Inguinal, Femoral + Umbilical Hernia Flashcards
what is an inguinal hernia
what is the difference between direct + indirect inguinal hernia
how does this impact management
when abdominal contents protrude into inguinal canal / through the superficial inguinal ring.
This viscera is normally made up of some small bowel, but not always.
Inguinal hernias can either enter this ring directly through the deep inguinal ring or indirectly through the posterior wall of the inguinal canal.
management is the same for both
what is the presentation of inguinal hernia
groin lump - superior + medial to pubic tubercle
reducible - disappears when you apply pressure or when patient lies down
discomfort, ache or burning –> worsens with physcial activity
not severe pain unless it is strangulated
lump can be present in scrotum
who is at risk of inguinal hernias
men
indirect - more common in young men
normally congenital due to patent processus vaginalis
direct - more common in older men
risk factors associated with increased intra-abdominal pressure e.g. coughing, heavy lifting, constipation
what is the management for inguinal hernias
if hernia is symptomatic –> repair laprascopically or open surgery using mesh
if hernia is asymptomatic –> watchful waiting –> monitor hernia and risk factor modification e.g. not strenous abdominal exercise
watchful waiting is is good if patient is frail, elderly or high risk for surgery
what are the risk factors for inguinal hernia strangulation
hernia being incarcerated (irreducible)
more likely to occur if there is a tight hernia neck
how does a strangulated inguinal hernia present
hard, irreducible, inflamed hernia
intense pain
fever
peritonitic features - guarding + tenderness
bowel obstruction –> distension, nausea + vomiting
bowel ischaemia –> bloody stools
what are the potential complications of an inguinal hernia
strangulation:
when blood supply to the herniated tissue is compromised –> medical emergency –> can lead to bowel obstruction and bowel ischaemia
incarcerated:
herniated tissue is irreducible –> bowel obstruction –> increased risk for strangulation
which type of inguinal hernia is more likely to strangulate
indirect are much more likely to than direct
what are femoral hernias
abdominal tissue which passes through femoral ring into potential space in femoral canal
how do femoral hernias present
lump in groin - inferior and lateral to pubic tubercle (found medial to the femoral pulse)
mildly painful
normally not reducible
can present acutely as strangulation
what are the complications of a femoral hernia
they are much more likely to strangulate due to tight hernia neck
so can present as surgical emergency as strangulation or obstruction —> can then lead to bowel ischaemia + resection needed
who is at risk of getting femoral hernias
women
women who have been pregnant in past (multiparous)
raised intra-abdominal pressure - coughing, straining, heavy lifting
overall femoral hernias are much less common than inguinal
what is the management for femoral hernias
all need to be treated surgically - through lapartomy or laprascopically
don’t use truss belts
how to differentiate between inguinal and femoral hernias
reducible:
inguinal are often reducible (unless incarcerated)
femoral are often irreducible
location:
inguinal - superior + medial to pubic tubercle, can protrude into scrotum
femoral - inferior + lateral to pubic tubercle (medial to femoral pulse)
cough impulse:
inguinal - cough impulse positive (feel in inguinal region + cough –> feels bulge)
femoral - no cough impulse
patient:
inguinal - male, younger (indirect) or old (direct)
femoral - female, older, multiparous
femoral are more serious but much less common
strangulation more common in femoral
what is an umbilical hernia
congenital:
failure of the umbilical ring to close after birth –> protusion of intra abominal contents through (omentum or small bowel)
acquired:
what are the risk factors for umbilical hernias
children:
afro-caribbean
down syndrome
mucopolysaccharide storage diseases
adult:
obesity
ascites
previous surgeries (incisional hernia)
what is the presentation and management of umbilical hernias
present at birth
bulge at the umbilicus - get bigger when baby cries or strains
reducible
usually resolve themselves by 3 yrs old
complications are very rare - due to wide hernia neck
what are potential differnetials for an inguinal or femoral hernia
lymphadenopathy - enlarged lymph node is non-reducible, use US to differrentiate, (mimicks femoral hernia)
femoral artery aneurysm - woud be pulsatile, use US to differntiate
abscess - fever
hydrocele or variocele in men -
lipoma of spermatic cord - doesn’t change in size with body position, use US to differentiate
