Hernia

Question 1

Common contents of umbilical hernia?

Answer 1

Extraperitoneal fat or omentum.
Even though hernial contents are often strangulated, bowel is not obstructed or damaged.

Question 2

Femoral hernias commoner in which gender?

Answer 2

Females - 70%

Question 3

Why is femoral hernia commoner in females?

Answer 3

Pelvis is wider and canal is larger

Question 4

Does femoral hernia have a cough impulse?

Answer 4

No

Question 5

What makes femoral hernia unique from inguinal hernia?

Answer 5

Not reducible
High risk of strangulation due to narrow neck
Usually no cough impulse

Question 6

3 approaches for open repair of femoral hernia?

Answer 6

Infrainguinal
Trans-inguinal
Supra-inguinal - for suspected strangulation

Question 7

Prevalence for inguinal hernia?

Answer 7

Male x10
2/3 are indirect
Peak at 5 years [indirect], 70-80 years direct
Obesity inversely related
Wrong collagen metabolism

Question 8

What does incarcerated inguinal hernia present?

Answer 8

Pain
Abdominal distension
N/V

Question 9

Complications of inguinal hernia pathway

Answer 9

Reducible -> Irreducible/Incarcerated -> Obstructed -> strangulated

Question 10

What does strangulated hernia cause

Answer 10

Ischemic bowel!
4-6 hours to gangrene

Question 11

In what hernia will there be no signs of IO even with strangulation?

Answer 11

Richter’s hernia. Hernia only involves part of bowel rather than entire circumference

Question 12

Imaging for inguinal hernia

Answer 12

Dynamic US with Valsalva
AXR (supine) if suspected IO 2! to IH

Question 13

Why use Valsalva in US for inguinal hernia?

Answer 13

To accentuate small hernia

Question 14

When do u use imaging for inguinal hernia?

Answer 14

When clinical findings is inconclusive

Question 15

Which hernia goes through Hasselbach?

Answer 15

Direct inguinal hernia

Question 16

2 options for surgical hernia repair?

Answer 16

Totally Extra-peritoneal repair = TAP
Trans-abdominal preperitoneal repair = TAPP

Question 17

Early complications of hernia op?

Answer 17

ARU
Hematoma
Seromas
Nerve injury

Question 18

Late complications of hernia op?

Answer 18

Chronic post-op groin pain
Vas Deferens injury - infertility
Recurrence 5%
Ischaemic orchitis
Testicular atrophy
Meshoma

Question 19

Where is McBurney’s point

Answer 19

2/3 the distance from ASIS to pubic symphysis

Question 20

Commonest hernia in females?

Answer 20

Direct inguinal hernia

Question 21

Name of simultaneously direct and indirect hernias?

Answer 21

Pantaloon hernias

Question 22

What hernia contains meckel’s diverticulum?

Answer 22

Littres hernia

Question 23

What does Howship-Rhomberg sign show?

Answer 23

Obturator nerve irritation causing inner thigh pain that can extend to knee on internal rotation of hip.
OBTURATOR HERNIA !!

Question 24

What is Spigelian Hernia?

Answer 24

Primary ventral hernias secondary to a defect in the Spigelian aponeurosis (fascia) that is comprised of the transversus abdominis and internal oblique aponeuroses.
Borders of the Spigelian aponeurosis are the rectus muscle medially and the linea semilunaris laterally

Question 25

Layers of abdominal wall? | Superficial to deep

Answer 25

Camper's fascia Scarpa's fascia Abdominal wall muscle Transversalis fascia Extra-peritoneal fat Parietal peritoneum

Question 26

Define hernia!

Answer 26

Abnormal protrusion of viscus through an abnormal opening in wall of cavity inside its normal container

Question 27

Where is deep inguinal ring?

Answer 27

2cm above midpoint of inguinal ligament Defect in transversalis fascia.

Question 28

Where is superficial inguinal ring?

Answer 28

Above and medial pubic tubercle. Defect in aponeurosis of external oblique

Question 29

Contents of inguinal canal?

Answer 29

Spermatic cord Testicular vessels Round ligament of uterus Ilioinguinal nerve Genital branch of genitofemoral nerve

Question 30

Where is femoral pulse?

Answer 30

Mid-inguinal point

Question 31

Where is inguinal ligament?

Answer 31

Between ASIS and pubic tubercle

Question 32

Landmarks for Hasselbach's triangle?

Answer 32

Medial = Lateral end of rectus abdominis Superior = Inferior epigastric vessels Inferior = Inguinal ligament

Question 33

Indirect vs Direct inguinal hernia anatomy?

Answer 33

Indirect = Neck is lateral to inferior epigastric vessels Direct = neck is medial to inferior epigastric vessels

Question 34

Boundaries of inguinal canal

Answer 34

Anterior = Ext oblique aponeurosis Posterior = Transversalis fascia Floor = Inguinal ligament Roof = Arching fibres of IO and TA

Question 35

What is inguinal ligament?

Answer 35

Inferior most edge of ext oblique aponeurosis

Question 36

Risk factors for inguinal hernia?

Answer 36

Male gender Age Obesity Family Hx Connective tissue disorders Chronic constipation Smoking COPD, chronic cough