Abdo Wall

Question 1

What is the management for hernia in:
Reducible
Irreducible:
Bilateral/Recurrent:
Obstrn/Strang:

Answer 1

Reducible → leave

Irreducible → elective

Bilateral/Recurrent → Laparoscopic

Obstrn/Strang → Hartmann’s

Question 2

List the structures in the inguinal canal (4; 3s)

Answer 2

3 arteries:
Testicular/Ovarian aa
Cremasteric aa
Vas deferens aa

3 nerves:
Genital branch (of genitofemoral)
Iliolinguinal
Sympathetics

3 others:
Vas deferens / round lig of uterus
Pampinform plexus
Testicular lymphatics

3 fascial coverings:
Internal spermatic fascia (from transversalis)
Cremasteric fascia (from int. oblique)
External spermatic fascia (from ext. oblique)

Question 3

Anatomically where do the deep + superficial inguinal rings lie

Answer 3

Deep = 1cm superior to MID-POINT INGUINAL LIG*
Superficial = 1cm superior/lateral to pubic tubercle

NB *ASIS→Pubic Tubercle
**diff to MID-INGUINAL POINT (ASIS→Pubic Symphysis)

Question 4

What are the boundaries of the inguinal canal

Answer 4

MALT
Sup: 2Muscles – transversalis / int. oblique mm
Ant: 2Aponeuroses – int. + ext. oblique
Inf: 2Ligaments – inguinal/lacunar
Post: 2T’s – transversalis fascia / conjoint Tendon

Question 5

What Ix are done into a suspected hernia

How are direct + indirect hernias differentiated

Answer 5

Clinical Exam should be enough
USS if cannot feel

Clinically: reduce + apply pressure on deep ring
• Direct – no change (cannot be controlled)
• Indirect – controls it

Only officially differentiated in theatre:
• Direct – inf epigastric aa lateral to hernia
• Indirect – inf epigastric aa medial to hernia

Question 6

List some DDx for a lump in the groin (7)

Answer 6

Inguinal hernia
Lipoma
Lymph node
Saphenous Ovarix (dilated saphenous vv)
Femoral aa aneurysm
Femoral neurofibroma
Psoas abscess

Question 7

What are the possible features of an inguinal hernia (6)

Answer 7

Asymp**
Pain – particularly when coughing or stooping
Change in bowel habit
Constipation
Burning sensation in the groin
Scrotal swelling (in males)

Question 8

What are the possible features of a paraumbilical hernia

Answer 8

Localised dragging pain
Enlarging lump
Reducible
Intermittent obstrn (tender/colic)
Commonly strangulate/obstruct