The document summarizes key details about the inguinal canal and inguinal hernias. It describes the anatomy of the inguinal canal including its entrance, exit, roof, floor, and walls. It then discusses direct and indirect inguinal hernias, their causes, signs and symptoms, examination findings, and surgical repair techniques like Lichtenstein and Shouldice repairs. Femoral hernias are also briefly covered.
Inguinal and femoral hernia:
A hernia is a protusion of a viscus or a part of viscus through and abnormal opening in the walls of its containing cavity. Details of inguinal hernia and few slides on other types of hernia.
Inguinal Hernia is the commonest problem in General surgery. All medical students should know everything about this common problem. In this ppt presentation I have covered all the details regarding Inguinal hernia thoroughly.
Inguinal and femoral hernia:
A hernia is a protusion of a viscus or a part of viscus through and abnormal opening in the walls of its containing cavity. Details of inguinal hernia and few slides on other types of hernia.
Inguinal Hernia is the commonest problem in General surgery. All medical students should know everything about this common problem. In this ppt presentation I have covered all the details regarding Inguinal hernia thoroughly.
An epigastric hernia is where fat pushes out through a weakness in the wall of your abdomen between your umbilicus (belly button) and sternum and forms a lump
Femoral hernia is the third common hernia after inguinal and incisional hernias. The swelling in femoral hernia is below and lateral to pubic tubercle. It is more common in females. Strangulation is very common in this hernia.
An epigastric hernia is where fat pushes out through a weakness in the wall of your abdomen between your umbilicus (belly button) and sternum and forms a lump
Femoral hernia is the third common hernia after inguinal and incisional hernias. The swelling in femoral hernia is below and lateral to pubic tubercle. It is more common in females. Strangulation is very common in this hernia.
This is an oblique intermuscular passage in the lower part of the anterior abdominal wall ,
Situated just above the medial half of the inguinal ligament
A brief presentation on inguinal hernia covering the all aspects regarding anatomy, presentation, treatment and complications, esp for undergraduate and post graduate students.
HERNIA isA hernia is a medical condition characterized by the protrusion of a...tekalignpawulose09
A hernia is a medical condition characterized by the protrusion of an organ or tissue through an abnormal opening in the muscle wall that typically holds it in place
Overview of Hernias with special emphasis on Inguinal Hernias. Management of obstructed, strangulated hernia, Bassini repair, McVay's repair, Tanner's slide
HIV discrimination among health providers in Malaysia by Dr RubzDr. Rubz
Although doctors took oath that they will treat everyone the best they can and without judging anyone but discrimination still exist especially in HIV affected people. Due to this issue, Pertubuhan Advokasi Masyarakat Terpinggir Malaysia has taken a step to engage with doctors at government sector and desensitize them and find the line to stand together.
Testicular cancer for public awareness by Dr RubzDr. Rubz
A presentation prepared for Charity Dinner with Fun Charity. All the profits of the event will go to FReHA (a NGO which supports women's and reproductive health.)
Prostate cancer for public awareness by DR RUBZDr. Rubz
A presentation prepared for Charity Dinner with Fun Charity. All the profits of the event will go to FReHA (a NGO which supports women's and reproductive health.)
Breast Cancer for public awareness by Dr RubzDr. Rubz
A presentation prepared for Charity Dinner with Fun Charity. All the profits of the event will go to FReHA (a NGO which supports women's and reproductive health.)
This is the first phase (qualitative) of the current project we are working on with the supervision of University Malaya and Yale School of Medicine.It will be publish as IBBS 2013 by end of the year. This slide is just a rough picture of what we are doing at the moment. This is copyright protected!
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. Inguinal Canal
3.75cm long directed downwards and medially
from the deep to superficial inguinal ring.Just
above the medial half of inguinal ligament.
The inguinal canal can be thought of as a
tunnel that travels from an "entrance", which is
lateral and deep, to an "exit", which is medial
and superficial. It, like a tunnel, also has a
roof, a floor, and two walls.
Or
pathway for the spermatic cord in males +
ilioinguinal Nerve or round ligament of the
uterus + ilioinguinal nerve in females
3. Entrance- deep inguinal ring in the transversalis fascia
(U-shape). Lies 1.25cm above the inguinal ligament.
