Inguinal hernia Flashcards
What is the definition of an inguinal hernia?
Protrusion of abdominal organ through weak muscles of the abdominal wall into the inguinal canal
How common are inguinal hernias?
Most common type of hernia – 70% of all hernias
What is the pathology of inguinal hernias (including direct and indirect)?
- Intestine/fatty tissue goes into the inguinal canal
- Through the transversalis fascia, internal oblique, external oblique
- Indirect: Congenital defect in abdominal wall, lateral to inferior epigastric artery. Originates at the deep ring and goes through the superficial ring like the spermatic cord
- Direct: weakness in abdominal wall over time, medial to inferior epigastric artery. Only goes through the superficial inguinal ring
What are the risk factors/aetiology of inguinal hernias?
- Males – bigger inguinal canal as more passes through it
- Hernia history
- Age – older = more risk
- Caucasian
- Weak abdominal wall
- Smoking
- Chronic cough
- Constipation
- Urinary obstruction
- Heavy lifting
- Previous abdominal surgery
- Obesity
What are the signs/symptoms of inguinal hernias?
- Lump in groin (medial and superior to pubic tubercle) – maybe painful
- Enlarged scrotum – maybe painful
- Lump appears when lifting something/straining/coughing/exertion
- Lump disappears when you lie down
- Nausea/vomiting – obstruction
- Constipation
- Obesity
What diseases can inguinal hernias present similarly to?
- Femoral hernia
- Hydrocele
- Undescended testes
What investigations are undertaken for suspected inguinal hernias?
- US
- CT – with contrast and the Valsalva manoeuvre being done is best
- MRI – when uncertain of hernia
What are the surgical treatments for inguinal hernias?
- Laparoscopic inguinal hernia surgery – only done if symptomatic
- Open laparoscopic inguinal hernia surgery – only done if symptomatic
What are the pharmacological treatments for inguinal hernias?
- Painkillers
* Fluids
What are the non pharmacological treatments for inguinal hernias?
- High fibre and water diet – to avoid constipation
- Weight loss advice
- Smoking cessation
- Truss hernia belt