Abdominal wall Flashcards
Define the terms reducible, irreducible, incarcerated, strangulated and sliding with respect to the description of hernias.
Reducible: Hernia can be replaced within its original containing space
Irreducible: Hernia cannot be replaced within its original containing space.
Incarcerated: The lumen of the hernia is occluded, preventing passage of contents, but blood supply remains.
Strangulated: Blood supply to hernia compromised, causing ischaemia.
Sliding: The GOJ slides upwards through hiatus orifice.
Define indirect and direct inguinal hernia.
Indirect: Hernia transverses the entire inguinal canal, entering the deep inguinal ring and leaving the superficial ring.
Direct: Viscus breaks through weakness in transversalis fascia and exits via superficial inguinal ring.
List the factors that predispose to the development of inguinal hernia.
Occupation including heavy lifting
Chronic cough
Obesity
Pregnancy
All of the above increase intra abdominal pressure
Weakness of transversalis fascia: previous hernias and age.
Describe the physical findings in patients with reducible inguinal herniae, including examination of the external ring and descent to the scrotum.
Cough impulse will be present.
Scrotal continuation is more common in indirect herniae.
Describe the physical findings in patients with an incarcerated inguinal herniae including the signs of bowel obstruction and possible strangulation.
Symptoms of obstruction will be present:
Constipation, distention, vomiting, pain.
Increased bowel sounds
Define a femoral hernia.
Pass through femoral canal which is usually occupied by fat and Cloquet’s lymph node.
The anterior border of the canal is the inguinal ligament, the medial border is the lacunar ligament and the lateral border is the femoral vein.
The posterior border is the pectineal ligament.
Describe the symptoms of patients with femoral hernias.
May experience obstructive symptoms.
Femoral ring is tight so strangulation is likely.
Describe the findings seen on physical examination of patients with femoral hernia.
More common in women than men.
Usually found inferiorly and laterally to the pubic tubercle.
Define an umbilical hernia and relate it to the embryological origin of the umbilicus.
Exomphalos: Rare, failure of the gut (mid-gut) to return to the abdominal cavity following the embryological rotation that occurs outside of the body. The bowel is contained within a translucent sac which runs through the defective anterior abdominal wall.
Congenital umbilical hernia: Failure to completely close the umbilical cicatrix.
Acquired para-umbilical hernia: Occurs just above or below umbilicus due to abdominal wall weakening.
List the factors that predispose to the development of umbilical hernias.
Exomphalos can be genetic factors, premature birth and male sex.
Congenital hernias are especially common in black children, premature births and male sex.
Para-umbilical hernias are more common in women, multi-parity, increased age and obesity
Describe the symptoms of patients with umbilical hernias.
Exomphalos if left untreated will lead to fatal peritonitis.
Congenital usually asymptomatic, neck is wide so rarely obstructs, parents should be reassured that most disappear spontaneously by 2 years of age.
Paraumbilical - Neck is less wide so less chance of strangulation. Contents tend to be omentum, transverse colon and small intestine. Some obstructive symptoms may be present and adhesions may develop.
Describe the findings on physical examination of patients with umbilical hernias, differentiating reducible and non-reducible hernias; and recognising the signs of strangulation.
Findings that support strangulation are warmth, redness, swelling and pain.
Discuss the incidence of incisional hernias according to the original incision and indication for operation.
Occurs through a defect created through a surgical incision.
Often via a midline laparotomy scar.
Incidence depends on:
Pre operative features: Chronic cough, obesity, cachexia, vit C deficiency.
Surgical factors: Poor technique, weak material.
Post op features: Chronic cough, distention, infection, haematoma.
Describe the risks of complications of incisional hernias.
There is usually a wide neck and as such strangulation is rare. If there is complete breakdown of the wound, a loop of bowel may protrude from the abdominal wall – much to the fear of patient and staff.
Describe the symptoms of patients with incisional hernias.
Usually asymptomatic.
Possibility of symptoms of obstruction - (constipation, vomiting, pain, distention)
