Herniae

Question 1

hernia

Answer 1

protrusion of an organ through a defect in the wall of the cavity containing it into an abnormal position

Question 2

reducible

Answer 2

contents of hernia can be completely replaced into the cavity

Question 3

irreducible

Answer 3

contents of hernia cannot be completely replaced into the cavity

Question 4

obstructed

Answer 4

bowel contents cannot pass through herniated bowel

Question 5

strangulated

Answer 5

ischaemia of contents of hernia (due to obstructed venous return) which unless relieved will lead to gangrene and perforation

Question 6

incarcerated

Answer 6

contents of hernia sac are stuck inside by adhesions

Question 7

indirect inguinal hernia

Answer 7

contents of hernia pass through inguinal canal due to a patent processus vaginalis
younger pts
hernia covered by processus vaginalis and all three fascial coverings
exits superficial ring inside cord, frequently passing into scrotum/labia majorus
more likely to strangulate

Question 8

direct inguinal hernia

Answer 8

contents pass through a weakness of anterior abdo wall in inguinal triangle
due to increase in AIP
covered by peritoneum and transversalis fascia
exit superficial ring but lateral to cord

Question 9

predisposing factors for inguinal hernia

Answer 9

increased IAP - chronic cough, squats, pregnancy, obesity

weakness of transversalis fascia - previous hernia, age

Question 10

scrotal continuation of a hernia

Answer 10

more common in indirect but can occur in either

Question 11

incarceration consequence

Answer 11

bowel obstruction - constipation, distension, vomiting, pain

Question 12

signs of strangulation and ischaemia

Answer 12

pain
redness
swelling
warmth
tenderness

Question 13

femoral hernia

Answer 13

weak point in anterior abdo wall
hernia enlarges and passes out of saphenous opening and into deep fascia
high risk of obstruction/strangulation

Question 14

Richter’s hernia

Answer 14

may occur in femoral canal

defined by only part of intestinal wall folding through the femoral ring

Question 15

presentation of femoral hernia

Answer 15

obstructed contents

globular lump below and lateral to pubic tubercle - groin lump

Question 16

groin lump differentials

Answer 16

inguinal hernia
lipoma
femoral artery aneurysm
saphenous ovarix
psoas abscess
lymph node

Question 17

femoral hernia gender difference

Answer 17

F>M

Question 18

true umbilical hernia

Answer 18

defect in transversalis fascia at umbilical ring specifically incomplete closure of umbilical cicatrix
more common in black, male, premature babies
covered by skin as opposed to exomphalos
generally asymptomatic
more prominent on coughing/laughing
reduce easily
rarely obstructed

Question 19

paraumbilical hernia

Answer 19

acquired just above/below umbilicus
raised IAP
common in obese, middle aged, multiparous women
localised dragging pain and enlarging over time
tender with colic from intermittent obstruction of bowel
reducible
strangulate

Question 20

predisposing factors to umbilical hernias

Answer 20

exomphalos may be due to:
genetics
premature birth
male
congenital:
black children
premature births
male
paraumbilical:
women
multiparity
increased IAP

Question 21

symptoms of umbilical hernias

Answer 21

exomphalos: untreated will rupture leading to fatal peritonitis
congential: asymptomatic, rarely obstructs, reducible
paraumbilical: strangulation risk, contents are omentum, transverse colon and small intestine, obstructive symptoms and adhesion, less likely to be reducible

Question 22

exomphalos

Answer 22

rare failure of gut to return to abdo cavity following embryological rotation that occurs outside of the body
bowel is contained within a translucent sac which runs through the defective anterior wall

Question 23

incisional hernia

Answer 23

through defect in a scar from previous abdo surgery

likelihood depends on: pre op status, closure at op and post op factors

Question 24

complications of incisional hernias

Answer 24

strangulation rare

if a complete breakdown of wound occurs a loop of bowel may protrude from abdo wall

Question 25

symptoms of incisional hernia

Answer 25

asymptomatic 
lump
bulge
local discomfort
subacute bowel obstruction
if adhesions develop, hernia becomes irreducible

Question 26

ventral hernia

Answer 26

midline ventral hernia seen as elongated gap between rectus muscles in elderly, wasted patients (divarication of recti)

Question 27

clinical features of ventral hernia

Answer 27

one or more small protrusions through linea alba above umbilicus
usually containing extra-peritoneal fat
asymptomatic
some painful
pain worse on physical exertion or after meals

Question 28

epigastric hernias

Answer 28

between xiphoid process and umbilicus

cough-producible

Question 29

hiatus hernia

Answer 29

stomach protrudes upwards through hole in diaphragm

sliding: continuation of oesophagus, GOJ
rolling: part of stomach above diaphragm