Hello and welcome to the Zero to Finals podcast.

My name is Tom and in this episode I'm going to be going through hernias.

And you can find written notes on this topic as always at zero to finals.com

slash herniers or in the general surgery section of the zero to finals surgery book.

So let's get straight into it.

Herniers occur where there is a weak point in a cavity wall, usually affecting the muscle or the

fascia.

This weakness allows a body organ, for example the bowel that would normally be contained within that cavity

to pass through the cavity wall. Let's talk first about the presentation. There are many

types of hernias that present differently depending on where they are and what organs are involved.

The typical features of an abdominal wall hernia are a soft lump protruding through the abdominal wall.

The lump may be reducible, meaning it can be pushed back into the normal place.

The lump may protrude when coughing, which raises the intra-abdominal pressure,

or on standing when it's pulled out by gravity, and there may be

aching, pulling, or a dragging sensation. Let's talk about the complications because these are really

important. There are three key complications of hernias. Incarceration, obstruction and strangulation. Incarceration is where the hernia cannot be

reduced back into the proper position, meaning it's irreducible. The bowel that's coming through the

hernia is trapped in the herniated position. Incarceration can lead to obstruction and strangulation of the hernia.

Obstruction is where the hernia causes a blockage of the passage of feces, fluids and gas

through the bowel. Obstruction presents with vomiting, generalized abdominal pain and

absolute constipation. Absolute constipation means not passing feces or phletus.

Strangulation is where the hernia is non-reducible. It's trapped with the bowel protruding.

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