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The Detailing Heamorrhage

  Heamorrage may be defined as escape of blood from the vascular system. ·         Classification of heamorrhage: ·         According to vessel involved/source: 1.Arterial:Bright Red.Spurting due to increased pressure. 2.Venous:Dark red.welling up due to low pressure. 3.Capillary:Generalized oozing. ·         Clinical /According to duration: 1.primary:Heamorrage occurring immediately   due to injure or surgery. 2.Reactionarywithin 24 hours of (usually 6 hours),due to clot dislodgement,sliping of ligature,release of vasospasm ,rise of BP,straining ar extubation,coughing.Examples:after thyroiectomy,tonsillectomy,prostatectomy, heamorroidectomy. 3.Secondary :Within 7-14days after primary heamorrhage ,cause -infection ,pressure necrosis ,malignancy. ·         According to exposure: 1.External:Bleeding that occurs during...

various types of hernia

Hernias occur when a viscus or part of it protrudes from within its normal anatomical cavity. Specific hernias are covered under their designated titles the remainder are addressed here.

Spigelian hernia

• Interparietal hernia occurring at the level of the arcuate line

• Rare

• May lie beneath internal oblique muscle. Usually between internal and external oblique

• Equal sex distribution

• Position is lateral to rectus abdominis

• Both open and laparoscopic repair are possible, the former in cases of strangulation

Lumbar hernia

The lumbar triangle (through which these may occur) is bounded by:

Crest of ilium (inferiorly), External oblique (laterally), Latissimus dorsi (medially)

Primary lumbar herniae are rare, most are incisional hernias following renal surgery

Direct anatomical repair with or without mesh re-enforcement is the procedure of choice

Obturator hernia

• Herniation through the obturator canal

• Commoner in females

• Usually lies behind pectineus muscle

• Elective diagnosis is unusual most will present acutely with obstruction

• When presenting acutely most cases with require laparotomy or laparoscopy (and small bowel resection if

indicated)

Richters hernia

• Condition in which part of the wall of the small bowel (usually the anti mesenteric border) is strangulated within

a hernia (of any type)

• They do not present with typical features of intestinal obstruction as lumenal patency is preserved

• Where vomiting is prominent it usually occurs as a result of paralytic ileus from peritonitis (as these hernias may

perforate)

Incisional hernia

• Occur through sites of surgical access into the abdominal cavity

• Most common following surgical wound infection

• To minimise following midline laparotomy Jenkins Rule should be followed and this necessitates a suture length

4x length of incision with bites taken at 1cm intervals, 1 cm from the wound edge

• Repair may be performed either at open surgery or laparoscopically and a wide variety of techniques are

described

Bochdalek hernia

• Typically congenital diaphragmatic hernia

• 85% cases are located in the left hemi diaphragm

• Associated with lung hypoplasia on the affected side

• More common in males

• Associated with other birth defects

• May contain stomach

• May be treated by direct anatomical apposition or placement of mesh. In infants that have severe respiratory

compromise mechanical ventilation may be needed and mortality rate is high

Morgagni Hernia

• Rare type of diaphragmatic hernia (approx 2% cases)

• Herniation through foramen of Morgagni

• Usually located on the right and tend to be less symptomatic

• More advanced cases may contain transverse colon

• As defects are small pulmonary hypoplasia is less common

• Direct anatomical repair is performed

Umbilical hernia

• Hernia through weak umbilicus

• Usually presents in childhood

• Often symptomatic

• Equal sex incidence

• 95% will resolve by the age of 2 years

• Surgery performed after the third birthday

Paraumbilical hernia

• Usually a condition of adulthood

• Defect is in the linea alba

• More common in females

• Multiparity and obesity are risk factors

• Traditionally repaired using Mayos technique - overlapping repair, mesh may be used though not if small bowel

resection is required owing to acute strangulation

 

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