haemorrhoids Flashcards

1
Q

define an inguinal hernia?

A

the abnormal protrusion of a peritoneal sac through a weakness of the abdominal wall in the inguinal region

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2
Q

what is a direct inguinal hernia?

A

• Protrusion of the hernial sac directly through a weakness in the transversalis fascia
- appears through hesselbachs triangle

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3
Q

what is an inguinal inguinal hernia?

A

• Protrusion of the hernial sac through the deep inguinal ring, following the path of the inguinal canal

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4
Q

what is a combination of both indirect inguinal hernias?

A

if indirect and direct inguinal hernias coexist = pantaloon hernia

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5
Q

which hernias are congenital?

A

indirect hernia

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6
Q

which hernias are acquired?

A

direct inguinal hernia

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7
Q

what are the risk factors of getting a hernia?

A
o	Male  
o	Prematurity 
o	Age  
o	Obesity  
o	Raised intra-abdominal pressure (e.g. chronic cough)  
o	Constipation  
o	Bladder outflow obstruction  
o	Intraperitoneal fluid (e.g. ascites
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8
Q

what is the epidemiology of an inguinal hernia?

A
  • common

- more likely in males

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9
Q

what are the presenting symptoms of inguinal hernias?

A
  • Asymptomatic
  • Patient notices a ‘lump in the groin’
  • May cause discomfort and ache worse with activity
  • Disappears on pressure or when the patient lies down
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10
Q

signs of inguinal hernias on physical examination

A
  • Groin lump that extends to the scrotum or labia
  • Check for cough impulse
  • Auscultation - there may be bowel sounds over the hernia
  • Check for signs of complications
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11
Q

what is the position of inguinal hernias?

A

superior and medial to the pubic tubercle

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12
Q

what is the position of femoral hernias?

A

inferior and lateral to the pubic tubercle

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13
Q

what investigations should be done for acute hernias?

A
o	Bloods 
•	FBC  (leukocytosis) 
•	U&Es  
•	CRP 
•	Clotting  
•	Lactate (raised)
•	Group and save (if operation is likely)  
•	ABGs - may show lactic acidosis from bowel ischaemia  
o	Imaging 
•	Erect CXR - check for perforation  
•	USS - exclude other causes of groin lump  
•	AXR - check for obstruction 
•	Herniogram – for unclear cases
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14
Q

management plan for inguinal hernias?

A
  • Asymptomatic hernias can be managed conservatively
  • Symptomatic or risky hernias are treated surgically
  • First time hernias can be treated with open inguinal hernia repair and a mesh
  • Recurrent / bilateral hernias can be treated with a laparoscopic approach with a mesh.
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15
Q

possible complications of inguinal hernias?

A
  • Incarceration
  • Bowel obstruction
  • Maydl’s hernia (strangulated W-shaped loop of small bowel)
  • Richter’s hernia
  • Strangulation
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16
Q

what are the features of richters?

A

o Characterised by lack of symptoms of obstruction when strangulated
o VBG – low PH, low pCO2, low bicarbonate
o Due to metabolic acidosis and partial respiratory compensation
o Presents with firm mass and necrosed skin

17
Q

what are the features of strangulation?

A
Indications:
o	new onset episodes of pain
o	 irreducible hernias 
Symptoms: 
o	Pain 
o	Fever 
o	Increase in size of hernia 
o	Peritonitis 
o	bowel obstruction 
o	bowel ischaemia 
Management: 
o	Immediate surgery 
o	Open/laparoscopic with a mesh
o	Dead bowel to be removed 
o	No manual reduction
18
Q

what is the prognosis for patients with inguinal hernias.?

A
  • Slowly enlarge if left alone

* Surgical mesh repair has a GOOD outcome