Hernias

Question 1

Types of hernia

Answer 1

Inguinal, femoral, umbilical, hiatal, incisional, epigastric, diaphragmatic, spiqellian

Question 2

Definition of a hernia

Answer 2

Part of an internal organ or tissue which protrudes through a muscle or tissue

Question 3

Types of inguinal hernia

Answer 3

Direct and indirect

Question 4

Types of hiatal hernia

Answer 4

Sliding and rolling

Question 5

Two main complications of hernias

Answer 5

Incarcerated or strangulated

Question 6

How does an indirect inguinal hernia develop

Answer 6

Peritoneal sac enters inguinal canal through deep inguinal ring, usually from failure of processus vaginalis to regress

Question 7

How does a direct ingunial hernia develop

Answer 7

Peritoneal sac enters inguinal canal through posterior wall, weakness of abdominal muscles

Question 8

Which inguinal hernia is acquired and which is often congenital

Answer 8

Direct - acquired
Indirect - congential

Question 9

Causes of ingiunal hernias

Answer 9

Weakened muscles in wall - pregnancy, obesity, strained abdominal area, long-standing cough, physical exertion, weak diaphragm

Question 10

Symptoms of inguinal hernia

Answer 10

Swelling or bulge in scrotum, groin or abdomen, increased pain, dull ache, signs of bowel obstruction

Question 11

Treatment of inguinal hernia

Answer 11

Belt to push hernia back in, robotic, lap or open surgery using mesh covering

Question 12

What is a strangulated hernia

Answer 12

When the blood supply is cut off from the area protruding through into the hernia, which required immediate attention

Question 13

What is an incarcerated hernia

Answer 13

When part of fat or intestine inside abdomen gets stuck and can not go back into abdomen

Question 14

What is a hiatal hernia

Answer 14

Abdominal contents protrude through an enlarged oesophageal hiatus in the diaphragm

Question 15

What is a sliding hiatal hernia

Answer 15

The gastro-oesophageal junction slides up into the chest through diaphragm

Question 16

What is a rolling hiatal hernia

Answer 16

The gastro-oesophageal junction remains in abdomen but part of the stomach protrudes into the chest alongside oesophagus

Question 17

Risk factors for hiatus hernia

Answer 17

Obesity, previous hiatal surgery, increased abdominal pressure

Question 18

% of hiatal hernias which are rolling or sliding

Answer 18

Sliding - 80%
Rolling - 20%

Question 19

Clinical features of hiatal hernia

Answer 19

Heart burn, dysphagia, regurgitation, SOB, odynophagia, chronic cough and chest pain

Question 20

Diagnosis of hiatal hernia

Answer 20

Barium swallow, endoscopy, oesophageal manometry

Question 21

Conservative management of hiatal hernia

Answer 21

Loose weight, elevate head of bed, avoid large meals before bed, avoid alcohol and acidic foods, no smoking

Question 22

Management of hiatal hernia

Answer 22

PPI for 4-8 weeks, or surgical management is Nissen’s fundolasty

Question 23

When is urgent surgery indicated

Answer 23

Haemorrhage, volvulus, ischaemia, necrosis, obstruction