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Small Bowel > Inguinal Hernias > Flashcards

Inguinal Hernias Flashcards

1
Q

What is a inguinal hernia

A

A protrusion of abdominal cavity contents into the inguinal canal

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2
Q

what is the most common type of hernia

A

Inguinal hernia ( 75% )

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3
Q

What are the two subtypes of inguinal hernias

A

Direct inguinal hernia - 20%

Indirect inguinal hernias - 80%

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4
Q

What happens in a direct inguinal hernia

A

Bowel enters the inguinal canal directly though a weakness in the posterior wall of the inguinal canal.

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5
Q

What are the borders of hesselbachs triangle

A

Lateral border of rectus abdominis

Inferior epigastric vessels

Inguinal ligament ( bit of lacunar ligament if you want to be picky)

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6
Q

Why do direct inguinal hernias occur

A

Abdominal wall laxity especially with increase in age

A significant rise in intra-abdominal pressure

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7
Q

Why do indirect inguinal hernias occur

A

Due to a incomplete closure of processus vaginalis

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8
Q

How are you able to differentiate between the direct and indirect hernias anatomically

A

Direct => medial to the inferior epigastric vessels

Indirect => lateral to the inferior epigastric vessels

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9
Q

what are the risk factors of developing inguinal hernias

A

Male

Increasing age

Raised intra-abdominal pressure - chronic cough, lifting heavy things, chronic constipation

Obesity

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10
Q

What are the clinical features of those with a reducible inguinal hernia that

A

Lump in the groin that disappears when patient lies flat or is pushed back by a doctor

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11
Q

what does a incarcerated hernia mean

A

A hernia that is stuck and cannot be reduced back to where it came from

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12
Q

How would a patient present if the hernia was incarcerated

A

Painful

Tender

Erythematous

Bowel obstruction

Strangulation

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13
Q

how do you clinically differentiate direct inguinal hernias from indirect

A

The hernia must first be reduced and then pressure over the deep inguinal ring must be applied.

Patient must then be asked to cough and if pressure is felt at the deep ring then this is a direct hernia. If pressure is not felt as the deep ring => indirect hernia

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14
Q

What is the inguinal ligament

A

Ligaments are from bone to bone and this one attaches from ASIS to the Pubic tubercle

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15
Q

What is the mid-inguinal point

A

Half way between the ASIS and pubic tubercle

This is where you can feel the femoral artery

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16
Q

What anatomical structure is found at the mid point of the inguinal ligament

A

Deep inguinal ring

17
Q

What are the differentials for groin lump

A

Femoral hernia

Saphena varix

Inguinal lymphadenopathy

Lipoma

Groin abscess

Internal iliac aneurysm

18
Q

How are inguinal hernias investigated

A

Usually a clinical diagnosis and patients may undergo exploratory surgery for definitive diagnosis

However USS may be performed if there is diagnostic uncertainty or to exclude other pathology

19
Q

How would you treat a symptomatic inguinal hernia

A

Surgical intervention

20
Q

How much is the risk of strangulation for a inguinal hernia that is not treated

A

3% per year

21
Q

What are the two surgical options to treat hernias

A

Open ( Lichtenstein technique )

Laparoscopic ( Total extraperitoneal or transabdominal pre-peritoneal)

22
Q

Which type of surgical repair is preferred in those with a primary inguinal hernia

A

Open mesh repairs

23
Q

When is a laparoscopic approach preferred over open

A

Those pts with bilateral hernias / recurrent

It can also be considered in those who are at risk of chronic pain

24
Q

What is the advantage of laparoscopic surgeries compared to open

A

Quicker post op recovery

Fewer complications

Less post op pain

25
Q

Which types of hernias require urgent medical attention

A

Irreducible/incarcerated

Obstruction - bowel lumen is obstructed

Strangulation - leads to bowel ischaemia

26
Q

What are the complications of inguinal hernias

A

Incarcerated

Strangulation

Obstruction

27
Q

what are the post op complications of hernias

A

Pain, bruising, haematoma, infection, urinary retention.

Reoccurrence

Chronic pain

Damage to vas

Small Bowel (5 decks)

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