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Hernia's (Inguinal Hernia (Risk Factors (Urinary obstruction, Heavy…
Hernia's
Inguinal Hernia
Pathophysiology
Direct hernia
Where the peritoneal sac enters the inguinal canal through the posterior wall of the inguinal canal - medial to the inferior epigastric vessels
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Indirect hernia
Follows the path of the inguinal canal, pass through the deep inguinal ring and if large then out through the superficial inguinal ring
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Clinical Presentation
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Bulging associated with coughing or straining (bowel movement, heavy lifting)
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Differential Diagnosis
Femoral hernia, epididymitis, testicular torsion, groin abscess, aneurysm, hydrocele and undescended testes
Epidemiology
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They pass through the internal inguinal ring, and, if large, out through the external ring
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Contents include the external and internal spermatic and cremasteric fascia plus the spermatic cord (15 objects)
Treatment
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Surgery
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Prosthetic mesh, open repair, laparoscopy
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Femoral Hernia
Pathophysiology
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Bowel enters the femoral canal, presenting as a mass in the upper medial thigh or above the inguinal ligament where it points down the leg, unlike an inguinal hernia which points to the groin
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Incisional Hernia
Can occur anywhere where there is an incision and follows a breakdown of muscle closure after surgery
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Hiatus Hernia
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30% of patients above 50, especially in obese women
Classification
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Irreducible hernia
Obstructed - intestine is obstructed within the hernia due to pressure from the edges of the hernia - but blood flow is maintained
Incarcerated - contents of the hernial sac are stuck inside by adhesion e.g. adhesions between the intestines and hernial sac
Strangulated - blood supply of the sac is cut off resulting in ischaemia +/- gangrene/perforation of the hernial contents - patent becomes toxic an requires urgent surgery
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Definition: the profusion of a viscus (organ) or part of a viscous through a defect of the walls of its contains cavity into an abnormal position