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19 Cards in this Set
- Front
- Back
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Definition of hernia
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Abnodmal protrusion of contents of a cavity outside the wall of the cavity
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Direct vs indirect inguinal hernia
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Direct comes through posterior inguinal wall.
Indirect hernia comes through deep ring |
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Where is deep inguinal ring
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2cm superomedial to the femoral artery
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Features of indirect hernias
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Tend to occur in children and younger adults
Males - line of weakness due to testicular descent Usually unilateral Can be painful Can extend into scrotum Can obstruct 1%/year Controlled by pressure over internal ring Lateral to inferior epigastric artery |
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Features of direct hernias
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Older adults, male, obese
Frequently bilateral Wide neck so usually painless and do not extend into scrotum / obstruct Not controlled by pressure over internal ring Origin is medial to the inferior epigastric artery |
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Differential diagnosis of lump in groin
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Femoral hernia
Hydrocoele Epididymal cyst Undescended testis Femoral artery anerysm Sapheno-varix Lipoma of cord Lymph nodes |
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How to describe inguinal hernia
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Side
Unilateral or bilateral Inguinal or femoral Direct / indirect Reducible or not incarcerated or not Strangulated |
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Features of strangulated hernia
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Pain, irreducibility, intestinal obstruction, dehydration and toxicosis
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Incarceration
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Hernia cannot be returned to peritoneal cavity and is painful but not toxic
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Strangulation
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The hernia cannot be returned to the epritoneal cavity and is painful and also toxic
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Phases of strangulation
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Venous obstruction, swelling, arterial occlusion -> infarction, necrosis and perforation, peritonitis, septicaemia etc
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Childhood hernia
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Almost always in males due to patent processus vaginalis
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Sliding hernia
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Contains sigmoid colon or caecum which forms posterior wall of hernia
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Littre's hermia
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Contains a Meckel's diverticulum
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Richter's hernia
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Contains a pportion of circumference of intestine
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Repair of inguinal hernia
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Herniotomy - excision of sac (nil else required in childhood)
Hernioplasty - repair of posterior wall of inguinal canal. Lichenstein - on-lay nylon mesh, tension free, stimulates intense fibrotic response 1% recurrence over 10/1 |
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Femoral hernia
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Underneath inguinal ligamentt is femoral canal, NAVXY X=(canal of lymphatics and space for femoral vein to expand as is a capacitance vessle)
Thin elderley women Usually unilateral Often incarcerate because small neck Frequently strangulate |
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Umbilical hernia
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Congenital in infants, frequently resolve
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Paraumbilcal hernia
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Pregnancy, weight loss,
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