Inguinal Hernia Flashcards
1
Q
What is an inguinal hernia
A
- Protrusion of abdo contents through inguinal canal
- Indirect or direct
2
Q
How common is it
A
- most common type hernia
3
Q
Who does it affect
A
- M>F (8:1)
4
Q
How common are indirect and direct hernias
A
- Indirect inguinal = 80%
- Direct = 20%
5
Q
What is an indirect inguinal hernia
A
- Pass through internal inguinal ring (if large also through external ring)
- Can strangulate)
6
Q
What is a direct inguinal hernia
A
- Push directly forward through posterior wall of inguinal canal –> into defect in abdo wall –> Hesselbach’s triangle
- Easily reducible, rarely strangulation
7
Q
What are boundaries of the inguinal canal
A
- Floor: inguinal ligament + lacunar ligament medially
- Roof: Fibres of transversalis, internal oblique
- Ant: external oblique aponeurosis + internal oblique for lateral 1/3
- Post: laterally = transversalis fascia, medially = conjoint tendon
8
Q
What are some of the risk factors in infants and adults
A
- In infants –> prematurity, male
- In adults –> male, obesity, constipation, chronic cough, heavy lifting, urinary obstruction, ascites
9
Q
What are the symptoms of inguinal hernia
A
- Swelling appear w/ lifting + accompanied w sudden pain (indirect more prone to cause pain)
- ‘Dragging’ sensation –> indirect
- Impulse (^ in swelling) on coughing
- May be reducible
10
Q
What are the signs of an inguinal hernia
A
- MASS ABOVER + MEDIAL TO PUBIC TUBERCLE
11
Q
How do you distinguish between an indirect and direct hernia
A
- Reduce hernia + occlude deep/int ring w. fingers, ask pt to cough or stand
- Hernia restrained = indirect
- Hernia appars = direct
12
Q
What investigations would you perform
A
- USS
- Dx largely clinical
13
Q
How do you treat
A
- Surgery - hernitomy, mesh techniques (reinforce post wall)
- Advise diet + stop smoking pre-op
- Warn about recurrence