Exit- superficial inguinal ring ,slitlike opening in the
external oblique aponeurosis.Lies 1.25cm above the
pubic tubercle
Roof -fibers of internal abdominal oblique ,transversus
abdominis muscles and medial crus of external oblique
muscle
Floor – inguinal ligament throughout, with lacunar
ligament (Gimbernat's ligament) added medially and
iliopubic tract
Anterior wall- external abdominal oblique aponeurosis
throughout, with internal abdominal oblique aponeurosis
added laterally and superficial inguinal ring
Posterior wall - mostly transversalis fascia, with conjoint
tendon (falx inguinalis/Henle's ligament) which is the
joining of internal abdominal oblique and transversus
abdominis aponeuroses, medially.and deep inguinal ring
4.
5. Inguinal
Triangle (of
Hesselbach)
1. Medially: lateral
edge of rectus
abdominis (linea
semilunaris)
2. Laterally: inferior
epigastric artery
3. Inferiorly: inguinal
ligament
(Poupart’s
ligament)
the weak fascia, where direct hernias occur, is located in
the inferior portion of this triangle
Indirect Hernias protrude lateral to Hesselbach's Triangle.
6. Blood supply
and Ner ve
Artery – Inferior Epigastric (lie
inner vation posteriorly and medially to deep
inguinal ring)
Vein – Inferior Epigastric
Nerve – Ilioinguinal and Iliogastric
During an open hernia repair, careful
dissection of the ilioinguinal nerve is
important for two reasons.
1. Because of the nerve distributions cited
above, injury during incision or closure
can result in pain following the L1
dermatome (including the scrotum or
labium majorum).
2. Because the ilioinguinal nerve has
motor distributions to the internal
oblique (which are inserted into the
lateral border of the conjoint tendon),
division of the nerve paralyzes these
muscle fibers, weakening the conjoint
tendon, which can precipitate a direct
inguinal hernia.
7. Spermatic cord
The classic description of the contents
of spermatic cord in the male are:
3 arteries: artery to vas deferens (or
ductus deferens), testicular
artery,cremasteric artery;
3 fascial layers: external spermatic,
cresmasteric and internal spermatic
fascia;
3 other structures: pampiniform plexua,
vas deferens(ductus deferens),
testicular lymphatics;
3 nerves: genital branch of the
genitofemoral nerve (L1/2), autonomic
and visceral afferent fibres, ilioinguinal
nerve (
The ilioinguinal nerve passes through
the superficial ring to descend into the
scrotum, but does not formally run
through the canal.
8. Inguinal hernia
“Affect 9% of men and 1% of female but it is more common
in female compare to femoral hernia” - (Browse’s introduction to the symptoms and
sign of surgical disease 4th edition)
Classification
Direct ,Indirect
Congenital , Acquired (by causes).
Complete , Incomplete, Bubonocele (type of indirect inguinal hernia)
Enterocle, Epiplocele/ Omentocele, Cystocle (content of hernia)
Special type :
1. Pantaloon hernia ( Direct and indirect in the same groin) – two sacs
by the inferior epigastric artery
2. Sliding hernia –Extraperitoneal bowel (cecum/terminall ileum on the
Rt and sigmoid colon on the Lt) which slides down into the inguinal
canal, pulling a sac of peritonuem on its surface
3. Maydl’s hernia –two loops of bowel in the sac with the strangulation of
the loop of bowel in the abdomen which connects them.
Clinically : Reducible, Irreducible, Obstructed/Incarcerated,
Strangulated, Inflamed
9. Etiology
Wall defect – weakness of the anterior wall
Ex:Omphocele and Gastroschisis
Embriogenic defect –
EX: Patent Processus Vaginalis and Patent canal of
Nuck in Female
Increased intraabdominal pressure
Pregnancy
Heavy lifting
Excessive weight
Straining during bowel movement or urination
Chronic coughing or sneezing
Smoking
Damage to ilioinguinal nerve due to previous
appendectomy
10. Inguinal Hernia
Direct IH Indirect IH
- Enter the inguinal canal - Comes out of the abdomen
through the medial half of cavity through out the deep
its weak posterior wall inguinal ring,travel along the
(through Hesselbach’s inguinal canal and then
triangle) to the inferior protruded out from the
epigastric artery and then superficial inguinal ring
protruded out from the - descends along the spermatic
superficial inguinal ring cord in males or the round
separate from the ligament in females.
spermatic cord. Congenital; through patent
processus vaginalis
Acquired: passes through
deep inguinal ring initially, i.e
lateral to the inferior epigastric
artery and exits through the
superficial ring.
