Femoral & inguinal hernias Flashcards
What is a hernia?
Hernia is a protrusion of a viscus into an abnormal space.
I.e. any structure that passes through a space or defect into an abnormal location
What does reducible hernia mean?
When the contents of the hernia can be pushed back into its original position.
What does incarcerated (irreducible) hernia mean?
When the hernia is compressed by the defect causing it to bee irreducible (unable to be pushed back into its original position)
What does obstructed hernia mean?
Mainly refers to hernia containing bowel where the hernia is so compressed that the bowel becomes obstructed, no longer patent.
What is a strangulated hernia?
When the compression around the hernia prevents blood flow into the hernial content causing ischaemia to the tissues and pain.
What is the most common type of abdominal hernia?
Inguinal hernia
Describe the anatomy of the inguinal canal.
Describe the route of inguinal ligament and canal.
Mention the significance of ASIS, pubic tubercle and contents of the inguinal canal.
Describe the location of deep & superficial inguinal ring.
Inguinal ligament runs between ASIS and pubic tubercle.
Within the ligament runs the inguinal canal.
Inguinal canal provides passageway for contents to exit the abdomen including spermatic cords in males, round ligament in females and the ilioinguinal nerve.
Entry point into the inguinal canal from the abdominal cavity is at the deep inguinal ring.
Exit point from the inguinal canal is at the superficial inguinal ring.
Deep inguinal ring is located just above the mid-point of inguinal ligament.
The superficial ring lies just above and medial to the pubic tubercle.
What is an inguinal hernia?
What are the two types of inguinal hernia?
A lump in the groin as a result of a protrusion or movement of abdominal contents through the exit point - the superficial inguinal ring
Two types = direct and indirect inguinal hernias
How is a direct inguinal hernia formed?
Direct inguinal hernia is caused by a weakness in the posterior wall of the inguinal canal.
Abdominal contents (i.e. fatty tissue, sometimes bowel) forced through this defect and enters the canal medial to the deep ring
How is an indirect inguinal hernia formed?
Abdominal contents pass through the deep inguinal ring through the inguinal canal and exits the superficial ring.
There is no posterior wall defect in an indirect inguinal hernia.
What are the differences between indirect and direct inguinal hernias?
- Both types of hernias can exit superficial ring and emerge in the testes but it is more common for INDIRECT HERNIA to do this => the path through both anatomical rings has less resistance than the abdominal wall defect path
- If by placing your finger over the deep inguinal ring reduces the hernia = indirect hernia.
If when you press the deep inguinal ring and the hernia still protrudes = direct hernia as the defect is medial to this point.
What causes an inguinal hernia?
Causes that increase intra-abdominal pressure & weakness of the abdominal muscles:
Chronic cough Constipation Heavy lifting Advanced age Obesity
How do most hernias present?
Painless swelling in groin that develops over time or suddenly ie after heavy-lifting.
Swelling is mostly asymptomatic and may come and go.
How do symptomatic hernias present?
Pain w/ coughing or stooping Change in bowel habit Constipation Burning sensation in groin Scrotal swelling
How do you typically diagnose a hernia?
Which investigation is carried out if diagnosis is uncertain?
Majority diagnosed via clinical exam (pressing deep inguinal ring)
If uncertain, ultrasound of the groin can differentiate other possible causes i.e. enlarged lymph nodes, fatty lumps or vascular pathology.
