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Question 1

Where are the three most common sites for hernias?

Answer 1

Inguinal canal, femoral ring and the umbilicus

Question 2

What a two points of weakness in the inferior part of the abdominal cavity?

Answer 2

The superficial and deep inguinal ring openings

Question 3

What is the inguinal canal?

Answer 3

The 4cm passage which arises between the superficial and deep inguinal rings.

Question 4

What passes through the inguinal canal?

Answer 4

The ilioinguinal nerve passes through here in men and women, as well as the spermatic cord or the round ligament of the uterus.

Question 5

Where do you find the inguinal canal?

Answer 5

In between the muscles of the anterior abdominal wall above the inguinal ligament.

Question 6

What is the inguinal ligament?

Answer 6

The inferior border of the aponeurosis of the external oblique muscle. It is attached between the ASIS and the pubic tubercle.

Question 7

Define an abdominal hernia

Answer 7

Protrusion of part of the abdominal viscus through a defect in the abdominal wall.

Question 8

What is the commonest form of hernia?

Answer 8

Indirect inguinal hernia

Question 9

Describe an indirect inguinal hernia

Answer 9

Hernia enters via the deep inguinal ring, extending along the inguinal canal. It can appear in the scrotum or the labium majora if it passes fully along the canal.

Question 10

Describe a direct inguinal hernia

Answer 10

Enters into the inguinal canal directly through its posterior wall through Hesselbach’s triangle. Usually only presents as a bulge in the inguinal region.

Question 11

Describe a difference between where inguinal and femoral hernias are in relation to the inguinal ligament

Answer 11

Inguinal hernias, the neck of the sac arises above the inguinal ligament. Femoral hernias, the neck of the sac arises below the inguinal ligament

Question 12

Describe a femoral hernia

Answer 12

The hernia sac protrudes into the femoral canal through the femoral ring. Appears as a bulge int he femoral triangle.

Question 13

What are the borders of the femoral triangle?

Answer 13

Superior: Inguinal ligamentMedial: Medial border of Adductor longusLateral: Medial border of SartoriusFloor: Pectineus, iliopsoas and adductor longus muscleRoof: Fascia lata

Question 14

What happens with femoral hernias?

Answer 14

Compresses the contents of the femoral canal as hernia is bounded by the femoral vein and lacunar ligament. Can increase in size if they pass through the saphenous opening into the subcutaneous tissue of the thigh.

Question 15

What are the characteristics of people who get femoral hernias?

Answer 15

More common in females than males (due to wider hips).Tend to be quite rare.

Question 16

What is a common complication of femoral hernias?

Answer 16

Strangulation of hernia often occur due to the rigid boundaries of the femoral ring.

Question 17

What is a diaphragmatic hernia?

Answer 17

Hernia protrude through a developmental defect in the diaphragm into the thoracic cavity.

Question 18

Describe an epigastric hernia?

Answer 18

Occur in the epigastric region, where there is a herniation between the xiphoid process and the umbilicus through the damaged fibres of the linea alba.

Question 19

What are the risk factors for epigastric hernias?

Answer 19

Obesity and pregnancy

Question 20

Describe umbilical hernias

Answer 20

Can be acquired or congenital – congenital hernias are present at birth and resolve with 2-3 years. Due to incomplete closure of anterior abdominal wall after ligation of the umbilical cord at birth. – acquired hernias are due to increased abdominal pressure due to heavy lifting, obesity, persistent coughing or multiple pregnancies (more common in men)

Question 21

What are the borders of hesselbach’s triangle?

Answer 21

Inferiorly – Medial half of the inguinal ligamentMedially – Lower lateral border of rectus abdominisLaterally – Inferior epigastric artery

Question 22

What are some complications that can occur with hernias?

Answer 22

Strangulation and incarceration

Question 23

Describe strangulation of a hernia

Answer 23

Constriction of the blood vessels to the tissue

Question 24

Describe incarceration of a hernia

Answer 24

Hernia cannot be reduced or pushed back into place without surgical intervention

Question 25

What is a divarication of recti?

Answer 25

Separation of the rectus abdominis and thinning of the linea alba

Question 26

Describe incisional hernias

Answer 26

A hernia which occurs along or close to the line of a previous surgery due to imcomplete healing of the previous surgical wound.

Question 27

Give some characteristics of incisional hernias

Answer 27

Can be complicatedLong surgery and recovery timeOften strangulate and cause pain.

Question 28

What can cause groin pain in sports people?

Answer 28

Tearing of the inguinal ligaments

Question 29

What is the different between the mid-point of the inguinal ligament and the mid inguinal point

Answer 29

MP of inguinal ligament – half way between ASIS and pubic tubercle. Find femoral nerve here. Mid-inguinal point – half way between ASIS and pubic symphysis. Where you palpate for the femoral artery.

Question 30

Where do you find the mid-inguinal point?

Answer 30

Halfway between the ASIS and pubic symphesis

Question 31

Where do you find the mid-point of the inguinal ligament?

Answer 31

Half way between the ASIS and pubic tubercle