s2. hernias Flashcards
what is a hernia?
protrusion of part of the abdominal contents beyond the abdominal wall
signs and symptoms - unstuck and incarcerates
unstuck hernia
- fullness or swelling
- gets larger when intra-abdominal pressure increases
- aches
incarcerated
- pain
- cannot be moved/ pushed back in
- nausea and vomiting
- systemic problems if bowel has become ischaemic
causes
weakness in abdominal wall
- congenitally related
- post surgery wounds not healed (incisional hernia)
- normal points of weakness e.g. inguinal/femoral canal, umbilicus
an increase in intra-abdominal pressure
- obesity
- weightlifting
- chronic constipation/ coughing
3 parts of a hernia
sac- pouch of peritoneum
contents of sac- commonly loops of bowel/omentum
coverings of sac- layers of abdominal wall
hernias in inguinal canal more common with who and which side?
7x more common in males
RIGHT side
what is processes vaginalis? clinical relevance to hernia?
pouch of peritoneum
if it doesn’t close/ obliterate as it should, its an area for inguinal hernia to develop
what forms floor of inguinal canal
inguinal ligament and lacunar ligament (medially)
what forms roof of inguinal canal
internal oblique / transverse abdominus
what forms posterior wall of inguinal canal?
transversals fascia
what tendon is found medially in inguinal canal?
conjoint tendon (of internal oblique and transverus abdomens)
what forms anterior wall of inguinal canal?
aponeurosis of external oblique
inguinal canal runs from
ASIS to pubic tubercle
relation of direct and indirect inguinal hernias to the inferior epigastric vessels
indirect is lateral to epigastric vessels
direct is medial to epigastric vessels
epigastric vessels to towards midline
borders of Hesselbachs triangle
Medial – lateral border of the rectus abdominis muscle.
Lateral – inferior epigastric vessels.
Inferior – inguinal ligament.
route of indirect inguinal hernia
passes through deep inguinal ring, inguinal canal then superficial inguinal ring
> depending on where processes vaginalis obliterated can potentially descent into scrotum
route of direct inguinal hernia
bulges through Hesselbachs triangle
in the vicinity of superficial inguinal ring
NOT inside inguinal canal!!
femoral hernia more common in who and why?
females
pelvic anatomy> femoral ring slightly bigger
what is omphalocele?
failure of midgut to return to the abdomen during development
- viscera covered in peritoneum outside the abdominal cavity therefore not exposed to amniotic fluid.
- often associated with other genetic problems
- high mortality rate
what is gastroschisis?
defect in anterior abdominal wall
- abdominal viscera not covered in peritoneum> exposed to amniotic fluid
- linked to problems with feeding and gut development
- better survival than omphalocele
- defect closed at birth but sometimes may not fit in abdominal cavity so has a staged surgery process
difference between omphalocele and gastroschisis?
O- viscera covered in peritoneum, not in gastroshisis.
higher mortality rate with O than G.
what is umbilical hernia
hernia at site of umbilicus.
close by age 3 without intervention
not usually painful
what is a para umbilical hernia
goes through lines alba in region of umbilicus
acquired adult
what is a strangulated hernia?
one where blood supply is disrupted. can lead to tissue necrosis.
