assalamualaikum w.b.t...
as i cannot sleep yet sebab nak study but not really focus enough..let me leave it here while revising..in case ada medical students or anyone yang tengah study and found this notes, moga bermanfaat :*
so, first thing first, what is hernia?
--> hernia is a protrusion of an organ or a part of the organ through the weak area of body's wall
basically, hernia consist of 3 parts - the sac, covering & contents
sac --> its a diverticulum of peritoneum that consist of mouth, neck, body, fundus
covering --> it derives from the layers of abdominal wall from which the sac pass through
contents --> can be varies - omentum (omentocele), intestine (enterocele), bladder/diverticulum/, ovary
what is the anatomical types of hernia? (ada 3...)
1) bubonocele --> the hernia remains in canal
2) funicular --> hernia pass through inguinal canal
3) complete --> when hernia enter the scrotum
what are the risk factors of inguinal hernia?
- chronic cough (such as pt w TB/ bronchiolitis/ etc)
- chronic constipation (due to increase in straining)
- any previous abdominal surgery (such as appendicectomy - sbb will weakend the abdominal wall)
- increase age
- smokers
- male (as male have small hole in the groin muscle that necessary for blood vessels to pass through to testicles)
- positive family history of hernia
what are the classifications of inguinal hernia?
1) reducible - when hernia can be reduce back into it's original site
2) irreducible - when hernia cannot be reduce back to it's original position
3) obstructed - usually associated with intestinal obstruction
4) strangulated - associated with pain & gangrene
5) occult - cannot be seen
***Lets get to know a bit about the anatomy (the important one related to IH)...***
1)what is inguinal canal?
-->it is an anoblique canal measuring about 3.75cm long & consist of 2 opening
2)what are the opening of inguinal canal?
-->deep inguinal ring - located 1.25cm above midpoint of inguinal ligament
-->superficial inguinal ring - located above & medial to pubic tubercle at external oblique aponeurosis (triangular shape)
3)what are the boundaries?
- anterior - aponeurosis at external oblique muscle, reinforce by internal oblique muscle laterally
- posterior - transversalis fascia laterally, conjoint tendon medially
- inferior - inguinal ligament, thickened medially by lacunar ligament
- superior - transversalis fascia, internal oblique, transversus abdominis
4)what are the Hesselbach's triangle border?
- medially: rectus abdominis muscle
- laterally: inferior epigastric vessels
- inferiorly: inguinal ligament
5)what are the content of inguinal canal?
-female : ileoinguinal nerve & round ligament
-male : ileoinguinal nerve & spermatic cord (kena tahu content spermatic cord too)
6)what is the difference of mid-inguinal point & midpoint of inguinal ligament?
- mid-inguinal point : location of femoral artery (in between ASIS & pubic symphisis)
- midpoint of inguinal ligament : location of deep inguinal ring (in between ASIS & pubic tubercle)
**Lets move on to HTPE**
in HT, what to ask?
1)name of pt
2)gender
3)age (sebab inguinal hernia in children usually caused by different cause than adult)
HOPI
1)about pain
-how do you describe the pain? (usually pt will said it feels like dragging sensation/aching)
- it can be referred pain too
- tender/ painful might related to strangulated
2)about other sx
- any chronic coughing/ constipation?
- any strain during micturition?
- any previous surgery? trauma?
PE
- firstly, ask patient to stand up
- do the 'can get above it' test to confirm that it is hernia****
---> hernia cannot get above
Inspection
- is it unilateral/ bilateral?
- is there any scar?
- any ulceration?
- how about the shape? pyriform (indirect)? oval (direct)?
- is there any skin changes?
- any positive cough impulse?
Palpation
- palpate for consistency --> soft, firm, hard
- do taxis test (reduction test) --> reducible/ irreducible
- do deep ring occlusion test*** --> is it bulge out (direct) or not bulge out (indirect)
***So, how to manage the pt?***
1) if the pt is child, the only procedure commonly done is herniotomy..why? because in children they not yet have the posterior wall
2) for adult:
-->herniorrhaphy<--
- this is a procedure of repairing tissue without putting mesh
- there's 3 types of herniorrhaphy --> basini, shouldice, mcvay/derning
- but the most common done nowadays is basini
- but basini has high recurrence rate
-->hernioplasty<--
- repair procedure of posterior wall by filling the conjoined muscle & inguinal ligament using mesh
- there's 3 types of hernioplasty --> lichtenstein, gilbert, stoppa repair
- the most common one nowadays is lichtenstein (recurrence rate <1%)
#thats all setakat ni..if ada tambahan later me tambah again :)
xoxo,
yanie
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