hernia

Question 1

Describe the difference between the mid-inguinal point and the midpoint of the inguinal ligament

Answer 1

mid-inguinal point halfway between the pubic symphysis and the ASIS. the femoral pulse can be palpated here.

The midpoint of the inguinal ligament is halfway between the pubic tubercle and the anterior superior illiac spine (the two attachments of the inguinal ligament) the opening of the inguinal canal is located just above this point.

Question 2

What are the boundaries (general) of the inguinal canal?

Answer 2

four boundaries anterior, posterior, roof and floor

Question 3

Anterior border of the inguinal canal

Answer 3

aponeurosis of external oblique, reinforced by the internal oblique muscle laterally.

Question 4

What is the posterior border of the inguinal canal?

Answer 4

transversals fascia

Question 5

What is the floor of the inguinal canal formed by?

Answer 5

inguinal ligament, thickened medially by the lacunar ligament.

Question 6

What is the roof of the inguinal canal formed by?

Answer 6

transversals fascia, internal oblique, and transversus abdominis

Question 7

What are the contents of the inguinal canal?

Answer 7

spermatic cord (males)
round ligament (female)
illioinguinal nerve (sensory innervation) genitials 

gential branch of the genitofemoral nerve- cremasteric reflex.

Question 8

What are the types of inguinal hernia?

Answer 8

direct and indirect

Question 9

What is a direct hernia?

Answer 9

where the peritoneal sac enters the inguinal canal through the posterior wall of the inguinal canal.

Question 10

what is a indirect hernia?

Answer 10

Where the peritoneal sac enters the inguinal canal though the deep inguinal ring.

Question 11

What is the most common type of inguinal hernia?

Answer 11

indirect caused by failure of the processes vaginalis to regress. Therefore these are mostly congenital

Question 12

What is the cause of a direct hernia?

Answer 12

mostly aquired due to weakening the abdominal wall.

Question 13

Where does a direct hernia enter the abdominal wall in relation to the epigastric artery?

Answer 13

medial to the epigastric artery.

Question 14

Where is a femoral hernia located?

Answer 14

inferior and lateral to the pubic tubercle on the upper medial thigh.

Question 15

What are the borders of the femoral canal?

Answer 15

lateral border the femoral vein
medial lacunar ligament
anterior inguinal ligament
posterior coopers ligament

Question 16

Spigellian hernia location

Answer 16

below and lateral to the umbilicus

it is lateral to the rectus sheath

Question 17

Femoral or inguinal what is the risk of strangulation?

Answer 17

inguinal lower risk of strangulation?

Question 18

What method can use to repair the paraumbilical hernia?

Answer 18

Mayo’s repair- tension suture

Question 19

What are the risk factors for an incisional hernia?

Answer 19

infection, obesity smoking

immunosupression.

Question 20

What are the indications for hernial repair?

Answer 20

complicated hernia
uncomplicated with moderate symptoms: inguinal pain on excretion, limiting daily living activities, manual reduction not possible

Question 21

what are the indications for open hernia repair?

Answer 21

complicated hernia
previous preperitoneal surgeries (hysterectomy, c section)
presence of ascites
recurrent hernia

Question 22

What are the indications for laparoscopic hernia repair?

Answer 22

bilateral hernai 
recurrent hernia (if originally had open)

Question 23

What is the surgical management of a hernia?

Answer 23

reinforcement of the posterior wall of the inguinal canal with a synthetic mesh or primary tissue approximation.

Question 24

What is preferred?

Answer 24

mesh because there is decreased reoccurrence rates and post op pain. it is contraindicated in the case of inguinal infection or contamination.

Question 25

What is a complicated hernia?

Answer 25

incarcerated (not reducible)

strangulated hernia (tight construction of the blood vessels)
emergency need to be in surgery within 4-6 hours 
symptoms of pain and erythema in the lower abdomen and scrotum. 
possible leads to intestinal perforation and peritonitis.

Question 26

What are the possible complications of mesh repair?

Answer 26

infection 
reoccurrence 
groin pain 
damage to surrounding structures 
urinary retention bladder injury