11. It is not always possible to distinguish clinically between a direct and indirect inguinal
hernia
Direct Inguinal Hernia Indirect Inguinal Hernia
In older men. These hernias never occur in females.All Acquired Common in young men. Congenital and acquired
Lies posteriomedial to the spermatid cord Lies anterolateral to the spermatid cord
Wider Neck and lies medial to inferior epigastric artery.Uncommon Narrow Neck and lies lateral to inferior epigastric artery
to reach down into the scrotum, and its generally smaller. Common
to bulge forward. They are often bilateral in the older person.
Bulge from the Hesselbach triangle Descend through deep inguinal hernia
Cough impulse :usually not increased in size Cough impulse: increased in size
Weakness anterior wall. Mostly do not descend the scrotum Patent Processus vaginalis. The persistence of the processus
vaginalis sac at birth associated with and following the descent of
the testis
Easy to reduce Difficult to reduce
Less chance of strangulation Generally indirect herniae should be surgically repaired because
they become larger, cause symptoms and may obstruct and
strangulate. Especially in children
12.
13. Congenital Inguinal
Hernia
Processus vaginalis is an embrogenic
developmental outpouching of the peritoneum
Gubernaculum -are embryonic structures
which begin as undifferentiated mesenchyme
attaching to the caudal end of the gonads
(testes in males and ovaries in females).
14. • An obvious bulge at the internal or
external ring or within the scrotum. The
parents typically provide the history of a
visible swelling or bulge, commonly
intermittent, in the inguinoscrotal region
in boys and inguinolabial region in girls.
The image shows depicts a 4-month-old
baby boy with a large right-sided indirect
inguinal hernia.
• The swelling may or may not be associated with any pain or discomfort. The
parents may perceive the bulge as being painful when, in truth, it causes no
discomfort to the patient.
• The bulge commonly occurs after crying or straining and often resolves during the
night while the baby is sleeping.
• Indirect hernias are more common on the right side because of delayed descent of
the right testicle. Hernias are present on the right side in 60% of patients, on the left
in 30%, and bilaterally in 10% of patients.
• If the patient or the family provides a history of a painful bulge in the inguinal region,
one must suspect the presence of an incarcerated inguinal hernia. Patients with an
incarcerated hernia generally present with a tender firm mass in the inguinal canal
or scrotum. The child may be fussy, unwilling to feed, and inconsolably crying. The
skin overlying the bulge may be edematous, erythematous, and discolored.
15. Sign and symptoms
an inguinal hernia either may not cause any symptoms or may
cause only a feeling of heaviness or pressure in the groin.
Symptoms are most likely to appear after standing for long
periods, or when you engage in activities that increase pressure
inside the abdomen, such as heavy lifting, persistent coughing
or straining while urinating or moving the bowels.
As the hernia grows, it eventually causes an abnormal bulge
under the skin near the groin. This bulge may become
increasingly more uncomfortable or tender to the touch.
In strangulated type: severe pain will occur so must do give
immediate treament. Cx: Necrosis due to blood supply cut.
In obstructed type: cardinal symptoms of intestinal obstruction
(colicky pain in abdomen, vomiting, abdominal distension and
absolute constipation)
16. Examination
Position:Ask Pt to stand .Dr sit
Size/shape : Indirect (pyriform with a stalk at the external inguinal ring.Usually
extend down to scrotum)
Direct (spherical and little tendency to enter into scrotum)
Position of penis: Large hernia push the penis to other side
Skin colour :Normal,Red(inflammed or strangulated). Longer term of truss
usage – discolouration and streaks of hyperpigmentation due to deposition of
hemosiderin). Scar in previous operation.
Temperature : Normal or warm (strangulated/Inflamed)
Composition: Gut (soft,resonant,bowel sound and fluctuant), Bowel
( resonant,hard ,tense and fluctuant), Small intestine ( Visible peritalsis, large
scrotal hernia), Omentum ( firm like rubber, non –fluctuant and dull to
percussion)
Tenderness : Manual pressure is uncomfortable but not painful. Pain
(strangulated, Inflamed)
Reducibility: No painful but sometime with excessive pressure can cause pain.
