Inguinal Hernias Flashcards
Define Inguinal herniae
Inguinal herniae involve abdominal contents passing into the inguinal canal (and can continue into the scrotum)
Two subtypes of inguinal herniae
- Indirect inguinal hernia
- Direct inguinal hernia
Most common type of inguinal hernia
Indirect inguinal hernia
Define indirect inguinal hernia
Abnormal protrusion of organs:
- lateral to the epigastric artery
- enters the inguinal canal via the deep inguinal ring
Inguinal hernia risk factors
- Old age - weaken abdo wall muscles
- COPD / constiptaion / BPH - increase intra-abdo pressure
- Smoking - affect collagen production
- Obesity
- Male
Define Direct inguinal hernia
Abnormal protrusion of abdo organs:
- medially to the epigatric artery
- enters the inguinal canal via the Hasselbach’s (inguinal) traingle
which type of inguinal hernia is at higher risk of complication
Indirect inguinal hernia
why do indirect inguinal hernia has a higher risk of complicaitons
narrow neck and longer course
Inguinal hernia Sx
- Lump in the groin
Inguinal hernia clinical examination findings
- Cough impulse for reducible inguinal hernia
- Reducibility - on lying down or with gentle pressure
- Unable to get above it - hernia sac is continuous with the abdominal cavity through the inguinal canal
what test is used to differentiate direct and indirect inguinal hernia
Deep ring occlusion test
Deep ring occlusion test finding for direct inguinal hernia
Swelling appears on cough impulse
Deep ring occlusion test finding for indirect inguinal hernia
NO swelling on cough impulse
How is the deep inguinal ring occlusion test performed
- Patient in standing position
- Reduced the inguinal hernia
- Apply pressure on to the deep inguinal ring to occlude
- Ask patient to cough
1st line imagin Ix for inguinal hernia
abdo/pelvis USS
How to differentiate direct and indirect inguinal hernia definitively
during surgery
