Abdominal Hernias

Question 1

different types of hernias - explain:

• irreducible?
• obstructed?
• strangulated?
• incarceration?

Answer 1

• irreducible = contents can’t be pushed back into place
• obstructed = bowel contents can’t pass
• strangulated = ischaemia occurs
• incarceration = contents of hernial sac are stuck inside by adhesions

Question 2

are inguinal hernias more common in men or women?

Answer 2

men 8:1

Question 3

Inguinal Hernias

Tissue protrudes at the exit point which is?

and emerge into?

Answer 3

Superficial inguinal ring

testes

Question 4

Two types of Inguinal hernias - explain the difference with regards to accessing the inguinal canal?

Answer 4

Direct = weakness in posterior wall of inguinal canal

Indirect = doesn’t pierce posterior wall - contents pass through deep inguinal ring.

Question 5

out of direct and indirect inguinal hernias - which one is more common + why?

Answer 5

Indirect

as less resistance to pass through both rings than to pass through defect in muscle wall

Question 6

what causes inguinal hernias?

Answer 6

^^ intra-abdominal pressures and weakness in abdo muscles

chronic cough
constipation
heavy lifting
ascites/obesity

Question 7

features of inguinal hernia?

Answer 7

pain when coughing
scrotal swelling
burning sensation in groin

Question 8

how do you determine if it is a direct or indirect inguinal hernia?

gold standard?

Answer 8

reduce hernia + occlude deep ring
ask patient to cough and if hernia is restrained then it is indirect, if not = direct

during surgery = direct arise medial to ‘inferior epigastric vessels’
indirect arise lateral to ‘inferior epigastric vessels’

Question 9

are the following associated with direct inguinal , indirect inguinal or femoral hernias

• can strangulate?
• rarely strangulate?
• frequently strangulate?
• frequently irreducible?
• most common?
• more common in females?

Answer 9

• indirect
• direct
• femoral
• femoral
• indirect
• femoral

Question 10

Tx for Direct + Indirect Inguinal Hernias:

conservative?

if small, no pain and not increasing in size?

if large, painful + altering bowel habit?

Answer 10

conservative: stop smoking + weight loss (pre-op)

leave it alone

surgery (open or laparoscopic repair)

N.B. SAME Tx for both direct and indirect inguinal hernias

Question 11

Femoral Hernias

inguinal hernias point towards groin whereas femoral groins point to?

are they likely to strangulate or be irreducible?

Tx?

Answer 11

femoral groins point to leg

BOTH

surgical repair

Question 12

Paraumbilical Hernias

where do they occur?

RF?

Tx?

Answer 12

occur just above/below umbilicus

RF = obesity + ascites

Tx = repair of rectus sheath