Cough impulse: Most lumps in the groin moves up and down with coughing
but in hernia, it expand in all direction.
17. Gentle continuous pressure on the
hernial mass towards the inguinal ring
is generally effective (Trendelenburg)
18. Management
Plan for surgery after routine
investigation
Investigation
- FBC – TWC, HB
- Blood sugar, urea and creatinine
- Urine for routine examination
- CXR PA view
- ECG
19. Surgical
Indirect inguinal hernia
Inguinal herniotomy (disect out and opening the
hernial sac,reducing any content and then
transfixing the neck of the sac and removing the
remainder) +- with herniorrhaphy
Procedure:
1.Excision of the hernial sac
2.Repair of the strecthed internal inguinal ring and
the transversalis fascia
3.Reinforcement of posterior wall of inguinal canal
20. Direct Inguinal hernia
Shouldice (Canadian) repair
Utilizes a multi-layered imbricated repair of
the inguinal canal floor where ring and fascia
are incised and carefully separated from the
deep inferior epigastric vessels and
ectraperitoneal fat before an overlapping
repair (double breasting) of the lower flap
behind the upper flap
21. Lichtenstein (tension-free) Repair
One of the most commonly performed
procedures
The tails of mesh are overflapped and
crossed and single is placed to create a new
“internal “ ring
A Marlex mesh patch is sutured over the
defect with a slit to allow passage of the
spermatic cord
23. McVay (Cooper’s ligament) Repair
Is for the repair of large inguinal hernias, direct
inguinal hernias, recurrent hernias and femoral
hernias
The conjoined tendon is sutured to Cooper’s
ligament from the pubic cubicle laterally
24. Laparoscopic hernia repair
-Current techniques include
○ Transabdominal preperitoneal repair (TAPP)
○ Totally extraperitoneal approach (TEPA)
○ TAPP- pneumoperitoneum and places a synthetic
mes preperitoneally by dissecting the perionuem off
the hernial orifices and positioning the mesh
beneath the peritoneum before closing.
○ TEPA-completely periperitoneal. Used in any
inguinal hernia, unilateral, recurrent or bilateral
hernia, and femoral hernia
25.
26.
27. Strangulated Hernia – EMERGENCY OP
Preop: resuscitate with adequate
fluid,empty the stomach with NG tube, Gv
antibiotic to contain infection and catherize
to monitor hemodynamic state
Inguinal herniotomy:incision on the
prominent part of swelling.
28. Femoral Hernias
More common in females than in males
Through a space bounded by the
ileopubic tract
Demonstrated by a mass below the
inguinal ligament
29. Femoral Canal
1.25cm in long and 1.25cm wide at its base,directed
upwards.Occupied most medial compartment of
femoral sheath and extends from femoral ring above
the saphenous opening.
Anterior – Inguinal ligament
Posterior- iliopectineal ligament, pubic bone and
fascia over Pectineus Muscle
Medial – Lacunar ligament and prolonged along the
iliopectineal ligament
Lateral – thin septum separating it from the femoral
vein
Space – Loose areolar tissue and lymph gland (Gland
of Cloquet)
30.
31. Clinical features
Common in right side twice more than left
side.Occasionally Bilateral
Rare in children. Common in age 50.More
common in Female than man
Sign and symptoms similar to Inguinal hernia
Rarely large sac present
40% presented with strangulation
Richter’s Hernia – intestinal obstruction
Thick walled with layer of fat and CT, cut cross
look like onion
Cannot control by truss
Urgent operation due to strangulation.
32. Surgical
Lockwood (low operation)
-sac dissect out below the inguinal ligament via groin
crease incision. Peel off all the anatomical layers
that cover the sac, deal with content. Then pull
down the neck of sac and ligate as high as possible
and allow to retract through femoral canal. Close
the canal by suturing to inguinal ligament to
iliopectineal line.
McEvedy (high operation)
Lotheissen (inguinal operation)
- Open the inguinal canal by inguinal herniorrhaphy.
