Hernia

Question 1

What is a hernia

Answer 1

protrusion of an organ or fascia of an organ through the wall of the cavity that normally contains it

Question 2

What are risk factors for abdominal hernias

Answer 2

-obesity
-ascites]
-increasing age
-surgical wounds

Question 2

What would be seen on observation with someone who has a hernia

Answer 2

palpable lump
cough impulse
pain
obstruction – more common in femoral hernias
strangulation - can compromise bowel blood supply leading to infarction

Question 2

What is the prevalence of inguinal hernias

Answer 2

they account for 75% of abdominal wall hernias

95% of patients are male

men have 25% lifetime risk of developing an inguinal hernia

Question 2

What are features of an inguinal hernia

Answer 2

groin lump
- superior and medial to pubic tubercle
- disappears on pressure / when patient lies down

discomfort and ache - often worse with activity , severe pain in uncommon

• strangulation is rare

Question 3

What is difference between direct and indirect inguinal hernia

Answer 3

Direct passes medial to inferior epigastric artery while indirect passes lateral to it

If pressure is applied to deep inguinal ring and the hernia still protrudes this indicates DIRECT hernia

Question 4

What is the management of inguinal hernias

Answer 4

Mesh repair
-Shouldice
-Lichtenstein

–open approach for unilateral
under local or general anaethetic

–laparoscopic for bilateral/recurrent
under general anesthetic

Hernia truss if unfit for surgery

Question 5

What is a femoral hernia

Answer 5

occurs when section of bowel / any part of abdominal viscera passes into femoral canal

Contents can pass via the femoral ring

Question 6

What is the epidemiology of femoral hernia

Answer 6

much less common than inguinal hernias

more common in women M:F -1:3
– effects of increased abdominal pressure in pregnancy means that femoral hernias are more common in multiparous women compared to nulliparous women

Question 7

What are the features of a femoral hernia

Answer 7

lump within groin that is mildly painful

Inferolateral to pubic tubercle

typically non-reducible

cough impulse often absent

Question 7

How is a diagnosis of a femoral hernia made

Answer 7

usually clinical but US can be an option

Question 8

What are some important differentials to exclude for femoral hernia

Answer 8

lymphadenopathy
abscess
femoral artery aneurysm
hydrocoele/ varcicocele in males
lipoma
inguinal hernia

Question 9

What are most inguinal hernias

Answer 9

80% are indirect and they are more common in men