7. Hernias

Question 1

What is a hernia?

Answer 1

Protrusion of part of the abdominal contents beyond the normal confines of the abdominal wall, beyond the confines of its containing cavity.

Question 2

What 3 parts does a hernia consist of?

Answer 2

The sac.
Contents of the sac.
Coverings of the sac.

Question 3

What forms the sac of the hernia?

Answer 3

Pouch of peritoneum.

Question 4

What forms the contents of a hernia?

Answer 4

Any structure found within the abdominal cavity, commonly loops of bowel and omentum.

Question 5

What forms the coverings of the sac in a hernia?

Answer 5

The layers of the abdominal wall through which the hernia has passed.

Question 6

Weaknesses in what 4 areas can lead to an abdominal hernia?

Answer 6

Inguinal canal.
Femoral canal.
Umbilicus.
Previous incisions (from surgery).

Question 7

What is the inguinal canal?

Answer 7

Is an oblique passage through the lower part of the abdominal wall.

Question 8

What abnormality in foetal development can lead to inguinal hernias in a male?

Answer 8

Incomplete (partial) obliteration of the processes vaginalis.

Question 9

What abnormality in foetal development can lead to scrotal hernias in a male?

Answer 9

No obliteration of the processes vaginalis.

Question 10

What forms the floor of the inguinal canal?

Answer 10

Inguinal ligament and the lacunar ligament reinforces it medially.

Question 11

What forms the roof of the inguinal canal?

Answer 11

The internal oblique and transverse abdominus.

Question 12

What forms the posterior wall of the inguinal canal?

Answer 12

The transversalis fascia (contains the deep ring), and is reinforces by the conjoint tendon medially.

Question 13

What forms the anterior wall of the inguinal ligament?

Answer 13

The aponeurosis of the external oblique (contains the superficial ring).

Question 14

What type of inguinal hernia is more common and occurs in more males than females?

Answer 14

Indirect hernias.

Question 15

What type of hernia is mainly right sides?

Answer 15

Indirect hernias.

Question 16

What is an indirect inguinal hernia?

Answer 16

Hernia taking an indirect path through the inguinal canal. Passes through the deep ring, into the canal and then out of the superficial. Can only occur if there was failure to obliterate the processus vaginalis during development.

Question 17

Where does an indirect inguinal hernia occur?

Answer 17

Lateral to the inferior epigastric vessels. Depending on where the processus vaginalis was obliterated, can potentially descend into the scrotum.

Question 18

What is a direct inguinal hernia?

Answer 18

Hernia bulging through Hesselbach’s triangle.

Question 19

Where does a direct inguinal hernia occur?

Answer 19

Medial to the inferior epigastric vessels, generally in the vicinity of the superficial inguinal ring.

Question 20

What is a femoral hernia?

Answer 20

Hernia into the femoral canal, entering via the femoral ring.

Question 21

Is a femoral hernia more common in males or females? Why?

Answer 21

Females (but still less common than inguinal hernias in females).
Due to different pelvic anatomy - femoral ring is wider.

Question 22

Why can femoral hernias become strangulated?

Answer 22

Easily get incarcerated (stuck), arterial pressure pushes blood in, venous pressure is too low, leads to inflammation, blood supply becomes compromised, bowel dies, leading to necrosis and sepsis.

Question 23

What are the boarders of the femoral ring?

Answer 23

Medially - lacunar ligament.

Laterally - femoral vein.

Question 24

What is an acquired adult umbilical hernia (para-umbilical hernia)?

Answer 24

Adult umbilical hernia, through the linea alba (midline fusion of the rectus sheath) in the region of the umbilicus.

Question 25

Is an acquired adult umbilical hernia more common in males or females?

Answer 25

Females.

Question 26

What is an epigastric hernia?

Answer 26

Hernia through the linea alba (midline fusion of the rectus sheath), between the xiphoid process and umbilicus. Usually started with a small hernia of extra-peritoneal fat, and chronic straining forces more fat out which can eventually pull the peritoneum through.

Question 27

What are the main symptoms of a hernia?

Answer 27

Depend on what bowel is involved, but is based around what happens if loops of bowel get trapped.
Pain, vomiting, sepsis due to strangulation.