[78] Inguinal Hernia Flashcards

1
Q

Define a hernia

A

The abnormal exit of tissue or organ through the wall of the cavity in which it normally resides

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2
Q

Where do inguinal hernias occur?

A

Protrusion of abdominal contents through the inguinal canal

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3
Q

What are the types of inguinal hernia?

A
  • Direct

- Indirect

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4
Q

What type of inguinal hernia is most common in children?

A

Indirect

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5
Q

What “congenital abnormality” underlies most inguinal hernias in children?

A

Patent processus vaginalis

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6
Q

What does a patent processus vaginalis allow for?

A

Emergence of bowel through deep inguinal ring into the inguinal canal

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7
Q

In what group of children are direct inguinal hernias more common?

A

Premature babies

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8
Q

Why are direct inguinal hernias more common in one group of children?

A

Premature babies have more weak and friable tissue

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9
Q

Weakness in what area leads to a direct inguinal hernia?

A

Hesselbach’s Triangle

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10
Q

What are the risk factors for inguinal hernia in children?

A
  • Male gender

- Prematurity

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11
Q

What is the typical presentation of an inguinal hernia?

A

Groin lump - potentially extending into the scrotum/labia

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12
Q

What can exaggerate a hernia?

A

Increased intra-abdominal pressure

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13
Q

What can cause increased intra-abdominal pressure?

A
  • Crying
  • Straining
  • Coughing
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14
Q

What may cause a hernia lump to disappear?

A

If the child relaxes and lies down

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15
Q

Are inguinal hernias symptomatic or asymptomatic generally?

A

Asymptomatic

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16
Q

If there is a scrotal hernia, is transillumination possible?

A

No

17
Q

How are inguinal hernias diagnosed?

A

Clinical diagnosis

18
Q

What is a differential for an inguinal hernia?

A

Hydrocoele (for scrotal hernias)

19
Q

How can most inguinal hernias be managed immediately?

A

‘Taxis’ - the hernia is gently compressed through the inguinal canal under good analgesia

20
Q

What is the benefit of performing reduction by taxis?

A

Surgery can be planned once any oedema has settled down and the child is well

21
Q

What should happen whilst waiting for surgery?

A

Educate the parents about signs of incarceration

22
Q

If reduction is not possible what may be required?

A

Emergency surgery

23
Q

What does surgical repair involve?

A

Ligation and division of the processus vaginalis

24
Q

What are the complications of inguinal hernia?

A
  • Incarceration
  • Strangulation
  • Bowel obstruction
  • Damage to the testis
25
Q

What are the symptoms of incarceration +/- strangulation?

A
  • Tenderness of the lump
  • Vomiting
  • Irritability
26
Q

In which age group is strangulation more common?

A

Infants