Hernia & abd wall probs

Question 1

Types of hernia by age

Answer 1

0-2 years: indirect inguinal hernia 2-20 yrs: hernia uncommon 20-50 yrs: indirect inguinal hernia 50+ yrs: direct inguinal hernia

Question 2

What are the layers of the abdominal wall?

Answer 2

Skin, subq fat, Scarpa’s fascia, external oblique muscle, internal oblique muscle, tranversus abdominis muscle, transversalis fascia, peritonal fat, peritoneum

Question 3

Femoral canal structures

Answer 3

Lateral to medial = NAVEL: nerve, artery, vein, empty space, lymph nodes

Question 4

Hesselbach’s triangle

Answer 4

Borders: inferiorly, inguinal ligament. medially, rectus abdominis. laterall, inferior epigastric vessels. Direct inguinal hernias come through Hesselbach’s triangle.

Question 5

Females usually have what type of inguinal hernia?

Answer 5

Indirect. Direct is very rare in females

Question 6

How to distinguish hydrocele from irreducible groin hernia?

Answer 6

Hydroceles transiluminate, groin hernias do not

Question 7

Direct inguinal hernia

Answer 7

Enters inguinal canal through its weakened posterior wall. Does NOT pass through inguinal ring. Predisposing factors: older, smoker, cough, straining, hard labor.

Question 8

Indirect inguinal hernia

Answer 8

Herniation through the internal inguinal ring -> external ring. If complete, can enter scrotum. If congenital, it is assoc with patent processus vaginalis. Occurs in bothmales > females, all ages.

Question 9

Femoral hernia

Answer 9

A form if indirect hernia arising out of the femoral canal beneath the inguinal ligament. Females > males, uncommon overall. High risk of strangulation.

Question 10

Surgical repair for peds umbilical hernia is indicated when?

Answer 10

Defect > 2 cm OR child > 3-5 yrs old OR protrusion disfiguring/disturbing

Question 11

Esophageal hiatal hernia type I (90%)

Answer 11

Sliding: GEJ and stomach herniate into thoracic cavity. Can lead to reflux, Barrett’s, etc. Medical management for GERD, less commonly do surgery (fundoplication).

Question 12

Esophageal hiatal hernia type II (rare)

Answer 12

Paraesophageal: herniation of stomach into the thorax by way of esophageal hiatus, w/o disruption of the GEJ. Needs prompt surgical correction.

Question 13

What types of hernias are assoc with obesity?

Answer 13

Direct inguinal, paraumbilical, and hiatal hernias

Question 14

Esophageal hernias picture

Answer 14