Professional Documents
Culture Documents
Hernia
DR MIN OO
Surgery
Outline
Definition
Types
Predisposing factors
Basic features of a hernia
Inguinal hernia
Applied anatomy
Examination of inguinal hernia
Differences b/t direct and indirect inguinal hernia
Some definitions
Video click for inguinal hernia examination
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Learning out come
To understand the basic principle for examination of hernia.
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What is hernia?
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Hernia protrusion of a viscous or part of
viscous through an abnormal opening in the
walls of its containing activity.
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WHY HERNIA
OCCUR?
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Predisposing factors ???
Obesity
Straining Smoking
Abdominal
Coughing Causes distension
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Composition of hernia
Sac Covering Contents
Derived Omentum- omentocele
from the Intestine- enterocoele
Sac is a
layers of
diverticulum of
abd wall Portion of circumference of
peritoneum
through intestine- Richters Hernia
which the Portion of bladder (or a
Consist of sac passes diverticulum)
mouth,neck, Ovary with or w/o
body and corresponding Fallopian
fundus tube
Meckels diverticulum-
Littres hernia
Fluid
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Classification
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Irrreducible Hernia-
Reducible Hernia- contents cannot be
contents can be returned to the
returned to abdomen abdomen but there is
no other complication
Obstructed Hernia-
irreducible hernia Strangulated Hernia-
containing intestine blood supply is
that is obstructed with obstructed
good blood supply
Inflammed Hernia-
contents of the sac
become inflammed
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Basic features of hernia???
Occur at weak point (Congenital or acquired)
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Various types of Herniae?(common)
Inguinal
Umblical
Incisional
Femoral
Epigastric
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Other rare herniae
Spigelian
Obturator
Lumbar
Gluteal
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Inguinal
Hernia
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Surface anatomy ?????
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Relation to the surrounding
structures
1.Anterior wall
Medially-external obliqueaponeurosis
Lateral- internal oblique muscle
2.Posterior wall
Medially strong conjoint tendon
Lateral- fascia transversalis
3.Floor
Medial- Lacunar ligament
Lateral- inguinal ligament
4.Roof
Arching of fibers of int oblique and
transverse muscles.
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Examination of the hernia
Ask permission
Exposure
Position
Third party
Privacy
Manner
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Ask the patient to stand up
Lying position ..why not?
Not possible to see the true size.
proper examination even not detect at all.
If suspect since early,start with standing position
If found during routine abdominal exam, complete
abd exam first and ask the patient to stand up to
examine properly.
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Look at the swelling from the front
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Feel from the front
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Feel from the side
Having exam the scrotal content & cant get above the lump
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Expansile cough impulse
Firmly compress the lump with fingers
Ask the patient to turn head toward to opposite side &
to cough
If Tense and expansile = cough impulse (+)
Note:
Localized swelling in the spermatic cord and undescended testis
come out during cough but not bigger nor tense .
(+) is diagnostic for hernia
(-) can not exclude diagnosis (e.g adhesion )
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Is the swelling is reducible?
Position????
Can control at internal ring =indirect
Can not control = direct
Note:
Reduction point to pubic tubercle
above and medial inguinal
Below and lateral .femoral
Only for reducible one
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Remove the finger and watch the
reappearance
NOTE:
Difficult in obese patient
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Percuss and auscultate
Intestine = resonant and audible bowel sound
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Feel the other side
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Examine the abdomen
pressure
e.g ..????
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Cardiovascular & respiratory assessment
Fitness
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Differences b/t
direct and indirect inguinal hernia
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Indirect inguinal hernia Direct inguinal hernia
Any age but common in young Elderly
Via deep inguinal ring and long the Via transversalis fascia (hasselbachs
inguinal canal triangle)
Patent or reopen processus vaginalis Weak abdominal wall/muscle
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Clinical features
Femoral hernia
Vaginal hydrocele
Undescended testis
Lipoma of cord
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Some definition ?????
Strangulated hernia ?
Richter`s hernia?
Maydl`s hernia?
Sliding hernia?
Incarceration ?
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Video for inguinal hernia examination
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THANK YOU
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