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Flashcards in Hernias Deck (18)
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1

Ing hernia px

Lump in groin
Aching or dragging, esp end of day
Pain and bulge when strain
Most comm abdo hernia

2

hernia ix

US
CT
MRI
Herniography

3

ing hernia mx

Repair if symps or irreducible or obstruc
Obs if eld or immobile and only mild symps
Open or laparoscopic surg

4

Indirect ing

Us yng pt
Congenital
Lat to infer epigastric A
Often desc into scrotum
Strangulation more likely
Mx- herniotomy for kid, open mesh rep, laparoscopic rep

5

Direct ing

Us adults
Acquired abdo wall weakness
Medial to infer epigastric A
Rarely desc into scrotum
Rarely strangulate
Mx- open mesh or laparoscopic
Direct hernias pass through hesselbachs triangle in transv fascia- bounds are ing lig, infer epig A, rectus musc.

6

Ing canal contents

Spermatic cord or round lig in fem
Ilioing N
Spermatic cord contents-
Testic A, cremasteric A and A to vas def
Br of genitofem N, autonomic Ns to testes, ilioing N
Ext spermatic fascia, cremasteric fascia, int spermatic fascia

7

Deep ing ring

Through transversalis fascia
1-2cm above ing lig
Midway btw pubic tubercle and ASIS- mid lig pt
Fem A is mid ing pt btw ASIS and PS

8

superfic ing ring

V shaped defect in ext obl aponeurosis
Above and medial to pubic tubercle

9

Femoral hernia px

High risk strangulation due to neck of sac having bony and lig strucs on three sides.
Below and lat to pubic tubercle, medial to fem pulse.
Can be asymp til incarceration or strangulation.
Can be mistaken for upper med thigh swelling.

10

Femoral hernia diffs

Low ing hernia
Fem canal lipoma
Femoral LN
Saphena varix
Fem A
Psoas abcess

11

Femoral hernia mx

All need repiar due to risk strang. Truss not an option.
Once reduced, fem canal should be narrowed tp prev recurr- low or high surgical appr.

12

femoral canal

Medial to fem V, in fem sheath
Fem ring opening- bounds are ing, lacunar and pectineal ligs, and fem V.
Surg rep risks obt A br of infer epig A.

13

Umb hernia classif

True- through umbillical cicatrix, us congenital, close bef age 3, more in afro caribb.
Paraumb- through periumb tiss, always acq, comm in obese and preg.

14

Epig hernias

Defects in linea alba btw xihisternum and umb where it is penetrated by Ns and BVs.

15

Umb hernia px

Can be painful
Occas strangulate
True- small, central, cont fat
Para- var size, distort umb, may cont bowel or omentum

16

Epig hernia px

Can be large
Midline
Often only cont fat
Mod risk strang

17

Umb and epig mx

Congenital umb only repair if persist til 2-3yr
Repair if symps and high risk complics
Us laparoscopic

18

Incisional hernia RF

Wound infec
Steroid use
Anaemia
Malnutrit
Midline laparotomy approach
Peak 5yr post op