Hernias

Question 1

What is a hernia?

Answer 1

protrusion of abdominal contents through congenital/acquired areas of weakness in the wall

Question 2

What are the main types of hernia?

Answer 2

1. inguinal (more common)

2. femoral

Question 3

What are hernias due to?

Answer 3

increase in intra-abdominal pressure

Question 4

What can cause an increase in intra-abdominal pressure?

Answer 4

1. Chronic cough
2. Smoking causing cough
3. Constipation
4. Pregnancy
5. Weight-lifting
6. Weakened abdominal muscles

Question 5

What is irreducible mean?

Answer 5

if they cannot be pushed back into the right place

Question 6

What does incarceration mean?

Answer 6

contents of the hernia sac are stuck inside by adhesions

Question 7

What does obstruction mean?

Answer 7

when bowel contents can’t pass through GI hernia

Question 8

What does strangulated mean?

Answer 8

blood supply cut-off, so you get ischaemia of the hernia

Question 9

Where are femoral hernias?

Answer 9

inferolateral to the pubic tubercle

Question 10

Where are inguinal hernias?

Answer 10

superomedial to the pubic tubercle

Question 11

What are inguinal hernias?

Answer 11

Abnormal protrusion of a peritoneal sac through a weakness of the abdominal wall in the inguinal region

Question 12

What are the two types of inguinal hernias and what do they have in common?

Answer 12

1. direct and indirect

2. both emerge at the superifical inguinal ring

Question 13

What is a direct inguinal hernia?

Answer 13

1. Protrusion of the hernial sac directly through a weakness in the posterior wall of the inguinal canal
2. Through Hesselbach’s triangle

Question 14

What is an indirect inguinal hernia?

Answer 14

Protrusion of the hernial sac through the deep inguinal ring, following the path of the inguinal canal

Question 15

What are the borders of hesselbach’s triangle?

Answer 15

1. Lateral border of rectus abdominis
2. Inferior epigastric vessels
3. Inguinal ligament

Question 16

What is the aeitology of inguinal hernias?

Answer 16

1. Congenital

2. Acquired - due to increased intra-abdominal pressure along with muscle and transversalis fascia weakness

Question 17

What is the epid of inguinal hernias?

Answer 17

• Common

* x9 more common in M

Question 18

What are femoral hernias?

Answer 18

Abdominal contents pass through a naturally occurring weakness called the femoral canal

Question 19

What is the epid of femoral hernias?

Answer 19

• Far less common than inguinal

* More common in F

Question 20

What are symptoms and signs of both hernias?

Answer 20

1. Typically ASx, other than presence of lump in the groin
2. Ask pt to cough if the hernia is not visible at first
3. Check if it is irreducible
4. Pain if incarcerated/strangulated

Question 21

What is the placement of both types of hernias?

Answer 21

1. Inguinal: lump extends towards genitalia (medially)

2. Femoral: lump is more lateral

Question 22

What are the Ix for hernias if painful and irreducible?

Answer 22

1. bloods (FBC, CRP, WBC)

2. imaging (CXR to check perforation), USS)

Question 23

What is important with examination of hernias?

Answer 23

examination of hernia whilst pt is supine and then when standing

Question 24

Which type of hernia is more likely to become incarcerated?

Answer 24

femoral are more likely to become incarcerated as they are situated in a tighter place

Question 25

What is the conservative managment of hernias?

Answer 25

Lifestyle changes: diet if overweight, limit increase in abdo pressure

Question 26

What is the management of uncomplicated hernias?

Answer 26

• elective repair
  1. mesh repair
  2. laparoscopic

Question 27

What happens in a mesh repair?

Answer 27

hernia is surgically reduced and a mesh is inserted to reinforce the defect where the hernia protruded through

Question 28

What is the management of hernias if obstructed/strangulated?

Answer 28

emergency laparotomy

Question 29

What are possible complications of hernias?

Answer 29

1. Incarceration
2. Strangulation
3. Bowel obstruction
4. Surgical complications