What is a femoral hernia
Protrusion of the peritoneal sac through the femoral ring and into the femoral canal
Describe the relation of a femoral hernia to the inguinal ligament
Posterior inferior
What does the lump in a femoral hernia feel like? Does this change when it becomes strangulated?
- Small- 2cm
- Hard and tender when strangulated
Are femoral hernias suitable for truss
No
During femoral hernia repair, between which 2 ligaments is the closure made
Inguinal and pectineal
Risk factors for femoral hernia (4)``
Female
Increased age
Pregnancy
Increased intra-abdominal pressure
How can you tell apart a femoral hernia and an inguinal hernia using the pubic tubercule
Femoral- infero-lateral
Inguinal-Superomedial
Define hernia
The abnormal protrusion of viscus through its normal coverings
What is a reducible hernia
A hernia that can be pushed back through the skin with minimal force
What is an incarcerated hernia
A hernia that becomes ‘trapped’- it will be irreducible but the contents still viable
How may an incarcertaed hernia appear
Red, painful, tender
Sometimes symptoms of bowel obstruction
What is a strangulated hernia
The blood supply is cut off to the intestines and organs
What is a hiatus hernia
When contents of the abdomen protrude into the thorax via the oesophageal hiatus
What is an inguinal hernia
Protubences of the peritoneal contens through the abdominal wall where it is weakened by the presence of the inguinal canal
What path do indirect inguinal hernias follow
The spermatic cord or the round ligament down the inguinal canal
What is the origin of indirect hernias in relation to the inferior epigastric artery
Lateral
Where is the weakness that leads to direct inguinal hernias
Posterior wall of the inguinal canal
What is the origin of direct hernias in relation to the inferior epigastric artery
Medial
A weakness in which muscle causes umbilical hernias
Linear alba
Are epigastric hernias superior or inferior to umbilical hernias
Superior
What is contained in the sac in an umbilical hernia
Omentum and bowel
When are epigastric hernias particularly painful
On exercise
Define incisional hernia
Breakdown of muscle closure at the site pf a previous abdominal wound
What is a pantaloon hernia and why is it so named
When a direct and indirect hernia develop of the same side of the groin
So named because the epigastric vessels separate the 2 hernia making them look like trousers
What conservative management can be offered for indirect hernias
A truss
What imaging can be used for hernias, and when
Ultrasound
Suggestive symptoms but no lump found (eg hiatus)
Do indirect or direct hernias protrude into scrotum usually
Indirect
Describe 3 features which can usually distinguish inguinal/ femoral hernias from other causes of lumps in the groin
- Can’t get above the lump
- Bowel sounds over lump
- Reducibility
What can cause umbilical hernia in adults
Ascites
What kind of hernia is a surgical emergency
Strangulated
Is mesh or suture repair more common
Mesh
What is the commonest cause of small bowel obstruction
Herniae
What are some signs of a strangulated hernia
Tachycardia
Pyrexia
WCC raised
In congenital indirect inguinal hernias what does the hernia pass through and what does it follow path of
- Patent Processus Vaginalis
- Path of the testes
What forms the hernia sac in direct inguinal hernias
Transversalis fascia
Describe the Lichtenstein procedure
- hernial sac reduced or excised
- mesh inserted to reinforce posterior inguinal canal
When is laparoscopic repair recommended for inguinal hernia
Recurrent and bilateral herniae
Describe the surgery for femoral herniae
Dissection of the sac
Reduction of contents
Ligation of sac
Closure between ligaments
Describe the surgery for strangulated herniae
Reduction of hernia, remove damaged tissue, use of synthetic mesh
Give some differentials of lumps in the groin
Hernia Soft tissue lumps Femoral artery aneurysm Saphena Varix Enlarged lymph node Undescended testes