Hernia | Western Sydney University

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

130

Pages:

5
Author:

Mariam A. A.

H ernia Abnormal protrusion of abdominal organs through a weakness of the abdominal wall Inguinal Hernias Epidemiology Most common type of hernias – 75% Direct vs Indirect Inguinal Hernia Direct Indirect More common in older people Secondary to abdominal wall laxity ot increase intrabdominal wall pressure Comes out of a weak region of the abdominal wall -> Hesselbach’s triangle More common in children and younger people A defect present from birth where the opening of the inguinal canal does not completely close. Incomplete closure of process vaginalis Make up 80% of inguinal hernia cases Can become larger and more likely to enter the scrotum Less common Usually, smaller Usually bilateral in older people Lower risk of incarceration Medial to the inferior epigastric vessels Anterior and lateral to spermatic cord with sac Testicular hernia less common here Usually, unilateral Higher risk of incarceration Lateral to the inferior epigastric vessels Posterior to spermatic cord with sac Testicular hernia more common here Risk Factors Male Increasing age Increase in intraabdominal pressure Chronic cough, constipation, heavy lifting. Clinical features Most are small and asymptomatic. lump Red flags: Severe and sudden pain or worsening pain Erythematous bulge Features of bowel obstruction – inability to pass stools or flatulence, nausea, vomit ot bloating Fever No longer reducible Investigations Clinical diagnosis Dragging discomfort in the groin – during lifting, straining or at the end of the day -> usually resolve with rest. Ultrasound is the first line imaging If features of obstruction or strangulation -> CT scan + IV contrast Best test to identify strangulated or incarcerated hernia Abdominal plain films are the least useful imaging tool for hernia assessment Complications Incarceration -> most common complication Strangulation -> most serious complication Obstruction Hematoma Seroma Recurrence Chronic pain Surgical Repair Methods for Inguinal Hernia Indications for surgery: In a child Adults with symptomatic hernia Methods Herniorrhaphy Usually for small hernias Usually for small children Surgical closure of the defect regardless of where it is Hernioplasty For large hernias Used for inguinal hernia because it benefits it more Open wall -> push contents into abdomen -> synthetic mesh placement -> suturing of the area