Inguinal and Femoral Herniae Flashcards Preview

Gastrointestinal Conditions > Inguinal and Femoral Herniae > Flashcards

Flashcards in Inguinal and Femoral Herniae Deck (27):
1

What is a hernia?

Protrusion of a viscus or part of a viscus through a defect of the walls of its containing cavity into an abnormal position

2

Hernias can be classified as:

Irreducible - contents can't be pushed back into place

Reducible - contents can be pushed back into place

Obstructed - Bowel contents cannot pass

Strangulated - Ischaemia occurs requiring urgent surgery

Incarceration - Contents of hernial sac are stuck by adhesion

3

Inguinal hernias are classified as:

Indirect (80%): Pass through internal inguinal ring and if large enough out through the external inguinal ring

Direct (20%): Push directly through the posterior wall of inguinal canal into a defect in abdominal wall (Hesselbach's triangle)

4

Defect in abdominal wall through which direct inguinal hernias pass into:

Hesselbach's triangle

5

Most common type of hernia?

Inguinal hernia

6

Sex preponderance of inguinal hernias?

M>F (8:1)

7

Which type of inguinal hernia can strangulate:

Direct

Indirect rarely do so

8

Risk factors for inguinal hernia:

* Male
* Chronic cough
* Obesity
* Constipation
* Urinary obstruction
* Heavy lifting
* Ascites
* Past abdo surgery
* Prematurity (infants)

9

Symptoms of inguinal hernia:

* Groin swelling
* Sudden pain

Indirect hernias:
* Scrotal pain
* Dragging sensation

10

Signs of inguinal hernia:

* Cough impulse
* Palpable inguinal mass
* Reducible/irreducible

11

Differential diagnosis of inguinal hernia:

* Femoral hernia
* Hydrocele
* Lymph node swelling
* Abscess
* Saphena varix
Dilatation of top of saphenous vein
* Varicocele
* Undescended testis

12

Investigations for femoral/inguinal herniae:

1. USS

2. MRI/CT (if still diagnostic doubt)

13

Management of inguinal herniae:

Reducible, no pain
Reassurance only

Irreducible, pain
Lichtenstein repair (mesh technique) reinforces posterior wall

Laparoscopic repair (TAPP/TEP)

14

What is the Lichtenstein repair?

Mesh technique to reinforce the posterior wall in irreducible, painful inguinal hernias

15

Contraindications to Lichtenstein repair?

* Strangulation
* Contamination with pus/bowel contents

16

Complications of inguinal herniae:

* Strangulation
* Incarceration
* Bowel obstruction
* Surgical complications
Recurrence
Infarcted testis/ovary
Wound infection
Bladder injury
Intestinal injury
Hydrocele

17

Sex preponderance of femoral hernia:

F>M

18

Most common type of hernia in women?

Inguinal

(But femoral occurs more in women than men, although its general incidence is lower)

19

Age group affected by femoral herniae?

Middle-aged and elderly

20

Pathophysiology of femoral hernia:

Bowel loop enters femoral canal.

Causing mass in the upper medial thigh or above the inguinal ligament

Mass points down the leg

21

How can an inguinal and femoral hernia be distinguished on clinical examination?

Femoral points down leg

Inguinal points towards groin

22

Risk factors for femoral hernia:

* Female
* Advancing age

23

Symptoms of femoral hernia:

* Lump in groin
Inferolateral to pubic tubercle
Increases with cough/strain

Strangulation
- Lower abdo pain (colicky)
- Red, tender lump
- Distention
- Vomiting

24

Signs of femoral hernia:

- Cough impulse
- Reducible/irreducible

Strangulation
- Abdo distention
- Tense, irreducible lump

25

Do inguinal or femoral hernias carry a higher risk of strangulation?

Femoral

High risk!

26

Management of femoral hernia:

Repair ASAP (high risk of strangulation)

Herniotomy: Ligation and excision of sac

Herniorrhaphy: Repair of hernial defect

27

Complications of femoral hernia:

* Strangulation (higher risk than inguinal)
* Obstruction
* Incarceration