Hernias

Question 1

What are the three key complications of hernias?

Answer 1

Incarceration, obstruction and strangulation

Question 2

What is the name for when only part of the bowel wall and lumen herniate through a defect in the abdominal wall, with the other side of that section of the bowel remaining within the peritoneal cavity?

Answer 2

Richter’s hernia - this is a surgical emergency as it can become very ischaemic/necrotic quickly.

Question 3

What is the name for when two different loops of bowel are contained within the hernia?

Answer 3

Maydl’s hernia

Question 4

What are the two types of hernia repair?

Answer 4

Conservative: if hernia has a wide neck:

Tension repair: suture tissues back together. Rarely performed.

Tension free repair: mesh sutured to muscles and tissues either side of the defect. Over time tissues grow into the mesh and provide extra support.

Question 5

What travels through the inguinal canal in males?

Answer 5

Spermatic cord and its contents

Question 6

Where is the deep inguinal ring located?

Answer 6

The mid-way point from the ASIS to the pubic tubercle

Question 7

What region does a direct inguinal hernia protrude through?

Answer 7

Hesselbach’s triangle/inguinal triangle

Question 8

What are the contents of the femoral triangle from lateral to medial across the top of the thigh?

Answer 8

Femoral nerve
Femoral artery
Femoral vein
Femoral canal

Question 9

What type of hernia occurs between the lateral border of the rectus abdominis muscle and the linea semilunaris?

Answer 9

Spigelian hernia

Question 10

What refers to a widening of the linea alba, forming a larger gap between the rectus muscles?

Answer 10

Recti divarication

Question 11

What sign refers to pain extending from the inner thigh to the knee when the hip is internally rotated?

Answer 11

Howship–Romberg sign

Question 12

What causes Howship–Romberg sign?

Answer 12

Compression of the obturator nerve, often due to an obturator hernia

Question 13

What are type 1 and type 2 hiatus hernias?

Answer 13

Type 1: sliding

Type 2: rolling

Question 14

What surgical procedure may be used to treat a hiatus hernia?

Answer 14

Laparoscopic fundoplication

Question 15

What is hernia incarceration?

Answer 15

This is when the hernia cannot be reduced back into its original position - it is irreducible.

This can lead to obstruction and strangulation

Question 16

What is hernia strangulation?

Answer 16

Non reducible and the base of the hernia is so tight that it cuts off blood supply causing ischaemia.

Question 17

Differential diagnoses for groin lumps in inguinal region?

Answer 17

femoral hernia 
lymph node
saphena varices (dilation of saphenous vein at junction with femoral vein)
femoral aneurysm
abscess
undescended/ectopic testicle
Kidney transplant

Question 18

What travels through the inguinal canal in females?

Answer 18

The round ligament where it inserts onto the labia major.

Question 19

How do you clinically differentiate an indirect inguinal hernia from a direct inguinal hernia?

Answer 19

Apply two fingers over the mid-point between the ASIS and the pubic tubercle. If the hernia no longer protrudes through the canal on pressure (coughing, straining etc) then this will be an indirect inguinal hernia.

Question 20

What are the borders of Hesselbach’s triangle?

Answer 20

RIP

Rectus abdominus muscle - medial border
Inferior epigastric vessels - superior and lateral border
Pouparts ligament - inferior border (inguinal ligament)

Question 21

What are the borders of the femoral canal?

Answer 21

“FLIP”

Femoral vein (lateral)
Lacunar ligament - medial
Inguinal ligament - anterior
Pectineal ligament - posterior

Question 22

Borders of the femoral triangle?

Answer 22

SAIL

Sartorius (lateral)
Adductor longus (medial)
IL - Inguinal ligament (superior)

Question 23

Clinical presentation of hiatus hernia?

Answer 23

Heartburn (GORD)

Regurgitation of food/fluids back into the mouth

Question 24

How do you diagnose a hiatus hernia?

Answer 24

Oesophageal manometry

X-ray - barium swallow

Upper GI endoscopy