Inguinal Hernias Flashcards
(29 cards)
What are the risk factors for an inguinal hernia in an adult?
- male sex
- obesity
- constipation
- chronic cough
- heavy lifting
What are the risk factors for inguinal hernias in infants?
- prematurity
- male sex
Do inguinal hernias occur gradually or suddenly?
In older children and adults they usually develop gradually
Can occur suddenly with an episode of heavy lifting
How might an inguinal hernia present?
- Swelling in the groin
- may appear with lifting
- may be accompanied by sudden pain
- An increase (or an impulse) may be palpable on coughing
- If a lump is present, it may be reducible
Briefly discuss the evolution of an inguinal hernia and how it would change clinical presentation
- First appearance
- usually easily reducible when patient reclines
- but if large it may require manual replacement
- With time…
- hernia enlarges and becomes harder to replace
- (due to fibrous adhesions forming)
- When it can no longer be reduced… it is irreducible or incarcerated
- can occur at any time
- strangulation can also occur at any time
- eventually leads to infarction and usually to bowel obstruction
What are the types of inguinal hernias?
Indirect
and
Direct
Where is the deep (internal) ring situated?
above the midpoint of the inguinal ligament
Inguinal Ligament is lateral to the epigastric vessels.
Midpoint of the inguinal ligament is halfway between the pubic tubercle and the anterior superior iliac spine
Where is the superficial (external) ring found?
superficial ring lies just superior to the pubic tubercle
What is contained in the inguinal canal?
- spermatic cord
- neurovascular and reproductive structures that supply and drain the testes
- round ligament (females only)
- ilioinguinal nerve
- contributes sensory innervation of genitalia
- nerve most at risk during repair
- genital branch of the genitofemoral nerve
*
What three vessels are contained in the spermatic cord?
- testicular artery
- cremasteric artery
- artery to the vas
What three nerves are contained in the spermatic cord?
- genital branch of genitofemoral
- autonomic supply to the testicle
- ilioinguinal nerve
What three structures are contained in the spermatic cord?
- vas
- pampiniform venous plexus
- testicular lymphatics
What type of inguinal hernias are more common?
Indirect
List the boundaries of the inguinal canal
- Anterior wall
- Poserior wall
- Roof
- Floor
Plus 2 openings: superficial and deep rings
What makes up the anterior wall of the inguinal canal?
aponeurosis of the external oblique, reinforced by the internal oblique muscle laterally
What makes up the posterior wall of the inguinal canal?
transversalis fascia
What makes up the floor of the inguinal canal?
the inguinal ligament, thickened medially by the lacunar ligament
Describe what happens in an indirect hernia
- Failure of the processus vaginalis to regress
- i.e. failuer of the inguinal canal to close properly after passage of the testis in utero or during neonatal period
- There’s a protrusion through internal inguinal ring which passes along the inguinal canal, through the abdominal wall, running laterally to the inferior epigastric vessels
Describe what happens in a direct hernia
the hernia protrude directly through a weakness in the posterior wall of the inguinal canal, running medially to the inferior epigastric vessels
Where is an indirect hernia in relation to the epigastric vessels?
lateral
Where is a direct hernia in relation to the epigastric vessels?
Medial
What are the differenital diagnoses for inguinal hernia?
- Femoral hernia
- either irreducible or reduces only slowly with pressure
- Hydrocele
- Spermatic cord hydrocele
- Lymph node swelling
- Abscess
- Saphena varix
- Varicocele
- Bleeding
- Undescended testis
What investigations would you do if you suspected an inguinal hernia?
Ultrasound is the least invasive method, if there is doubt
What surgical technique is used for open hernia repair?
Lichtenstein technique
(a piece of open-weave polypropylene mesh is used to repair adn reinforce the abdominal wall. Gives earlier mobility and has a very low recurrence rate)
