an inguinal hernia present?
Soft lump in the inguinal region (in the groin)
What are the 2 types of inguinal hernias?
Direct vs Indirect
What is a direct inguinal hernia?
Hernia due to weakness in the abdominal wall through Hesselbach’s triangle
What are the boundaries of Hesselbach’s triangle?
Medial – lateral border of the Rectus Abdominis
Lateral – Inferior epigastric vessels
Inferior – Inguinal ligament
What is a Indirect Inguinal hernia?
Where the bowel herniates through the inguinal canal which runs between the deep and superficial inguinal ring
What is the significance of the inguinal canal in males during foetal development?
Allows the spermatic cord and its contents to travel from inside the peritoneal cavity, through the abdominal wall and into the scrotum
What is the significance of the inguinal canal in females during foetal development?
The round ligament, attached to the uterus, passes through the deep inguinal ring, inguinal canal and then attaches to the labia majora
What is the purpose of the processus vaginalis?
What normally happens to this structure?
The processus vaginalis (pouch of peritoneum) allows the testes to descend from the abdominal cavity, through the inguinal canal and into the scrotum
Normally after the decent, the deep inguinal ring closes and the processus vaginalis is obliterated
How may development failure lead to a an indirect hernia?
When there is failure of the inguinal ring to close and the processus vaginalis remains intact
This leaves a patent tract through which the bowel can herniate through
What specific finding on examination can help differentiate a direct vs indirect inguinal hernia?
When an indirect hernia is reduced and pressure is applied to the deep inguinal ring - It will remain reduced!
