Hernia (inguinal, femoral, other)

Question 1

Define inguinal, femoral and umbilical hernia

Answer 1

Inguinal-protrusion of the abdominal contents through a dilated inguinal ring (indirect) or floor of the inguinal canal (direct)
Femoral-protrusion of the abdominal contents under the inguinal canal-through the femoral canal
Umbilical-protrusion of the abdominal contents through the anterior wall fascia (often because it failed to close)

Question 2

Aetiology and risk factors of inguinal, femoral and umbilical hernia

Answer 2

Direct inguinal-Usually from excessive strain + weakening of the wall
Indirect-often from defects present from birth
Femoral-staining pushing content under the canal
Umbilical-in 25% of children, abnormal close after the umbilical cord in cut-allows passage after strain
Can also have acquired umbilical hernia-pregnancy, ascites, obesity, tumours

Risk factors
all of them more common with age (except birth umbilical ones and indirect)
EDS/ marfans

Inguinal
Direct-stain job
men >>women
indirect-birth issue+stain. YOUNG>OLD (indirect MORECOMMON)
Femoral-women>men
Aqquired umbilical-women>>men

Question 3

Epidimology of inguinal, femoral and umbilical hernia

Answer 3

Inguinal hernia by far most common. indirect most common one for YOUNG people
70000 surgeries per year (0.14% of total uk pop). lifetime risk-27% for men and 2 % women

Femoral-5% of hernia repairs-lot less common. Women> men. Older> younger

Umbilical-
either at birth (or soon after), or Women»>men (pregnancy is biggest risk factor

Question 4

Signs and Sx of inguinal, femoral and umbilical hernia

Answer 4

Direct-mass protruding in groin-not in scrotum-swelling
Groin pain
if bowel has passed in-abdo pain, better after reducing
can cause acute abdomen if obstructing/ischemic
nausea and vom with obstruction
Cough impusle is key diagnostic tech

Indirect-younger patients, men. Bulge in the scrotum, feels tender and uncomfortable
complications are same (acute abdomen

Femoral
Bulge under the groin line (but big ones can go above-look like inguinal)
Enlarge on cough
should be possible to reduce

Umbilical-
Umbilical pain, mass protruding out.sharp pain on cough/strain
GI issues related to obstruction (colic, pain, N&V)
growing in size
soon becomes irreducible

Question 5

Investigations of inguinal, femoral and umbilical hernia

Answer 5

CLINICAL!
imagine if too obese to see anything
but are often missed (esp femoral)-

Question 6

Management of inguinal, femoral and umbilical hernia

Answer 6

waiting strategy is valid-keep eye on it and make sure its not growing/ causing complicaitons -choice to pt. complications not that common

only option is surgical repair,
need Sx treat in the meanwhile
+ Prophylaxis abx after

Question 7

Complications of inguinal, femoral and umbilical hernia

Answer 7

Many many post operative complication cause sensitive area

from the disease-bowel gets trapped in there-
cause bowel obstruction (large or small)
can become ischemic if coiled up weird
can also a pool for infection-sepsis
reduce QOL in general

Question 8

Prognosis of hernias

Answer 8

Excellent after surgical repair. improve qol a lot
recurrence <2%
complication of surgery disappear with time

open repair-can lead to chronic groin pain for a bit