Hernia

Dr. Suleiman JastaniahAssociated Proff,

College of MedicineConsultant G.S Al Noor

Specialist Hospital

DEFINITION :

PREDISPOSING FACTORS :

COMPOSITION OF THE HERNIA : *SAC---------neck ,body ,fundus .

*COVERINGS.

*CONTENTS.

CLASSIFICATION :

1.Reducible. 2.Irriducible.

3.Obstructed.

4.Strangulated.

INGUINAL HERNIA*ANATOMY :*TYPES : DIRECT: Weakness in Hessalbach’s triangle . Indirect : -Common in young. -There are 3 types . 1.Bubonocele. 2.Funicular. 3.Complete.

CLINICAL FEATURES:

DEFF.DIAGNOSIS : 1. Vaginal Hydrocele. 2.Encysted hydrocele of the cord. 3. Femoral hernia. 4. Undescended testis. 5.Lipoma of the cord .

Management :

Sliding Hernia.

FEMORAL HERNIAANATOMY :

-The 3rd common hernia.-F>M

CLINICAL FEATURE :

DIFF. DIAGNOSIS: 1.Inguinal Hernia :above and medial to the pubic tubrcle.

2.Saphena Varix :sacular enlargement of long saphenous vein. - +ve fluid thrill. -venous hum. 3.Inguinal lymph node. 4.Lipoma. 5.Femoral Hernia. 6.Psoas Abscess. 7.Psoas Bursa.TREATMENT :SURGERY.

PARAUMLICAL HERNIAIn adults-----------F>MOne inch around the umblicus.Common in multipara.Types : 1.Simple. 2.Obsructed. 3.Strangulated.TREATMENT :SURGERY.

UMBLICAL HERNIA : Common in children.EXAMPHALOS : -MAJOR. -MINOR.

EPIGASTRIC HERNIA : A defect in the midline between xiphoid process and umbilicus. It is mainly extraperitonial fat.CLINICAL FEATURE : *PAINLESS. *PAINFUL. *REFERD PAIN.TREATMENT :Surgery.

INCISIONAL HERNIACAUSES : 1.Factors related to wound closure. *The suture material. *The method of closure. *The drainage through the wound. 2.Coughing ,Vomiting ,Abdominal distention. 3.Peritonitis. 4.General condition of the patient. 5.Associated illness.

HERNIAS IN CHILDERN*INGUINAL.*FEMORAL.*UMBLICAL. -Inguinal Hernia 90% in males. -It is due to patent procuss vaginalis.

ObstructedStrangulated.

RARE HERNIAS1.Richter’s Hernia: portion of the circumference of the intestine is strangulated.2.Littrle’s Hernia: It contains Meckle’s diverticulum.3.Interstetial Hernia: The hernial sac passes between the layers of the abdominal wall.4.Spigelian Hernia :Interparietal hernia at the level of arcuate line.5.Maydl’s Hernia: 2 loops of intestine are incarcerated in the sac with strangulation of intaabdominal part.

SCROTUM :

*HYDROCELE : Abnormal collection of serous fluid in tunica vaginalis . Primary Secondary *Trauma *Epididmo-orcitis *Tumor *Lymphatic obstruction

TYPES :

>Congenital >Infantile >Vaginal >Encysted

VARICOCELE : dilated and tortuous veins in pampiniform plexus.

UNDESCENDED TESTIS : Testis which is in its anatomical path but has failed to reach the scrotum.

ECTOPIC TESTIS :

Which has descended to an abnormal site . *Superficial Inguinal pouch *Femoral Triangle . *Perineum . *Base of the penis.

COMPLICATIONS : >Hernia >Torsion >Trauma >Tumor >infertilityTUMOUR : Painless testicular swelling Loss of testicular sensation.