3. Abdominal and groin hernias

Question 1

Describe: Hernias (3)

Answer 1

• defects in the abdominal wall or other anatomical structures leading to protrusions of peritoneal structures from their containing cavities.
• reducible or nonreducible, obstructed, incarcerated, or strangulated.
• Generally, large hernias are less likely to become nonreducible and incarcerated compared with smaller hernias.

Question 2

Indirect inguinal hernias are more common in males due to what?

Answer 2

to failure in processus vaginalis closure during embryogenesis.

Question 3

Name causal conditions of hernia (5)

Answer 3

Question 4

Describe HX and physical exam: Hernia (3)

Answer 4

• HX:
  
  • Inquire about personal or familial Hx of hernias and rule out other causes for palpable abdo wall masses (e.g., lymphadenopathy, undescended testicle)
• Physical exam
  
  • Perform a careful physical exam, including a cough impulse, to determine the location, size, and character of the hernia, and the presence of other undiagnosed hernias.
  • Inspect for signs of surgical scars to explain a potential ventral hernia.
  • The proper position for examining inguinal hernias is the upright standing position. The hernia will present at the location of the superficial inguinal ring (external inguinal ring). An exam for the presence of a patent process vaginalis should be performed.

Question 5

Name Differential diagnosis of a mass in the groin (7)

Answer 5

• Undescended testicle
• Femoral aneurysm
• Lymphadenopathy
• Hydrocele
• Spermatocele
• Varicocele
• Testicular tumor

Question 6

Describe investigations: Hernia (2)

Answer 6

• No routine blood work is needed in the workup of a hernia.
• A U/S study is useful in establishing a diagnosis of a groin hernia; however, surgical/symptomatic groin hernias should be apparent on exam.

Question 7

Describe management: Hernia (2)

Answer 7

• All hernias should be assessed by a general surgeon for consideration of repair due to the risk of incarceration and strangulation.
• A patient who presents with a nonreducible hernia in the setting of increased pain or signs of hemodynamic instability should undergo urgent operative exploration. Referral to a general surgeon should not be delayed by investigations or imaging studies.

Question 8

Factors that influence postoperative recurrence of hernias include what? (4)

Answer 8

• Aberrant collagen states or metabolic disorders (e.g., Ehlers-Danlos syndrome)
• Compromised tissue healing (e.g., malnutrition or suppressed immunity)
• Increased intra-abdo pressure (e.g., obesity or ascites chronic straining (BPH, constipation), chronic cough))
• Repair failure: (e.g., postoperative infection, inadequate repair)