-IBIS-1.5.0-
tx
musculoskeletal system
hernia
diagnoses
definition and etiology
definition:
The protrusion of a structure through a weakness in the abdominal wall.
inguinal:
Male:
indirect: are the most common in both sexes and occur often in children
originates above the inguinal ligament near the midpoint
often protrudes into the scrotum
palpation with examiner's finger into the inguinal canal reveals a mass meeting the finger in the canal
direct: are less common
usually occur in men over 40
are found above the inguinal ligament close to the pubic tubercle
rarely extrude into the scrotum
palpation reveals a bulge anteriorly which pushes the examiner's finger forward
femoral:
are palpable below the inguinal ligament and medial to the femoral artery and vein
do not protrude into the scrotum
the inguinal canal is empty
Female:
indirect: A protrusion through the internal inguinal ring, often producing a bulge over the middle of the inguinal ligament.
direct: A protrusion through the posterior wall of the inguinal canal
(Hesselbach's triangle). The bulge is noticed close to the pubic tubercle, that is, more medially than the indirect hernia. This type of hernia is infrequently seen in females.
femoral:
protrusion occurs through the femoral canal.
etiology:
A weakness in the wall of the abdomen allows protrusion of a serosa-lined pouch to protrude into the femoral or inguinal canal. The danger lies in the possibility of strangulation and infarction of the protruding structure, commonly the small intestines. Inguinal hernias are more common in males than females since the spermatic cord and testes descend through the inguinal canal, leaving it more patent and therefore susceptible.
signs and symptoms
Male:
Pain and swelling in the femoral canal or scrotum
Constipation
A palpable mass felt by the examiner's finger inserted into the inguinal canal or over the femoral canal; the mass is made more obvious as the patient stands or bears down
Female:
Pain may or may not present.
Hernia may or may not be reducible.
(+) physical exam; however, it is hard to perform the exam for inguinal hernias on women.
course and prognosis
May cause strangulation of the structures involved and subsequent infarction as the structure swells and cuts off blood supply.
Unless the hernia becomes strangulated and leads to gangrene, the prognosis is favorable. Surgery is the treatment of choice for conventional physicians.
Various treatments are available to replace the protruding tissue and maintain closure of the hernia opening.
differential diagnosis
Male:
hydrocele
varicocele
Female:
lymphadenopathy
saphenous vein varicosity
footnotes