Hernia

Question 1

What is hernia

Answer 1

A protrusion of a viscus or part of a viscus through a defect or weakness in the wall of its containing cavity.

Question 2

Classification of hernia

Answer 2

1) external: sac protrudes tru the abdominal wall. Commonest. Egs: inguinal,femoral(commoner in females), epigastric, paraumbilical, umbilical, spigelian, diastasis recti,obturator, lumbar, gluteal, sciatic

2) Internal hernia: sac doesn’t protrude outside the the trunk egs:
Diaphragmatic, paraesophageal, paraduodenal,foramen magnum hernia, transmesenteric, Winslow hernia(epiploic) , sigmoid mesocolon hernia, hiatic.

Question 3

Risk factors/causes of hernias

Answer 3

Chronic cough,weight lifting, constipation,previous hx, abdominopelvic surgery,pregnancy,congenital,old age, straining to urinate,ascites

Question 4

Clinical features of Hernia

Answer 4

Bulging pouch,pain, nausea, vomiting,abdominal distension (strangulation), fever,constipation,urinary incontinence

Question 5

What’s Inguinal (Hesselbach) Triangle? List borders

Answer 5

Triangular area on the inferior aspect of the anterior abdominal wall within the groin. Is is an area of weakness.

Media border: lateral border of rectus muscle
Lateral border: inf epigastric vessels
Inferior border: inguinal lig

Question 6

Types of inguinal hernia

Answer 6

Direct and indirect

Question 7

Characterise direct and indirect hernia

Answer 7

Direct

• common in old ppl
• protrude tru area of weakness
• Comes our tru posterior wall of inguinal canal. Doesn’t enter scrotum
• media to inferior epigastric vessels

Indirect
-Deep ring: formed by the transversalis fascia-> a weak point
-more in young ppl
-sac is anteriolateral to spermatic cord
-lateral to inferior epigastric vessels
More prone to complications
* in children inguinal hernia is indirect in99% cod of patent processes vaginalis

Question 8

What is pantaloon hernia?

Answer 8

Occurrence of both direct and indirect inguinal hernias at the same time.

Question 9

Investigations in hernia

Answer 9

Dx is made clinically 
Fbc 
Urinalysis 
E/U/Cr
Abdominal USG 
Chest X-ray 
ECG if >40yrs

Question 10

Complications of Hernia

Answer 10

Irreducibility (incarceration)
Obstruction 
Strangulation
Inflammation 
Rupture
Peritonitis 
Fistula formation 

FOR PIIS