Hernias Flashcards
(23 cards)
define hernia
Protrusion of any viscus from its proper cavity
What can a hernia lead to?
Can lead to an incarcerated & often obstructed bowel or a strangulated bowel w/ a compromised blood supply
What is a reducible hernia?
A hernia sac & contents that move freely in & out of the fascia
What is an incarcerated hernia?
When a hernia & contents are not reducible = “incarcerated”
What can incarcerated hernia lead to?
- When a sac content is incarcerated, risk that it can become “strangulated”
A. Requires emergent surgery
B. (+) signs of bowel obstruction (pain, N/V, toxic appearance, fever)
What is an epigastric hernia?
Located on the front abdominal wall from the sternum to the navel
What is an umbilical hernia?
A. appears as a bulge at umbilicus
B. It occurs when the muscle around the navel doesn’t close completely
C. Common & typically harmless condition
D. Umbilical hernias are most common in infants, but can affect adults as well
-In an infant, an umbilical hernia may be especially evident when the infant cries, causing the baby’s bellybutton to protrude.
What is an incisional hernia?
- can occur through an incision site post laparotomy
- At sites of prior abdominal surgery, usually asymptomatic
- Patients present w/ a bulge at the site
- The bulge may become larger upon standing or w/ increased intra-abdominal pressure
What is a femoral hernia?
- Appears as a bulge in the upper thigh
- F > M
- Occur just below the inguinal ligament, when abdominal contents pass thru femoral canal
- Exits from the retroperitoneal space along the femoral vessels in the femoral canal
A. Occasionally confused w/ inguinal canal hernia
What is an inguinal hernia?
1. Appears as a bulge in the groin. A. M > F B. May extend into scrotum -Direct -Indirect
Describe an obturator hernia
- An obturator type of abdominal wall hernia in which abdominal content protrudes through the obturator foramen
A. May not have local swelling, because hernia is hidden w/in deeper structures
B. May c/o abdominal pain or medial thigh pain, weight loss, or recurrent episodes of SBO
C. Pressure on the obturator nerve causes pain in medial thigh that is relieved by thigh flexion
D. Pain may be exacerbated by extension or external rotation of the hip (Howship-Romberg sign)
Describe a spigelian hernia?
- Spigelian hernia (Lateral ventral hernia, Semilunar hernia)
A. Abdominal wall hernia that occurs through a defect in the spigelian fascia
B. Lateral edge of the rectus muscle at the semilunar line (costal arch to the pubic tubercle)
What is a spigelian hernia at risk for?
Usually small and therefore ↑ risk of strangulation
What are the predisposing factors for hernias?
- Chronic constipation, straining w/ BM
- Chronic cough
- Cystic fibrosis
- Enlarged prostate, straining to void
- Extra weight
- Heavy lifting
- Poor nutrition
- Smoking
- Overexertion
- Cryptorchidism (undescended testicle)
- Genetic predisposition
What are the sxs of hernias?
- Most often there are no symptoms
- Sometimes there may be discomfort or pain
- Pain can worsen w/ standing, straining, or lifting heavy objects
- Patients can c/o of a visual bulge
When is surgery indicated for for umbilical hernias?
- Many umbilical hernias close on their own by age
A. If doesn’t resolve by age 3 or those that appear during adulthood may need surgical repair
Describe a direct inguinal hernia
- Develops medial to the internal inguinal ring
Posterior wall weakens as the transversalis fascia thins, & a bulge results - Usually contain properitoneal fat & bladder wall
A. Rarely found to extend into the scrotum
Describe indirect inguinal hernia
- Due to a persistence of the processus vaginalis through the internal ring along the course of the spermatic cord or round ligament. a portion of the small intestine enters the inguinal canal
- The processus vaginalis is located anterior and medial to the structures of the spermatic cord or round ligament
- With time, pressure applied by the intra-abdominal contents in the sac causes enlargement of the sac & dilation of the internal inguinal ring
How are hernias diagnosed?
- Diagnosis by H & P
- The mass may increase in size when coughing, bending, lifting, standing or straining
- The hernia may not be obvious in infants & children, except when the child is crying or coughing
Where is Hesselbach’s triangle? Why is it important?
- Area of the anterior abdominal wall bounded by the inferior epigastric vessels, inguinal ligament and the lateral border of the rectus abdominis
- Direct inguinal hernias leave the abdomen through this triangle
What are the physical exam pearls for hernias?
- For inguinal hernias, place a fingertip into the scrotal sac and advance up into the inguinal canal
- If hernia comes from superolateral to inferomedial and strikes the distal tip of the finger, it most likely is an indirect hernia
- If hernia strikes the pad of the finger from deep to superficial, it is more consistent w/ a direct hernia
- A bulge felt below the inguinal ligament is consistent w/ a femoral hernia
- In general, the physical examination should be performed w/ the patient in both the supine & standing positions, w/ & w/out Valsalva maneuver
What are the dx studies for hernias?
- Ultrasound
- CT
- MRI (rare)
How are hernias managed?
- If the hernia is not painful & doesn’t interfere w/ ADL’s, no treatment other than education & prn follow up is required
- If the patient experiences pain or if the hernia is not reducible, a surgical consult should be made