Tranversalis fascia is incised to medial side of
peigastric vessel and enlarged the opening. Open
peritoneum,withdraw sac from femoral canal.Deal
with the content. Suture the conjoined tendon to the
iliopectineal line to form a shutter
33. Umbilical hernia
Congenital (exomphalos)
1 in 6000 births due to failure of all or part of
midgut to return to the coelom during the early
fetal life
Age: Hernia wont be noticed till the umbilical is separated and
healed.Noticed after some months
Common in Afro- Carribean race
Symptoms: Swelling, others are rare. Sometime parental anxiety
or intestinal obstruction
Examination : hemispherical shape,overlie and easy to palpate
on the abdominal Size can be 0.5cm – 10cm) Composition:
Soft, compresibble, and reducible.usually contained bowel and
resonant to percussion.Cough impulse invariable
34. Omphocele (contain organ outside the
abdomen) More common
Gastroschisis (umblical cord is not involved
and usually at right mid.)
35. In adult:
acquired ( due to defect to umbilical cicatrix)
True umbilical hernia
Secondary to intraabdominal pressure,
pregnancy and ascites
P/E: Distended abdomen
36. Management
Non-op
For premature infant with gigantic intact sac. Daily apply with desiccating
antiseptic solution.If successful,an eschar forms over the sac.Once the
granulisation tissue grow- ventral hernia can be repaired later age.
Skin flap closure
-sace is gently trimmed.The skin is freed from the fascial edges and
undermined laterally.Ligate the umbilical vessel for monitoring. Put skin
flap at midline with simple sutures and ventral hernia closed later
Primary closure
-sac dissect away from skin edge and fascia,evacuate the intestinal fully
from meconium,fluid and etc through NG tube.Strect abdominal wall
gradually to double the volume.Then replace the viscera and close the
fascia layer under moderate tension.
Herniorrhaphy after 2 years
Op
-small curved incision immediately below the umbilicus. The sin cicatrix is
dissected upwards and the neck of the sac isolated.Once the sac is
empty,either invert it into abdomen or ligate by transfixation and
excised.
37. Paraumbilical hernia
Common acquired umbilical hernia.
Common in mid age and old age.Common in women and men
especially in parous and obese women
Defect that is adjacent to the umbilical scar
Does not bulge into the centre of umblicus and not attach to the centre
of sac
Symptoms: Discomfort and swelling, pain worsen by prolong standing
and sternous exercise
Strangulated type contain extraperitoneal fat or omentum. Normally
bowel is not obstructed
P/E: bulge at beside umbilicus (pushed one side and stretched into a
cresent shape)maybe infected with foul smelling discharge ,collection of
dried- up sebacuoes secretion)
Smooth surface and edge is easy to define
Composition : firm, usually contain omentum .if contain bowel,(soft and
resonant). Reducible
Expansile cough impulse
38. Treatment
If untreated, hernia will increase in size and strangulation
can occur.
Indication: present symptoms and patient is not obese
Umbilical herniorrhaphy ( small )– primary herniorrhaphy
Transverse incision around the umbilicus and subcutaneous
tissue are dissected off the rectus sheath to expose the
neck of sac.Deal with content. Remove sac and close
peritoneum. Aponeurosis on both side of umbilical ring is
mobilised to allow an overlap.Interrupted matress
sutures are inserted into aponeurosis.
- If large- prosthetic buttressing of the abdominal wall.
(paraumbilical hernio plasty)
39. Incisional hernia
Age: all ages but common in adult.Mostly in obese pt.
Acquired scar in the abdominal wall caused by a previous
surgical operation (peritonitis) and injury
Pt remembered that it caused by the scar.usually occur in
first year of operation but maybe also in later age.
Might has hx of weakened the abdominal msuculature,
chronic cough,obesity or steroid therapy
Symptoms :lump and pain.Maybe intestinal obstruction
(distension, colic , vomit, constipation and severe pain in
the lump)
Irreducible , expansile cough impulse, local tissue thin
and weak
40. Treatment
If pt obese- weight reduction by dieting
before op.
Simple apposition
Complex apposition (various type of
layered closure)
Plastic fibre mesh or net closures
- Method of choice but in defect <4cm
41. References
Bailey & Love’s 25th Edition
A manual On Clinical Surgery By S.Das
Browse’s Introduction To The Symptoms
And Sign of Surgical Disease 4th Edition
Dissector Answers by University of
Michigan Medical School
University of Connecticut Health Center
Bedside Clinics in Surgery by Makhan Lal
Saha
Melbourne Hernia Clinic