Hernia Flashcards
(35 cards)
How is a hernia caused?
weak point in a cavity wall, usually affecting the muscle or fascia. This weakness allows a body organ (e.g., bowel) that would normally be contained within that cavity to pass through the cavity wall.
Typical presentation of a hernia:
A soft lump protruding from the abdominal wall
The lump may be reducible (it can be pushed back into the normal place)
The lump may protrude on coughing (raising intra-abdominal pressure) or standing (pulled out by gravity)
Aching, pulling or dragging sensation
3 main complications of hernia’s
Incarceration
Obstruction
Strangulation
What happens in incarceration?
hernia cannot be reduced back into the proper position (it is irreducible). The bowel is trapped in the herniated position. Incarceration can lead to obstruction and strangulation of the hernia.
What is obstruction?
hernia causes a blockage in the passage of faeces through the bowel. Obstruction presents with vomiting, generalised abdominal pain and absolute constipation
What happens in strangulation?
where a hernia is non-reducible (it is trapped with the bowel protruding) and the base of the hernia becomes so tight that it cuts off the blood supply, causing ischaemia. This will present with significant pain and tenderness at the hernia site.
Surgical emergency
Bowel will die quickly
What is an inguinal hernia?
Inguinal hernias present with a soft lump in the inguinal region (in the groin).
2 types of inguinal hernia’s:
Indirect inguinal hernia
Direct inguinal hernia
Differential diagnoses for lumps in the inguinal region:
Femoral hernia
Lymph node
Saphena varix (dilation of saphenous vein at junction with femoral vein in groin)
Femoral aneurysm
Abscess
Undescended / ectopic testes
Kidney transplant
What is the inguinal canal?
tube that runs between the deep inguinal ring (where it connects to the peritoneal cavity), and the superficial inguinal ring (where it connects to the scrotum).
Males and the inguinal canal
Inguinal canal is what allows the spermatic cord and its contents to travel from inside the peritoneal cavity, through the abdominal wall and into the scrotum.
Female inguinal canals
round ligament is attached to the uterus and passes through the deep inguinal ring, inguinal canal and then attaches to the labia majora.
What is an indirect inguinal hernia?
where the bowel herniates through the inguinal canal.
Indirect inguinal hernia pathophysiology
- inguinal ring remains patent, and the processus vaginalis remains intact.
- This leaves a tract from the abdominal contents, through the inguinal canal and into the scrotum.
- The bowel can herniate along this tract, creating an indirect inguinal hernia.
What is a direct inguinal hernia
- Direct inguinal hernias occur due to weakness in the abdominal wall at Hesselbach’s triangle
- hernia protrudes directly through the abdominal wall, through Hesselbach’s triangle
- Pressure over the deep inguinal ring will not stop the herniation.
HESSELBACH’s triangle (RIP mnemonic)
R – Rectus abdominis muscle – medial border
I – Inferior epigastric vessels – superior / lateral border
P – Poupart’s ligament (inguinal ligament) – inferior border
What is a femoral hernia?
Femoral hernias involve herniation of the abdominal contents through the femoral canal.
This occurs below the inguinal ligament, at the top of the thigh.
What is the opening between peritoneal cavity and femoral canal?
Femoral ring
What is the femoral ring?
femoral ring is the proximal opening of the end of the femoral canal which leaves only a narrow opening for femoral hernias, putting femoral hernias at high risk of:
Incarceration
Obstruction
Strangulation
Boundaries of femoral canal (FLIP mnemonic)
F – Femoral vein laterally
L – Lacunar ligament medially
I – Inguinal ligament anteriorly
P – Pectineal ligament posteriorly
What is the femoral triangle?
larger area at the top of the thigh that contains the femoral canal. You can remember the boundaries with the SAIL mnemonic
SAIL mnemonic
S – Sartorius – lateral border
A – Adductor longus – medial border
IL – Inguinal Ligament – superior border
NAVY-C mnemonic for contents of femoral triangle from lateral to medical across top of the thigh:
N – Femoral Nerve
A – Femoral Artery
V – Femoral Vein
Y – Y-fronts
C – Femoral Canal (containing lymphatic vessels and nodes)
What is an incisional hernia?
occur at the site of an incision from previous surgery.
