Types of hernia by age
0-2 years: indirect inguinal hernia 2-20 yrs: hernia uncommon 20-50 yrs: indirect inguinal hernia 50+ yrs: direct inguinal hernia
What are the layers of the abdominal wall?
Skin, subq fat, Scarpa's fascia, external oblique muscle, internal oblique muscle, tranversus abdominis muscle, transversalis fascia, peritonal fat, peritoneum
Femoral canal structures
Lateral to medial = NAVEL: nerve, artery, vein, empty space, lymph nodes
Borders: inferiorly, inguinal ligament. medially, rectus abdominis. laterall, inferior epigastric vessels. Direct inguinal hernias come through Hesselbach's triangle.
Females usually have what type of inguinal hernia?
Indirect. Direct is very rare in females
How to distinguish hydrocele from irreducible groin hernia?
Hydroceles transiluminate, groin hernias do not
Direct inguinal hernia
Enters inguinal canal through its weakened posterior wall. Does NOT pass through inguinal ring. Predisposing factors: older, smoker, cough, straining, hard labor.
Indirect inguinal hernia
Herniation through the internal inguinal ring -> external ring. If complete, can enter scrotum. If congenital, it is assoc with patent processus vaginalis. Occurs in bothmales > females, all ages.
A form if indirect hernia arising out of the femoral canal beneath the inguinal ligament. Females > males, uncommon overall. High risk of strangulation.
Surgical repair for peds umbilical hernia is indicated when?
Defect > 2 cm OR child > 3-5 yrs old OR protrusion disfiguring/disturbing
Esophageal hiatal hernia type I (90%)
Sliding: GEJ and stomach herniate into thoracic cavity. Can lead to reflux, Barrett's, etc. Medical management for GERD, less commonly do surgery (fundoplication).
Esophageal hiatal hernia type II (rare)
Paraesophageal: herniation of stomach into the thorax by way of esophageal hiatus, w/o disruption of the GEJ. Needs prompt surgical correction.
What types of hernias are assoc with obesity?
Direct inguinal, paraumbilical, and hiatal hernias
Esophageal hernias picture