Hernias

Front 1

What is a hernia?

Back 1

Any structure passing through another so as to end up in the wrong place.

Protrusion of a viscus through an abnormal opening, so as to end up in the wrong place.

Protrusion of tissue or viscus through the muscle tissue or membrane in which it is normally maintained

Front 2

Complications hernias?

Back 2

Incarceration - formation of adhesions results in the contents of the hernia being fixed in place

Obstructed - bowel contents cannot pass through them

Strangulated - ischaemia occurs because the blood supply has been compromised

Front 3

What is an inguinal hernia?

Back 3

2 types: direct and indirect

Direct - hernia pushes through posterior wall of inguinal canal

Indirect - hernia psses hrough the internal inguinal ring and possibly out the ext ring

Front 4

Cause of indirect hernia?

Back 4

Failure of the embryological connection between peritoneum + tunica vaginalis to close = patent processus vaginalis

This passage is needed for the decent of the testis in men.

Therefore very uncommon in females - consider testicular feminisation.

If the processus vaginalis contains peritoneal fluid only = communicating hydrocele

Front 5

Rx indirect hernia?

Back 5

Surgical closure processus vaginalis with high ligation

Front 6

Causes direct inguinal hernia?

Back 6

Chronic increase abdo pressure, e.g:

Chronic cough
Constipation
Urinary obstruction
Weight lifting
Ascites
Abdo surgery

Front 7

Inguinal anatomy

Back 7

Inguinal ligament - runs pubic tubercle to ant sup iliac spine

Internal inguinal ring - mid point inguinal ligament or 1.5cm above femoral pulse

External ring - just above and medial to the pubic tubercle

Front 8

Where does the ing lid run?

Back 8

Front 9

What makes up the inguinal canal?

Back 9

Floor = inguinal ligament
Roof = fibres transversalis, int oblique + conjoint tendon
Front = Ext oblique aponeurosis + int oblique
Back = lateral;transversalis fascia medial;conjoint tendon

Front 10

Examination inguinal hernia?

Back 10

Ask patient to reduce lump themselves.

Ask patient cough - inguinal hernias appear infero-medial to the ext ring

Differentiate direct from indirect - occlude internal ring after reduction then get patient to cough - if it reappears = direct hernia

Front 11

Where is a femoral hernia?

Back 11

Inferior and laterial to pubic tubercle

Remember - inguinal are superior and medial

Front 12

Boundaries femoral canal?

Back 12

Ant + medial = inguinal ligament

Lateral = femoral vein

Posteriorly pectineal ligament and pectineus muscle