Session 2 Hernias Flashcards
What is a hernia
A protrusion of part of the abdominal wall contents beyond the normal confines of the abdominal wall
Parts of a hernia
Contents of sac, the sac, coverings of the sac
General signs and symptoms of hernia
Increased intra abdominal pressure
Swelling
Discomfort
Nausea and vomiting
Necrotic bowel (peritonitis)
Lots of pain if incarcerated
4 common hernias
Inguinal
Femoral
Umbilical
Incisional
What is inguinal canal
Oblique passage through the lower part of the abdominal wall
Inguinal canal men vs women
Men abdomen to scrotum
Women uterus to labium majus
Inguinal canal embyology
Processus vaginalis proceeds descent of testes
Testes are initially retroperitoneal
Gubernaculum guides descent of testis
Processus vaginalis key points
Can obliterate at different points
Walls of Inguinal canal
Anterior wall- aponeurosis of external oblique
Posterior- transversalis fascia
Floor and roof and medial Inguinal canal
Floor is Inguinal ligament
Roof is internal oblique and transverse abdominus
Medial is lacunar ligament
Indirect hernia’s key points
Small bowel enters Inguinal canal via deep ring
Herniates to varying degrees relating to obliteration of Processus vaginalis
Lies lateral to inferior epigastric vessels
Direct Inguinal hernias key points
Protrudes through weakness in Hesselbachs triangle
Lie medial to inferior epigastric vessels
Hesselbachs triangle borders
Lateral abdominal rectus
Supero lateral inferior epigastric vessels
Inferior Inguinal ligament
Anatomy of femoral triangle
NAVEL
Nerve artery vein empty space (femoral canal) lymphatics
Borders of femoral triangle
Sartorial, Inguinal ligament, adductor longus
Strangulated hernia process
Incarcerated, stuck, irreducible, blood supply compromised, ischaemic , tissue of constants of hernia becomes necrotic, breaks down, strangulated hernia
What happens in umbilical hernia
Hernia goes through umbilical ring - defect in linea Alba, should close
Umbilical hernia salient clinical points
Not usually painful, most close alone, unusual to have incarceration or strangulation, surgery very effective
What are para umbilical hernias
Affect adults,
Hernia through defect in linea alba near umbilicus
Obesity and female = risk factor
Risk of strangulation
What are incisional hernias
Herniate through previous incision, majority remain asymptomatic
Risk factors for incisional hernias
Previous surgery, emergency surgery
Obesity
Mid line
Wound infection
Features of red
Red is midline - through linea alba, extendable, lots of post op pain
Features of green
Paramedian
Poor cosmetics, can damage nerves and structures e.g. falciform ligament
Features of yellow blue and turquoise
Yellow- gridiron, appendectomy
Blue- kocher, open cholecystectomy (gall bladder removal)
Turquoise- pfannenstiel (obstetric and urology)
