004 Hernias - Introduction to Clinical Surgery Lectures

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    004 Hernias - Introduction to Clinical Surgery Lectures - Presentation Transcript

    1. Hernias Nick Harvey
    2. Hernias
      • What is a hernia?
        • Protrusion of a viscus or part of a viscus through a defect in the wall that retains it.
      • Basic Physical Signs of a Hernia
        • Occur at a natural weak point
        • Cough impulse
        • Reducible
    3. Hernias: Surgical Anatomy
      • Sac
        • neck, body, fundus
      • Contents
        • Bowel
        • Omentum
    4. Hernias: Surgical Anatomy
      • Common sites
        • Inguinal (direct/indirect)
        • Femoral
        • Umbilical
        • Paraumbilical
        • Incisional
        • Epigastric
      • Rare sites
        • Spigelian
        • Lumbar
        • Obturator
        • Gluteal
    5. Hernias: Pathological Type
      • Reducible
      • Irreducible ‘Incarcerated’
      • Obstructed
      • Strangulated
      • Inflamed
    6. Hernias: Special Types
      • Sliding or Rolling
      • Richter’s
      • Maydl’s
    7. Hernias: Inguinal Anatomy
      • Anterior Superior Iliac Spine (ASIS)
      • Pubic Tubercle (PT)
      • Pubic Symphysis (PS)
      • Inguinal Ligament
      • Vessels (NAVY)
    8. Hernias: Inguinal Anatomy
    9. Hernias: Inguinal Anatomy
    10. Hernias: Indirect Inguinal Hernia
    11. Hernias: Direct Inguinal Hernia
    12. Hernias: Femoral Hernia
    13. Hernias: History
      • Onset, Course, Duration
      • Painful or Painless?
      • Other Lumps
        • Present or past?
        • Same type?
      • Effect on General Condition
        • Symptoms and signs of bowel obstruction
      • Cause?
        • Chronic cough, chronic constipation, symptoms of urinary obstruction
      • Does the lump disappear?
    14. Hernias: Examination
      • Patient standing
      • Stand on the same side as the hernia
      • Ask the patient to cough
      • Examine as in any other swelling
      • Try to reduce the henia
        • Comment in direction/contents
      • Try to find the cause
        • Examine abdomen, chest, DRE
    15. Hernias: Inspection
      • Site
      • Size
      • Shape
      • Symmetry
      • Surface
      • Skin overlying
      • Scars
      • Special signs
        • Cough impulse
    16. Hernias: Palpation
      • Tenderness
      • Temperature
      • Can you get above the swelling?
      • Surface
      • Edge
      • Consistency
        • Doughy or gurgly?
      • Relation to Surrounding Structures
        • Pubic Tubercle, Vessels
      • Draining Lymph Nodes
      • Special signs
        • Cough impulse
        • Reducibility
    17. Hernias: Relationship with pubic tubercle
    18. Hernias: Special Signs
      • Cough impulse
      • Reducibility?
        • Comment on direction/contents
      • Internal ring test
    19. Differential Diagnosis of a Groin Lump
      • Surgical sieve!
      • Inguinal hernia
      • Femoral hernia
      • Enlarged lymph nodes
      • Ectopic testis
      • Femoral aneurysm
      • Sapheno-varix
    20. Hernias: Diagnosis
      • Anatomical
        • Side, inguinal, femoral umbilical…
      • Pathological
        • Reducible, irreducible, obstructed, strangulated, inflamed.
      • Recurrent or not?

    + Nick HarveyNick Harvey, 2 years ago

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