Chapter 84: Hernias

Question 1

A hernia that is firm, often painful, and nonreducible by direct manual pressure

Answer 1

Incarcerated

Question 2

A consequence of incarceration and implies impairment of blood flow (arterial, venous, or both)

Answer 2

Strangulation

Question 3

Seventy-five percent of all hernias occur in the ____, making it the most common form of hernia

Answer 3

Seventy-five percent of all hernias occur in the inguinal region, making it the most common form of hernia

Question 4

The most common hernias in women

Answer 4

Inguinal hernia

Question 5

Hesselbach triangle is constructed with

Answer 5

Lateral border of the inferior epigastric arteries, a medial border with the rectus sheath, and an inferior border of the inguinal ligament

Question 6

Hernia that passes directly through a weakness in the transversalis fascia in the Hesselbach triangle

Answer 6

Direct inguinal hernia

Question 7

Hernia that passes from the internal to the external inguinal ring through the patent process vagina- lis, and then to the scrotum

Answer 7

Indirect inguinal hernia

Question 8

Hernia the result of a defect in the anterior abdominal wall and can be either spontaneous or acquired

Answer 8

Ventral hernias

Question 9

Hernia that account for up to 20% of all abdominal wall hernias. They are often the result of excess wall tension or inadequate wound healing

Answer 9

Incisional hernias

Question 10

Patient with chronic ascites are at risk for this kind of hernia

Answer 10

Umbilical hernia - strangulation is unusual

Question 11

True or False

The femoral hernia is particularly prone to complications, such as incarceration and strangulation

Answer 11

True

The femoral hernia is particularly prone to complications, such as incarceration and strangulation

Question 12

True or False

Femoral hernias are more common in men, with a 10 to 1 male predilection

Answer 12

False

Femoral hernias are more common in women, with a 10 to 1 female predilection

Question 13

Also known as a lateral ventral hernia, arises at the lateral edge of the rectus muscle and the arcuate (semilunar) line

Answer 13

Spigelian hernia

Question 14

The classic presentation of spigelian hernia is

Answer 14

The classic presentation is abdominal pain associated with an anterior lateral abdominal wall mass or bulge

Question 15

The best imaging for diagnosis of hernia

Answer 15

CT scan

Question 16

The typical patient of this hernia is an elderly frail female with signs and symptoms of intestinal obstruction

Answer 16

Obturator hernia

Question 17

Sign Calle for a pain in medial portion of the thigh due to obturator nerve compression

Answer 17

Howship-Romberg sign

Question 18

Involves only the antimesenteric border of the intestine and involves only a portion of the wall circumference

Answer 18

Richter hernia

Question 19

True or False
Doppler US can detect the arterial flow to the loop of bowel, but is usually not sensitive enough to detect venous flow and cannot detect lymphatic flow. Thus, Doppler US can be insensitive for strangulation

Answer 19

True
Doppler US can detect the arterial flow to the loop of bowel, but is usually not sensitive enough to detect venous flow and cannot detect lymphatic flow. Thus, Doppler US can be insensitive for strangulation

Question 20

Most useful for diagnosis in children and pregnant women given its lack of ionizing radiation

Answer 20

Ultrasound

Question 21

Steps for hernia reduction

Answer 21

• NPO status in case reduction attempts are unsuccessful.
• Adequate IV narcotic analgesia.
• Apply cold packs to the hernia site to reduce swelling and make reduction attempts easier.
• Grasp and elongate the hernia neck with one hand, and with the other hand, apply firm, steady pressure to the proximal part of the hernia at the neck at the site of the fascial defect. US can aid in the identification of the fascial defect if it is not clinically obvious. Applying pressure on the most distal part of the hernia can cause bulging (or ballooning) at the hernia neck and prevent reduction.
• Consult surgery if the reduction is unsuccessful after one or two attempts.