Herniaes

Question 1

Define a hernia?

Answer 1

A protrusion of an viscera through its surrounding wall.

Question 2

Define the following terms:

• reducible/irreducible
• incarcerated
• strangulated
• sliding

Answer 2

Reducible/Irreducible: can you push it back in

Incarcerated: contents are stuck to the sack and therefore may become obstructed

Strangulated: an irreducible hernia with its blood supply cut off, patient will be in pain and unwell due to lactate build up.

Sliding: Referring to a hiatus hernia when its slides up through the oesophageal aperture.

Question 3

Describe the risk factors of developing a hernia?

Answer 3

Weakness of a wall:
Pregnancy
Surgery
Obesity 
Age
Male

Raised Intra-abdominal pressure:
Pregnancy
Heavy lifting
Chronic cough
Constipation
Mass/Ascites

Question 4

How would you differentiate between a femoral or inguinal hernia?

Answer 4

Femoral hernias are inferolateral to pubic tubercle and are herniations through the femoral canal. They are much more common in females.

Inguinal hernias are superolateral to the pubic tubercle and are herniations through the deep ring or both deep and superficial ring. Occur in males.

Question 5

What are the different types of inguinal hernias? Outline the boundaries of Hasselbachs triangle.

Answer 5

Direct and indirect.

Direct goes directly through the abdominal wall through the superficial inguinal ring (essentially a small hole in the internal oblique) which is found within hasslebachs triangle.* More common.

Indirect goes through both the deep ring and then the superficial ring.

Hasslebachs triangle’s borders are:
Medial border: Lateral margin of the rectus sheath
Superolateral border: Inferior epigastric vessels
Inferior border: Inguinal ligament

Question 6

How can you tell differentiate between a direct and indirect inguinal hernia?

Answer 6

Ask patient to reduce the hernia.

Press on the deep ring and ask the patient to cough:
If it reappears = direct hernia
If it doesn’t = indirect hernia

If the hernia goes into the scrotum it is indirect.

Question 7

Describe the locations of an incisional, epigastric and umbilical hernia?

Answer 7

Incisional are in any areas of previous surgery, tends to be bigger the scar the greater risk of a hernia.

Epigastric is in the epigastric region it is a peas sized swelling.

Umbilical from the umbilicus, usually are congenital as there is weakness from the umbilical cord. Can also occur in raised intra-abdominal pressure (ascites)

Question 8

How should you describe any lump?

Answer 8

4 Students 3 Teachers round the CAMP FIRE

Site
Size
Shape
Surface

Tenderness
Temp
Transillumination

Consistency/colour
Appearance of pt
Mobility
Pulsatile

Fluctuence
Irreducible
Regional lymph nodes
Edges

Question 9

Describe what causes an epigastric hernia?

Answer 9

It is caused by a defect in the linea alba (ligamentous band in the centre of the rectus abdominus)

Question 10

What is divarication of the recti?

Answer 10

It is when there is weakness in the linea alba causing there to be a split between the 2 sides of the rectus abdominus.

Does not require surgery as there is no risk of any complications such as obstruction or strangulation.

Question 11

Describe the management of obstructed or strangulated hernias?

Answer 11

Emergency surgery as there is risk of bowel necrosis and perforation.

Question 12

Describe how an inguinal hernia may present on examination?

Answer 12

Above inguinal ligament.
Cough impulse.
May be reducible.

Question 13

Describe how an femoral hernia may present on examination?

Answer 13

Below inguinal ligament and lateral to the pubic tubercle.
Cough impulse.
Less likely to reduce.

Question 14

Describe how a lipoma may present on examination?

Answer 14

Mobile, soft and superficial.
Well demarcated.
Non tender.

Question 15

Describe how lympadenopathy may present on examination?

Answer 15

Multiple lumps.
Rubbery and mobile.

Reactive:

• tender
• infection in legs or genital skin

Cancer:

• non tender
• multiple
• causes melanoma of the genital/anal/leg skin

Question 16

Describe how a sebaceous cysts may present on examination?

Answer 16

Enlargement of a hair follicle.

Superficial.
May see a hair follicle.
If squeezed sebum may come out.

Question 17

Describe how an abscess may present on examination?

Answer 17

Red hot tender lump. (may be an infected sebaceous cyst)

Question 18

Describe how a saphena varix may present on examination?

Answer 18

Dilation of the saphenous vein at the junction with the femoral vein.

Lump at the top of the groin.
May appear bluish.
Disappears when the patient is lying down.

Question 19

Describe how a femoral aa pseudoaneurysm may present on examination?

Answer 19

Damage to an aa which can cause bleeding a clot forms but blood keeps flowing due to the defect keeping it present.

Red inflamed swelling.
May be tender.
Pulsatile.

Question 20

Name some differentials for a lump in the groin

Answer 20

Inguinal hernia, femoral hernia, lipoma, femoral aa aneurysm, saphenous ovarix, psoas abscess, lymph node, undescended testis

Question 21

Describe the boundaries of the femoral triangle

Answer 21

Laterally: Satorius muscle
Medially: Abductus longus
Superiorly: Inguinal ligament

Question 22

Which hernia are the most common in both males and females

Answer 22

Inguinal hernia.

Femoral hernias are more common in females than males but overall inguinal hernias happen more therefore are the most common type of hernia in females.