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Hernia (Types
hernias (Inguinal (Diagnosis (Examination
Lump above and…
Hernia
Types
Umbilical
Pathophysiology
Often congenital, infantile or assoc pregnancy/obesity/ascites
Inguinal
Diagnosis
Examination
Lump above and medial to pubic tubercle
Check reducibility and ask patient to cough
Occlude deep ring, ask patient to cough (if it appears - direct; if not, indirect)
Investigations
Laparoscopy: diagnosis (indirect - lateral to inf epigastric vessels;
direct - medial to inf epigastric vessels)
Pathophysiology
Inguinal canal: deep ring (midpoint of inguinal ligament, 1.5cm superior to
femoral pulse), superficial ring (superioromedial to pubic tubercle)
Indirect: pass through the internal and external rings, into the scrotum
via processus vaginalis alongside the spermatic cord; can strangulate
Direct: pass via internal ring then forward via defect in the
abdominal wall (Hesselbach's triangle); rarely strangulates
Management
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Surgery
Adults: herniorrhapy (laparoscopic mesh repair)
Children: herniotomy (ligantion and division of PV, remove sac)
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Diaphragmatic
Pathophysiology
Congenital developmental defect allows herniation of abdo
contents into chest; impairs lung development
Femoral
Pathophysiology
Through femoral canal
Inferior to inguinal ligament, lateral to pelvic tubercle
Often irreducible, prone to strangulation
Diagnosis
Mass in upper medial thigh or above inguinal ligament
(inferior and lateral to pubic tubercle)
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Paraumbilical
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Risk factors
Obesity, ascites
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Epigastric
Pathophysiology
Midline above umbilicus, pass through linea alba
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Risk factors
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Increased abdominal pressure
(chronic cough, pregnancy,
ascites, constipation, heavy lifting)
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Pathophysiology
Reducible hernias can be pushed back,
irreducible hernias cannot
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Complications
Irreducible/incarcerated
Cannot be pushed back
Pain, may lead to obstruction/strangulation
Obstructed
Painful hernia, distension, N+V
ABCDE resuscitation
ASAP surgical referral
Strangulated
Painful hernia, shocked/septic
ABCDE rescucitation
ASAP surgical referral
Diagnosis
History
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SH
Occupation, living arrangements,
diet, exercise, smoking, alcohol
PC/HPC
Lump (site, onset, reducible/painful,
changes over time, associated symptoms)
Examination
Abdo exam
Site, size, consistency, cough reflex,
reducibility, colour, temperature, tense/tender
Bowel sounds (nil if obstructed)
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Investigations
Bedside
Obs (shock, sepsis)
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