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Gastrointestinal > Lecture 4- Abdominal hernias > Flashcards

Lecture 4- Abdominal hernias Flashcards

1
Q

A hernia is a

A

protrusion of part of the abdominal contents beyond the normal confines of the abdominal walls

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2
Q

hernia

Consists of three components:

​

A
  • Contents of the sac
  • The sac itself (peritoneum)
    • Coverings of the sac (layers of the abdominal wall)
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3
Q
A
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4
Q

Signs and symptoms

A
  • Fullness/swelling
  • Increase in size when intraabdominal sweeling increases e.g. coughing, weight lifting
  • Painful/ constant ache
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5
Q

If a hernia gets stuck (incarcerated)

A
  • Cannot be reduced (pushed back in)
  • Painful
  • May feel sick/ vomiting
  • Tissue damage- ischaemia and necrosis
  • Leaking bowl- sepsis
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6
Q
A
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7
Q

Common hernias

A
  • Inguinal hernias
  • Femoral
  • Umbilical
  • Incisional hernias
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8
Q

what is the inguinal canal

A
  • Inguinal canal is an oblique passage in the lower part of the abdominal wall
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9
Q

male inguinal canal hernia

A

Male – abdomen –> scrotum

7x more likely in men

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10
Q

female inguinal canal hernia

A
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11
Q

embryology of the inguinal canal

A

(diagram is a sagittal view of the development of the testes)

  • Descent of the testes helps us understand the development of the inguinal canal and inguinal hernias
  • Processes vaginalis is the pointy part of the peritoneal cavity (antero infero)
  • Tunica vaginalis is a remnant of the processes vaginalis
  • Gubernaculum becomes the scrotal ligament (yellow)
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12
Q

embryology of the inguinal canal: problems

A

Problems come when the processes vaginalis does not obliterate properly

(you can have different amounts of peritoneal in the testis depending on where and if

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13
Q

When the processes vaginalis does not obliterate……

A
  • The cavity can fill with fluid create a hydrocele
  • Can also provide a pathway for hernias into the scrotum
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14
Q

MUSCLES of the anterolateral abdominal wall

A

external oblique

internal oblique

transverse abdominus

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15
Q

3D image of the inguinal canal

A
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16
Q

floor of the inguinal canal

A

inguinal ligament (thickened roll of the external oblique)

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17
Q

lacunar ligament

A

is a triangular extension of the inguinal ligament that goes down and inserts on the pectineal line- a ridge on the superior ramus of the pubic bone

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18
Q

posterior wall of the inguinal canal

A

transversalis fascia- where deep ring comes from

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19
Q

roof of the inguinal canal

A

muscular arches of the internal oblique and transversus abdominus

20
Q

anterior wall of the inguinal canal

A

aponeurosis of the external oblique (superficial ring)

21
Q

% of hernias that are inguinal

A

75%

22
Q

two types of inguinal hernias

A

indirect- 50%

direct- 25%

23
Q

% of umbilical hernia

A

10%

24
Q

% of incisional hernia

A

10%

25
Q

% of femoral hernia

A

3-5%

26
Q

indirect inguinal henrias are more common in

A

males (x7)and mainly affect right side

27
Q

Indirect inguinal hernia

A

‘a hernia where the herniating structure exits the containing cavity of the abdominal wall by entering the deep ring of the inguinal canal, progressing varying lengths down the canal according to where the processes vaginalis was obliterated. Lies lateral to the inferior epigastric vessels’

Part of the abdominal contents goes through the inguinal canal

  • Enters via the deep ring
  • Depends on where the processes vaginalis obliterated as to how far it goes down the inguinal canal e.g. if it didn’t obliterate at all it could go into the scrotum
28
Q
A
29
Q

direct inguinal hernia

A

‘Does not enter the inguinal canal, it bulges through the weak point in the anterior abdominal wall- Hesselbach triangle. This hernia will also potentially bulge at the location of the superficial inguinal ring ( a weakness).’

  • Lies medial to the inferior epigastric vessels

*we class the hernia by the location it exits*

30
Q

femoral hernias are more common in

A

females (due to anatomical differences in pelvic anatomy)

  • Females still have more inguinal hernias than femoral
    • Uncommon because the femoral ring is quite small
    • More dangerous due to higher likelihood of incarceration – becomes stuck- irreducible ( blood goes (high pressure of artery) in but cant come out)
      • Strangulated hernia
31
Q

outline why femoral hernias are bad

A
  • Femoral hernia can go down the femoral canal
  • Can pop out the saphenous opening
  • Location of femoral hernia is inferior to inguinal ligament
32
Q

umbilical hernias facts

A

hernia through the umbilical rings

  • Common condition (most resolve spontaneously
  • M= f incidence
33
Q

umbilical hernias risk factors

A
  • prematuee
  • african descent
  • low birth rate
34
Q

physiology of umbilical hernia

A
  • A hernia through the umbilical rings
    • Defect in linea alba
    • Umbilical cord passes through
    • Should normally close (age 3-4)
35
Q

umbilical hernia is rarely associated with

A

incarceration or strangulation

  • surgery is very effective
36
Q

Para-umbilical hernia (umbilical hernia that effects adults)

A
  • Hernia through defect in linea alba – near umbilicus
  • F>M
  • Obesity risk factor
  • Risk of strangulation
37
Q

Incisional hernias

A

Hernias that come through a previous incision

38
Q

incisional hernia Risk factors

A
  • Previous surgery
  • Emergency surgery x 2 risk
  • Obesity
  • Midline incision
  • Wound infection
  • Advancing age
  • Hernia
39
Q

prognosis for incisional hernia

A
  • Majority remain asymptomatic
  • 6-15%= incarcerates
  • 2% strangulation
40
Q

common incisions for abdominal surgery

A
  • midline incision
  • paramedian incision
  • gridiron
  • pfannestiel
  • kocher
41
Q

Midline incision –

A

through lineal alba- can be extended – post op pain

42
Q

2. Paramedian incision-

A

poor cosmetic results- can damage nerves/ structures

43
Q

Gridiron –

A

appendicectomy

44
Q

Pfannestiel –

A

obstetric and urology

45
Q

Kocher incision-

A

open cholecystectomy (removal of gall bladder- mostly done by key hole)

Gastrointestinal (35 decks)

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