Abdominal Wall Hernia - School of Medicine：腹壁疝-医学.ppt

Abdominal Wall Hernia Essentials MA MURPHY FRCSI Objectives Understand the term hernia Basic anatomical knowledge Clinical features of common hernia Complications of hernias Examination of a hernia Differential diagnoses of a lump in the groin Management of hernia Hernia A protrusion of an organ or tissue outside its’ normal compartment Common External Hernias ABDOMINAL WALL GROIN Midline Umbilical Para- umbilical Epigastric Inguinal Direct/ Indirect/ Combined Femoral Incisional Common Presentations A lump Comes and goes Appears on straining /coughing A pain Dragging pain/ Pain on exertion Incidental finding on examination/ imaging Presenting as a complication Incarceration/ Intestinal obstruction Inguinal Hernia Commonest external hernia Male preponderance Infant / adult Direct / indirect / combined Weakness / increased pressure Cause pain / discomfort Carry risk of complications Treated surgically Inguinal Hernia - History OBJECTIVES Establish differential diagnoses Identify risk factors and significant co-morbid pathologies (e.g. increased intra-abdominal pressure due to ascites or chronic airways disease) Inguinal Hernia - History Onset Duration Symptoms Other hernia(e) Irreducibility Gastrointestinal system Respiratory system Surgery / anaesthesia Inguinal Hernia - Examination Surface markings Anterior superior iliac spine Pubic tubercle Midpoint of inguinal ligament Inguinal Hernia - Examination OBJECTIVES Confirm diagnoses Out rule differentials Establish type Determine contents Reducibility Identify co-morbid pathologies Direct V’s Indirect Direct Post wall Less common Older Smaller Hesselbachs Medial Lower risk Indirect Deep ring 70% Congenital Scrotal Deep ring Lateral Strangulate Inguinal Hernia Examination Standing / Lying Supine Cough impulse Reducibility Contents Bowel sounds Scrotal contents Differential Direct /Indirect/Combined Femoral hernia Hydrocele Lipoma Lymph node Testicular tumour Saphenous varix Inguinal Anatomy The inguina