Hernia

Question 1

General hernia positions

Answer 1

Question 2

Strangulated definition

Answer 2

Blood supply compromised due to pressure at neck of hernia

Question 3

Maydl’s Hernia

Answer 3

Herniating double loop of bowel

Strangulated portion may reside as a single loop inside the abdomen

Question 4

Littre’s hernia

Answer 4

Hernial sac containing strangulated Meckel’s diverticulum (small pouch in small intestine near umbilicus)

Question 5

Amyand’s hernia

Answer 5

Inguinal hernia containing strangulated Appendix

Question 6

Richter’s hernia

Answer 6

Only part of circumference of bowel is within sac

Most commonly seen with femoral hernias.

Can strangulate without obstructing.

Question 7

Pantaloon

Answer 7

Simultaneous direct (being fat/old) and indirect(congenital abnormality) hernia

Question 8

Herniotomy

Answer 8

Excision of hernial sac

Question 9

Herniorrhaphy

Answer 9

Suture repair of hernial defect

Question 10

Hernioplasty

Answer 10

Mesh repair of hernial defect

Question 11

Epidemiology of inguinal hernias

Answer 11

M>F 9:1 due to descent of testes

Commoner on the right

Question 12

Indirect inguinal hernias anomaly

Answer 12

-Congenital patent processus vaginalis

Question 13

Route of indirect inguinal hernia

Answer 13

• Emerge through deep ring
• Same 3 coverings as cord and descend into the scrotum

Question 14

Direct inguinal hernias route

Answer 14

• Acquired (increased intra-abdominal pressure)
• Emerge through Hesselbach’s triangle

Question 15

Which one is more common, direct or indirect inguinal hernia

Answer 15

indirect 80%

direct 20%

Question 16

Which strangulates direct or indirect inguinal hernia

Answer 16

indirect

Question 17

Which inguinal hernia do young get

Answer 17

indirect

Question 18

Questions to ask for inguinal hernias

Answer 18

• Reducible?
• Ever episodes of obstruction / strangulation?
• Predisposing factors: cough, straining, lifting?
• Occupation and social circumstances?
• Children worse when crying?

Question 19

Non surgical treatment of inguinal hernias

Answer 19

• Reduce Risk Factors: cough, constipation
• Lose weight
• Truss (hernia pants)

Question 20

Surgical rx of inguinal hernia

Answer 20

Tension-free mesh

Question 21

Femoral hernia definition

Answer 21

Protrusion of viscus through femoral canal

Question 22

Clinical features of femoral hernias

Answer 22

Painless groin lump:

• neck inferior/lateral to pubic tubercle
• cough impulse
• often irreducible

Often present with strangulation/obstruction

Question 23

Treatment of femoral hernias

Answer 23

50% risk of strangulation within 1 month so urgent surgery needed

Elective = Lockwood approach

Emergency = McEvedy approach

Question 24

Incisional Hernias definition

Answer 24

Hernia through surgical incision

Question 25

Risk factors for incisional hernias (pre/intra/post operation)

Answer 25

Pre op:- Age- Obesity

Intra-op:- Surgical skill (inappropriate sutures)- Incision type- Placing drains through wounds

Post-op:- Increased intra abdo pressure- Infection - Haematoma

Question 26

Treatment of incisional hernias

Answer 26

Conservative- Manage risk factors: e.g. constipation, cough- Weight loss- Elasticated corset or truss

Surgical- Nylon mesh repair: open or lap

Question 27

Risk factors of umbilical hernias

Answer 27

• Afro-Caribbean
• Trisomy 21 (Down’s)
• Congenital hypothyroidism

Question 28

Management of umbilical hernias

Answer 28

• Usually resolves by 2-3yrs
• Mesh repair if no closure.
• Can recur in adults: pregnancy or gross ascites

Question 29

Paraumbilical hernia features

Answer 29

• Acquired: middle aged obese men
• Defect through linea alba just above or below umbilicus
• Small defect –> strangulation (often omentum)

Question 30

Parumbilical hernia treatment

Answer 30

Mayo technique (sutures) or Mesh repair

Question 31

Epigastric hernia features

Answer 31

• Young, M>F
• Pea-sized swelling caused by defect in lineaalba above the umbilicus.
• Usually contains omentum: can strangulate

Question 32

Treatment of epigastric hernias

Answer 32

Mesh repair