Flashcards in Inguinal and Femoral Herniae Deck (27):
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
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
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)
Defect in abdominal wall through which direct inguinal hernias pass into:
Most common type of hernia?
Sex preponderance of inguinal hernias?
Which type of inguinal hernia can strangulate:
Indirect rarely do so
Risk factors for inguinal hernia:
* Chronic cough
* Urinary obstruction
* Heavy lifting
* Past abdo surgery
* Prematurity (infants)
Symptoms of inguinal hernia:
* Groin swelling
* Sudden pain
* Scrotal pain
* Dragging sensation
Signs of inguinal hernia:
* Cough impulse
* Palpable inguinal mass
Differential diagnosis of inguinal hernia:
* Femoral hernia
* Lymph node swelling
* Saphena varix
Dilatation of top of saphenous vein
* Undescended testis
Investigations for femoral/inguinal herniae:
2. MRI/CT (if still diagnostic doubt)
Management of inguinal herniae:
Reducible, no pain
Lichtenstein repair (mesh technique) reinforces posterior wall
Laparoscopic repair (TAPP/TEP)
What is the Lichtenstein repair?
Mesh technique to reinforce the posterior wall in irreducible, painful inguinal hernias
Contraindications to Lichtenstein repair?
* Contamination with pus/bowel contents
Complications of inguinal herniae:
* Bowel obstruction
* Surgical complications
Sex preponderance of femoral hernia:
Most common type of hernia in women?
(But femoral occurs more in women than men, although its general incidence is lower)
Age group affected by femoral herniae?
Middle-aged and elderly
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
How can an inguinal and femoral hernia be distinguished on clinical examination?
Femoral points down leg
Inguinal points towards groin
Risk factors for femoral hernia:
* Advancing age
Symptoms of femoral hernia:
* Lump in groin
Inferolateral to pubic tubercle
Increases with cough/strain
- Lower abdo pain (colicky)
- Red, tender lump
Signs of femoral hernia:
- Cough impulse
- Abdo distention
- Tense, irreducible lump
Do inguinal or femoral hernias carry a higher risk of strangulation?
Management of femoral hernia:
Repair ASAP (high risk of strangulation)
Herniotomy: Ligation and excision of sac
Herniorrhaphy: Repair of hernial defect