Hernia + Miscellaneous

Question 1

What is an inguinal hernia

Answer 1

Bowel moved into inguinal canal

Question 2

What is an indirect hernia

Answer 2

Bowel passes through weakness in the internal ring

Question 3

How do you know it is indirect

Answer 3

Press down on deep ring + reduce

Won’t refill on cough impulse

Question 4

What is a direct hernia

Answer 4

Bowel pushes through weakness in posterior wall

Question 5

How do you know it is direct

Answer 5

Reduce the hernia
Occlude the deep ring 
Ask patient to cough or stand 
Will refill on cough if direct
Won't refill if indirect as blocked off 
Doesn't hang into scrotum

Can only truly determine at surgery

Question 6

Where is the superficial (external) ring

Answer 6

Above and medial to pubic symphsis

Question 7

Where is the femoral ring

Answer 7

Below and lateral to PS

This is where femoral hernia is

Question 8

Where is deep ring of inguinal canal

Answer 8

Between ASIS and PS

Question 9

What is the anatomy of inguinal canal

Answer 9

External oblique = infront
Inguinal ligament = floor
Rectus abdominas = medial
Transverse abdominas

Question 10

WHat are the contents

Answer 10

Vas deferens
Testicular artery and vein
Genitofemoral nerve
Ilioinguinal nerve

Question 11

What are the symptoms of inguinal hernia

Answer 11

Bulge
Sensation of drag
Increases with cough
Reduces lying flat
May become irreducible and painful
May obstruct

Question 12

What is a strangulated hernia

Answer 12

Blood supply cut of
Rare in inguinal
Common in femoral

Question 13

What are the symptoms of strangulation

Answer 13

Tender red stcotum so always ask for this 
Red
Sudden pain
Fever
Tachycardia

Question 14

How do you examine a hernia

Answer 14

Stand and get to cough
Lie flat and cough while pressing
CHeck other side

Question 15

What are the RF for hernia

Answer 15

Male
Older as ring gets bigger
Obesity 
Weight lifting
Manual job
Chronic cough
Obstruction
Constipation
Past abdo surgery
Ascites

Question 16

What are women with hernia likely to have

Answer 16

Inguinal hernia

Question 17

Who is most likely to have a femoral

Answer 17

Women

Question 18

What imaging for hernia

Answer 18

USS

Differentiate fromLN

Question 19

How do you treat hernia

Answer 19

Weight loss
Stop smoking
If becomes irreducible = urgent surgery as risk of strangulation

Question 20

What are surgical options

Answer 20

MESH / open - reinforce posterior wall

Laparoscopic

Question 21

What are complications of surgery

Answer 21

Recurrecne
Chronic pain
Mesh infection
Testicular damage
Bowel damage

Question 22

What are complications of hernia

Answer 22

Incarcerated - can’t reduce
Strangulation - necrosis
Obstruction

Question 23

WHat is SMA syndrome

Answer 23

Duodenum gets obstructed by aorta and SMA

Question 24

What are symptoms of weak sphincter

Answer 24

Diarrhoea
Incontinence
Key is formed stool still leads to incontience not just diarrhoea

Question 25

How do you investigate

Answer 25

DRE - tone GI physiology to measure sphincter USS

Question 26

How do you Rx

Answer 26

Sural nerve stimulation

Question 27

What do you do for loose stools

Answer 27

Send stool culture | If on Ax suspect C.diff

Question 28

If tired / weight loss / diarrhoea

Answer 28

``` FBC Ferritin Thyroid Coaelic qFIT ```

Question 29

If Hb low

Answer 29

Haematinic bloods

Question 30

How can you give contrast

Answer 30

Oral IV Rectal - not routine Double = oral and IV

Question 31

Why is contrast useful

Answer 31

Time around body allows you to visualise PA = 15s Aterial = 90s Portal venous = 3 miuntes

Question 32

When do you do USS

Answer 32

``` Gall stone Intra+extra hepatic dilatation Portal vein Liver texture LIver mets Pancreatic tumour Exclude spleen / kidney / aorta pathology ```

Question 33

WHen do you do pancreatico-biliary EUS

Answer 33

Small pancreatic tumour + bile duct stone Dx of duoedenal / pancreatic cancer Allow FNA

Question 34

When is CT useful

Answer 34

STage malignancy | Acute pancreatitis + complication

Question 35

When is MRCP used

Answer 35

Hepatic + pancreatic duct if not fit for ERCP / no intervention CBD stones and biliary No contrast or invasion Miss small stone / PSC/ stricture

Question 36

What does PTC allow

Answer 36

Visualisation of biliary tract Percutaneous acess + stent Use if ERCP fails as bigger risk

Question 37

What is calprotectin

Answer 37

Neutrophil in inflammation release protein | Higher lower down the bowel

Question 38

What is QFIT

Answer 38

Immunotherapy | FOB was detecting blood / Hb

Question 39

How do you investigate iron anaemia

Answer 39

``` FBC Ferritin (not in inflammation) - low Transferin- low TIBC - high Colonoscopy once confirmed ```

Question 40

What does TIBC show if iron is low

Answer 40

High if iron deficiency as want more binding receptors for iron to bind do Low in haemachromatosis

Question 41

What causes iron deficiency anaemia

Answer 41

Blood loss Malabsorption Mentruation Pregnancy

Question 42

How do you differentiate iron deficiency from anaemia of chronic disease

Answer 42

Anaemia chronic disease has low TIBC as don't want iron available for pathogen

Question 43

What is a hernia

Answer 43

Protrusion of viscous or part through a defect of the walls of its containing cavity

Question 44

Irreducible

Answer 44

Cannot push back into place | Need to reduce to prevent obstruction, strangulation and necrosis

Question 45

Obstructed

Answer 45

Content cannot pass | eg. faeces can't pass through bowel

Question 46

Strangulated

Answer 46

Non reducible and becomes so tight it cuts of blood supply Significant pain and tenderness at site Ischaemia occurs = urgent surgery

Question 47

Incacerated

Answer 47

Contents of sac stuck inside by adhesions