Hernias

Question 1

What is the definition of a hernia?

Answer 1

The protrusion of a viscus or part of a viscus through a defect of the wall or its containing cavity into an abnormal position.

Question 2

What type of hernia is this describing?

Contents cannot be pushed back into place.

Answer 2

Irreducible

Question 3

What type of hernia is this describing?

Bowel contents cannot pass - features of intestinal obstruction.

Answer 3

Obstructed

Question 4

What type of hernia is this describing?

Ischaemia occurs - patient requires urgent surgery.

Answer 4

Strangulated

Question 5

What type of hernia is this describing?

Contents of hernia sac are stuck inside by adhesions.

Answer 5

Incarcerated

Question 6

What is the most common type of hernia?

Answer 6

Indirect inguinal hernia

Question 7

What type of hernia can most easily strangulate?

Answer 7

Indirect inguinal hernia

Question 8

What type of hernia reduces easily and rarely strangulates?

Answer 8

Direct inguinal hernia

Question 9

What type of hernia is more common in females, is irreducible and can easily strangulate?

Answer 9

Femoral hernia

Question 10

Where are inguinal hernias located relative to the pubic tubercle?

Answer 10

Superior and medial

Question 11

What are the risk factors for developing an inguinal henria?

Answer 11

Male, chronic cough, constipation, urinary obstruction, heavy lifting, ascites, past abdominal surgery.

Question 12

Where is the deep inguinal ring located?

Answer 12

Mid-inguinal point (ASIS to pubic tubercle)

Question 13

Where is the superficial inguinal ring located?

Answer 13

Just superior-medial to the pubic tubercle.

Question 14

What is the route of an indirect inguinal hernia?

Answer 14

Pass through the internal inguinal ring and, if large enough, out through the external ring.

Question 15

What is the route of a direct inguinal hernia?

Answer 15

Push through directly forwards through posterior wall of the inguinal canal, into a defect in the abdominal wall (Hesselbach’s triangle).

Question 16

How can you distinguish a direct from an indirect inguinal hernia?

Answer 16

1. With patient sitting, reduce hernia and occlude deep inguinal ring with two fingers.
2. Ask patient to cough
3. If the hernia is restrained, it is indirect, if not, it is direct.
4. Repeat exam when patient is standing.

Question 17

What is the management for an inguinal hernia?

Answer 17

1. Weight loss if overweight and stop smoking pre-op.

2. Mesh techniques are mainstay - reinforce posterior wall of canal.

Question 18

Where are femoral hernias located in relation to the pubic tubercle?

Answer 18

Inferior and lateral

Question 19

What is the difference between inguinal and femoral hernias in which direction they point?

Answer 19

1. Inguinal - towards groin

2. Femoral - down leg

Question 20

What are the borders of the femoral triangle?

Answer 20

Inguinal ligament, sartorius (medial border), and adductor longus (medial border).

Question 21

What is the path of a femoral hernia and how does it present?

Answer 21

1. Bowel enters femoral canal.

2. Mass in the upper medial thigh or above the inguinal ligament.

Question 22

What are the differentials for a femoral hernia and how do you differentiate?

Answer 22

1. Inguinal hernia
2. Saphnea varix - disappears when lying, blue tinge
3. Enlarges Cloquet’s node - infection, metastases from anus/vulva.
4. Lipoma
5. Femoral aneurysm - pulsing

Question 23

What is the treatment for a femoral hernia?

Answer 23

Surgical repair