Hernias Flashcards
(45 cards)
What is a hernia?
protrusion of contents through a defect in the wall of the cavity in which it normally lies
What is the difference between a true hernia and a false hernia?
a true hernia has a peritoneal covering or sac
Define reducible in respect to a hernia
contents are readily manipulated back into the cavity
Define incarcerated in respect to a hernia
contents are fixed into abnormal locations
- cannot be reduced
What is the problem when a hernia is strangulated?
incarceration obstructs vascular supply
- usually a surgical emergency
What are the principles of herniorrhaphy?
- ensure tissue viability
- return viable contents
- obliterate redundant tissue in the sac
- secure closure of defect without tension
- use the patient’s own tissue when possible
What is the most common type of abdominal hernia?
umbilical hernias
Describe the clinical signs/presentation of an umbilical hernia
- soft, round mass at the umbilical scar
- often reducible
- if the viscera is trapped, may be hard and painful
How is an umbilical hernia usually managed?
- conservative management
- may close spontaneously in patients < 6 months
- repair during elective period/neuter
- if incarcerated, enlarge ring and dissect sac free
Describe the indirect form of inguinal hernias
- passes through the vaginal process
- called a scrotal hernia in males
Describe the direct form of inguinal hernias
- passes through inguinal musculature
- less common
Describe the congenital form of inguinal hernias
- more common in males
- delayed inguinal ring narrowing from late testicular descent
Describe the acquired form of inguinal hernias
- more common in intact females
- shorter and larger inguinal canal
- estrogen/estrus predisposes
What are the clinical signs/presentation of an inguinal hernia?
- painless mass in inguinal area
- can be unilateral or bilateral
How is an inguinal hernia diagnosed?
- ability to reduce
- if unable to reduce, use imaging
Describe the traditional repair of an inguinal hernia
- incision over the lateral aspect of the swelling
- reduce contents, extend ring if necessary
- close the ring
Which vessels should be avoided in traditional repair of inguinal hernias?
- pudendal artery
- genitofemoral nerve
Describe the features of the ventral midline approach to correcting inguinal hernias
- commonly done in females
- can inspect both sides
- avoids mammary tissue
- perform one layer closure over ring
What is a scrotal hernia?
an indirect inguinal hernia in a male
What are the clinical features of a scrotal hernia?
- painful swelling
- usually unilateral
How is a scrotal hernia usually managed?
- incision over ring, reduce contents, and close ring
- castrate to decrease risk of recurrence
What are the clinical signs of acute traumatic abdominal hernia?
- bulging mass
- asymmetric abdomen
- reducible contents
- palpable ring
How is an acute abdominal hernia repaired?
- ventral midline approach
- explore abdomen and repair any organ injury
- use tension relieving pattern
What approach is usually used for a chronic abdominal hernia repair?
approach over the hernia
