GU- Inguinal hernia

Question 1

Inguinal hernia definition

Answer 1

intusion of organ through inguinal canal, usually bowel.

Question 2

Indirect

Answer 2

bowel protrudes through deep inguinal ring through inguinal canal lateral to inferior epigastric artery

Question 3

direct

Answer 3

bowel protrudes between interior epigastric artery and edge of rectus muscle

Question 4

incarcerated

Answer 4

hernia that cannot be returned or reduced by manipulation. Can become strangulated

Question 5

Is this common?

Answer 5

most common surgical condition in children

Question 6

_____ % are on the right side

Answer 6

60%

Question 7

____ % are on the left side

Answer 7

30%

Question 8

___ % are bilateral

Answer 8

10%

Question 9

most common type is

Answer 9

indirect (99%)

Question 10

____ % present before age 1, with most seen in the first ___ months

Answer 10

50%, 6 months

Question 11

Ratio boys to girsl

Answer 11

4:1

Question 12

incidence

Answer 12

10-20 per 1,000 live births

Question 13

higher incidence is seen in, higher risk

Answer 13

males

premies

positive family history

CF

undescended testes

hypospadias

congenital dislcation of hip

congenital abd wall defects

Question 14

Where is the bulge and where does it extend to?

Answer 14

Bulge in inguinal area extending to scrotum

Question 15

bulge is pronounced during periods of

Answer 15

crying/straining

Question 16

will have h/o

Answer 16

intermittant groin/labial/scrotal swelling

hernia spontaneously reduces when relaxing

parents usually first to notice

Question 17

questions for parents?

Answer 17

when was it noticed?

how often does it occur?

does the child appear uncomfortable?

Signs of intestinal obstruction?

Question 18

What are the signs of intestinal obstruction?

Answer 18

Vomiting, abd distention

Question 19

Where is the bulge

Answer 19

level of external/internal ring

Question 20

placing finger in inginal canal is only done

Answer 20

in adults

Question 21

how is exam performed?

Answer 21

supine position, legs and arms extended above head, wait for cry

cry will increase ABD pressure, and should demonstrate bulge ober external ring/scrotal swelling

Question 22

How is exam performed in older children?

Answer 22

Standing

Question 23

Why do we palpate testes before palpation of inguinal bulge?

Answer 23

Retractile testes which are common in infants and young children can be mistaken for hernia

Question 24

abdominal exam components

Answer 24

distension?

masses?

tenderness?

Question 25

If swelling is not noted during the exam, how is the silk sign performed?

Answer 25

To check for thickening/silkiness of the spermatic cord by palpating the spermatic cord over the pubic tubericle. Rubbing together the area feels like silk indicated the presence of hernia sac around cord and is reliable sign especially in unilateral

Question 26

Diagnostic testing

Answer 26

for all girls with inguinal hernia, requires rectal exam by experienced provider may need pelvid US- can diff between hydrocele and hernia and determine if incarcerated Dx otherwise made by H&P

Question 27

Differential dx:

Answer 27

Ing hernia: swelling vaires during day, size increases with size/straining Incarcerated ing hernia: persistant bulge, discomfort, pos/neg abd distension, Hydrocele: swelling does not change in size throughout day, gradually disappears in first year

Question 28

Can transillumination differenciate between hydrocele and inguinal hernia?

Answer 28

No

Question 29

Treatment:

Answer 29

surgery is usually done 1-2 weeks after diagnois inguinal hernias do not spontaneously resolve

Question 30

Referral criteria?

Answer 30

Referral to peds surg when diagnosis made

Question 31

complications -incarcerated hernia

Answer 31

-immediate reduction under sedation

Question 32

Complications Strangulated incarcerated hernia

Answer 32

SURGICAL EMERGENCY blood supply is compromised

Question 33

complications ischemia/infarction of testes

Answer 33

can occur in boys with undescended testes and inguinal hernia

Question 34

complications - ovarian/fallopian tube infarction

Answer 34

blank

Question 35

Education: s/s of incarcerated hernia

Answer 35

abd distension vomiting pain, irritablilty, erythema persistant bulge that does not reduce Stress importance of f/u and surg visits operative repair in first year, increased risk of incarceration after 1 year

Question 36

immediate referral red flags

Answer 36

unable to reduce painful, tender, hard, or red surgery will happen within 24-48 hours