Survival tips for Hernia

Hernia

Gk- off shoot
Lt - rupture

Hernia is defined as an abnormal protrusion of a viscus or a part of viscus through as opening , artificial or natural with a sac covering it.

Common hernia :

Inguinal hernia
Incisional hernia
Femoral hernia
Umbilical hernia

Causes :

coughing
obesity
straining
Intra-abominal malignancy

Parts-

covering
sac - narrow in indirect hernia, wide in direct hernia( fundus,body , neck)
content

Hernia without neck- direct hernia, incisional hernia

Classification :

Reducible
Obstructive
Strangulated
Irreducible
Inflammed

Taxis
used in irreducible or partially reduced hernia
trial reduction by flexing and medially rotating the hip

Different types of hernia -

1. Gibbon's hernia- hernia with hydrocoele
2. Berger's hernia - hernia in Pouch of Douglas
3. Grynfelt/s hernia- Upper lumbar triangle hernia
4. Petit's hernia - Lower lumbar triangle hernia
5. Cloquet's hernia- hernia through pecteineal fascia
6. Narath's hernia - behind femoral artery
7. Hesselbach's hernia - lateral to femoral artery
8. Serofini's hernia - behind femoral vessels
9. Laugier's hernia - through lacunar ligament
10. Tealse's hernia - in front of femoral vessels
11. Richter's hernia - part of circumference of bowel wall is gangrenous
12. Littre's hernia - hernia with Meckels's Diverticulum
13. Sliding hernia - Posterior wall of sac is formed by colon or bladder
14. Maydl's hernia - 'w' hernia
15. Phantom hernia - Localised muscle buldge following muscular paralysis
16. Spigelian hernia - through spegelian fascia
17. Obturator hernia - through obturator foramen
18. Femoral hernia - hernia medial to femoral vein
19. Beclard's hernia - femoral hernia through saphenour opening

Use 5 fingers of hand to complete all test of hernia:

Thumb - for deep ring occlusion test
Index, middle and ring finger - Ziemanp's test
Little finger - for superficial ring invagination test

Rules for hernial examination:

Never forget to examing opposite site.
Never forget to do per rectal examination.
Never forget to examine urethra.
Never forget to check abdominal muscle tone.


Hope this small piece of info will help u to initiate to study hernia more
comprehensively.

Live with passion
Sushant-passion

[Khushboo]

Thanx a lot for such valuable information as it will really help a lot of students

[SUMAN-SAJAN]

Thanks sushant for this useful post.

[SUMAN-SAJAN]

Thanks Sushant. It will help a lot students like me , who are still to read Hernia.

[SPRimal]

thanks mitra for ur great and helpful post

jus keep it up

[Sanju]

Thank you for the post....

[SUMAN-SAJAN]

SOME MORE FACTS ON HERNIA

Femoral hernia is more common in females as compared to males but again the commonest hernia in females is inguinal hernia.

Femoral hernia is below and lateral to the pubic tubercle where as inguinal hernia is medial and above the pubical tubercle.
It refers not to the position of the hernia but to the point at which the hernia reduces into the abdominal wall.

Difference between hernia and hydrocele.
Hernia differs from hydrocele in that :
-in hernia we can't get above the swelling but in hydrocele we can
-cough impulse is positive in hernia not hydrocele
-testis is palpable in hernia not hydrocele
-translumination test is positive in hydrocele and negative in hernia


Classification of hernia
According to site
umbilical
epigastric
spigelian
inguinal
femoral
gluteal

According to presentation
Irreducible
Reducible
obstructed
strangualted
inflammed

According to content
enterocele
omentocele
reichter's hernia
littre's hernia

congenital or acquired .



Why is femoral hernia more likely to strangulate ?
Because of narrowness of the neck (femoral ring) and its rigid surround:
Anteriorly: inguinal ligament
Posteriorly :Pectineus muscle and pubic ramus
Medially : lacunar ligament and pubic bone
Laterally : femoral vein


What is usual site of strangulation of the inguinal hernia ?
Superficial or external inguinal ring


Direct inguinal hernia lies outside the spermatic cord while indirect lies within it .


Why is indirect inguinal hernia common in right ?
Right processus vaginalis become oblitered later than the left and right testis descend later than the left.

Indirect inguinal hernia is more common in young and the direct in the elderly.

Types of indirect inguinal hernia
Bubonocele - lies within the inguinal canal
Funicular - there is small funis (stalk) between the testis and processus vaginalis ie. lies few centimetres above the testis
Complete (scrotal)- where processus vaginalis is intact, hernia reaches scrotum


Differential diagnosis of inguinal hernia
In male :
vaginal hydrocele
encysted hydrocele of cord
spermatocele
femoral hernia
incompletely descended testis
lipoma of cord

in female :
hydrocele of canal of Nuck
femoral hernia


Differential diagnosis of femoral hernia
inguinal hernia
saphenous varix
enlarged femoral lymph node
lipoma
femoral aneurysm
psoas abscess
distended psoas bursa