Inguinal Hernia Flashcards
What is an inguinal hernia?
Protrusion of abd contents enter inguinal canal
Causing visible / easily palpable bulge
What are the risk factors for an inguinal hernia? (5 things)
- Age
- Male
- Obesity
- Raised intra-abd pressure: heavy lifting / chronic cough / chronic constipation
- Previous abd surgery
What are the 2 different types of hernia?
- Direct
- Indirect
How do you define a DIRECT inguinal hernia? (2 things)
- Bowel enters inguinal canal DIRECTLY thru posterior wall of inguinal canal –> thru weakness in Hesselbach’s Triangle
- Causes a Peritoneal bulge
What are the borders of Hesselbach’s triangle? (3 things)
- Rectus abdominis
- Inf epigastric vessels
- Inguinal ligament
How do you define an INDIRECT inguinal hernia?
Bowel enters inguinal canal via Deep Inguinal Ring
Which type of inguinal hernia is more common?
INDIRECT
How does an INDIRECT inguinal hernia arise? (2 steps)
Congenital
- Incomplete closure of Processus Vaginalis (outpouching of peritoneum)
- –> Embryonic testicular descent of Bowel contents
How does a DIRECT hernia arise? (2 things)
- Abdominal wall laxity
- Significant rise in intra-abd pressure
What test can you do to distinguish between DIRECT and INDIRECT inguinal hernias? (5 steps)
- Locate Deep Inguinal Ring (midway between Ant Sup Iliac Spine n pubic tubercle)
- Reduce hernia (by compressing it towards Deep Inguinal Ring)
- Apply pressure over Deep Inguinal Ring
- Ask patient to cough / stand
- If hernia comes back = DIRECT // If it does not = INDIRECT
doesnt come back bc ur compressing da DIR innit
What is the gold standard way of distinguishing between DIRECT and INDIRECT inguinal hernias?
Surgery
- Direct = medial to Inf epigastric vessels (aka in H triangle)
- Indirect = lateral
What are the other differentials that present similarly (lump in groin) to inguinal hernias? (6 things)
- Femoral hernia
- Inguinal lymphadenopathy
- Lipoma
- Groin abscess
- Internal iliac aneurysm
- Hydrocele / varicocele / testicular mass (if mass extends into scrotum)
How do you diagnose an inguinal hernia?
When would imaging be required? (3 things)
Clinical diagnosis
Imaging (CT) only needed if
1. Diagnosis uncertain
2 Exclude other pathology
3. Complications of obstruction / strangulation
How do you manage a patient with inguinal hernia?
- Surgery
- 1/3 patients no symptoms –> conservatively
What is the surgical management of a patient with inguinal hernia?
- Open mesh repair (for primary inguinal hernia)
- Laparoscopic (for recurrent / bilateral)
