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19 Cards in this Set

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Definition of hernia
Abnodmal protrusion of contents of a cavity outside the wall of the cavity
Direct vs indirect inguinal hernia
Direct comes through posterior inguinal wall.
Indirect hernia comes through deep ring
Where is deep inguinal ring
2cm superomedial to the femoral artery
Features of indirect hernias
Tend to occur in children and younger adults
Males - line of weakness due to testicular descent
Usually unilateral
Can be painful
Can extend into scrotum
Can obstruct 1%/year
Controlled by pressure over internal ring
Lateral to inferior epigastric artery
Features of direct hernias
Older adults, male, obese
Frequently bilateral
Wide neck so usually painless and do not extend into scrotum / obstruct
Not controlled by pressure over internal ring
Origin is medial to the inferior epigastric artery
Differential diagnosis of lump in groin
Femoral hernia
Hydrocoele
Epididymal cyst
Undescended testis
Femoral artery anerysm
Sapheno-varix
Lipoma of cord
Lymph nodes
How to describe inguinal hernia
Side
Unilateral or bilateral
Inguinal or femoral
Direct / indirect
Reducible or not
incarcerated or not
Strangulated
Features of strangulated hernia
Pain, irreducibility, intestinal obstruction, dehydration and toxicosis
Incarceration
Hernia cannot be returned to peritoneal cavity and is painful but not toxic
Strangulation
The hernia cannot be returned to the epritoneal cavity and is painful and also toxic
Phases of strangulation
Venous obstruction, swelling, arterial occlusion -> infarction, necrosis and perforation, peritonitis, septicaemia etc
Childhood hernia
Almost always in males due to patent processus vaginalis
Sliding hernia
Contains sigmoid colon or caecum which forms posterior wall of hernia
Littre's hermia
Contains a Meckel's diverticulum
Richter's hernia
Contains a pportion of circumference of intestine
Repair of inguinal hernia
Herniotomy - excision of sac (nil else required in childhood)
Hernioplasty - repair of posterior wall of inguinal canal. Lichenstein - on-lay nylon mesh, tension free, stimulates intense fibrotic response 1% recurrence over 10/1
Femoral hernia
Underneath inguinal ligamentt is femoral canal, NAVXY X=(canal of lymphatics and space for femoral vein to expand as is a capacitance vessle)
Thin elderley women
Usually unilateral
Often incarcerate because small neck
Frequently strangulate
Umbilical hernia
Congenital in infants, frequently resolve
Paraumbilcal hernia
Pregnancy, weight loss,