hernia management

Question 1

hernia superior and medial to the pubic tubercle?

Answer 1

inguinal

Question 2

who gets inguinal hernias?

Answer 2

men - minguinal

Question 3

risk factors for inguinal hernias?

Answer 3

obesity, heavy lifting, constipation, pregnancy

Question 4

Direct and indirect inguinal hernia?

Answer 4

Direct is less common
weakness in abdominal wall
medial to epigastric artery

Indirect is more common
Lindirect - lateral to epigastric artery
if scrotal mass that you can’t get above - its an indirect hernia

Question 5

two types of inguinal hernia?

Answer 5

direct and indirect

Question 6

which inguinal is reduceable and restrainable ?

Answer 6

indirect

Question 7

which hernia is more likely to strangulate? direct or indirect?

Answer 7

indirect (in the scrotum)

Question 8

why do you get indirect inguinal hernias?

Answer 8

failure of the deep inguinal ring to close

Question 9

femoral hernias more common in males or females?

Answer 9

females

Question 10

paediatric hernias more common in boys or girls?

Answer 10

boys

Question 11

If under one year old, management of paediatric inguinal hernia?

Answer 11

urgent surgery (risk of strangulation)

Question 12

epigastric hernia due to defect in ?

Answer 12

linea alba

Question 13

midline mass above the umbilicus

Answer 13

epigastric

Question 14

who are epigastric hernias most common in ?

Answer 14

teenage boys

Question 15

occurs in newborns due to defect in trasnversalis fascia?

Answer 15

umbilical

Question 16

most umbilical hernias will resolve by age?

Answer 16

3

Question 17

para umbilical hernia is strongly assocaited with ?

Answer 17

obesity and ascites

Question 18

where would you find a para umbilical hernia?

Answer 18

mass above or below the umbilicus

Question 19

hernia at lateral edge of rectus sheath ?

Answer 19

spigelian

Question 20

where does a spigelian hernia appear ?

Answer 20

inferior and lateral to umbilicus

Question 21

hernia at site of previous surgery ?

Answer 21

incisional

Question 22

what sort of stuff is around inguinal hernia (pneumonic)

Answer 22

NAVEL 
nerve
artery 
vein 
empty space 
lymphatics

Question 23

where could an indirect hernia strangulate?

Answer 23

at the deep inguinal ring

Question 24

what do you do with femoral hernia?

Answer 24

repair is recommended

Question 25

where do femoral hernias go?

Answer 25

down the femoral canal (not the inguinal canal)

Question 26

how do you repair an inguinal hernia?

Answer 26

usually done with a mesh technique

Question 27

what should a patient be advised before inguinal hernia repair?

Answer 27

lose weight and stop smoking

Question 28

what advice should you give about returning to work after hernia repair ?

Answer 28

Patients can return to work, including manual labour and driving after 2 weeks if they feel comfortable.

Question 29

repairing an inguinal hernia?

Answer 29

mesh technique

Question 30

how to differentiate between direct and indirect?

Answer 30

you should reduce the hernia, then occlude the internal inguinal canal with 2 fingers. Ask the patient to cough. If it pops out, then is direct, if it stays in then its indirect!