Hernias

Question 1

What is a hernia?

Answer 1

A protrusion of an organ/organ fascia through the wall of the cavity in which it is contained.

Question 2

What does the ‘neck’ of a hernia refer to?

Answer 2

Point of protrusion through the defect
- diameter of neck dictates severity & risk of strangulation

Question 3

What is the difference between reducible & irreducible hernias?

Answer 3

Reducible - (incarcerated) no risk of ischaemia, can push back in

Irreducible - (strangulated) far more serious, strangled by neck, blood supply threatened = ischaemic bowel

Question 4

What is the typical profile of an inguinal hernia?

Answer 4

• elderly M; hx heavy lifting
• reducible lump
• above & medial to PT

Question 5

Differentiate between a direct & indirect inguinal hernia.

Answer 5

Direct - medial to inferior epigastric artery
- through abdominal wall

Indirect - lateral to IEA
- through superficial to deep inguinal ring

Question 6

What is a patent processus vaginalis?

Answer 6

PPV - communication between peritoneum & scrotum (congenital defect)
- felt as a scrotal lump like an indirect hernia but cannot get above it as connected into abdomen

Question 7

What is the cough impulse?

Answer 7

Reduce hernia, ask patient to cough.
- reduced at MPIL, will reappear elsewhere (+)

+ve = indirect hernia

Question 8

How would a femoral hernia present?

Answer 8

• multiparous F
• below & lateral to PT
• painful, irreducible (sequelae common)
• narrow neck req emergency surgery

Question 9

What is a differential of a femoral hernia?

Answer 9

Sapheno varix

Question 10

What is an incisional hernia?

Answer 10

Protrusion through iatrogenic weakness - 10% abdominal ops
Risk - nutritional, obesity, steroids, cough
- oft have wide neck so strangulation rare

Question 11

What is a hernia truss?

Answer 11

Conservative alternative to hernia surgery - belt worn over hernia to keep it reduced & to relieve discomfort
(especially with incisional as healing & while strengthening abdo wall muscles)

Question 12

What is Littré’s hernia?

Answer 12

Herniation of Meckle’s diverticulum

Question 13

What is Maydl’s hernia?

Answer 13

A W-shaped herniation (2 protrusions)

Question 14

Richter’s hernia?

Answer 14

Rare: ante-mesenteric bowel border protrudes through fascial defect
- little risk strangulation

Question 15

Difference between umbilical & paraumbilical hernias?

Answer 15

Umbilical - central, symmetrical
Paraumbilical - asymmetric

Question 16

Where would you find an epigastric hernia?

Answer 16

Midline between XSP & umbilicus

Question 17

Why would a COPD patient be at risk of a hernia?

Answer 17

Persistent cough

Question 18

Spigelian hernia?

Answer 18

Protrusion through spigelian fascia (btw rectus abdominis & transversus abdominis)

Question 19

How might an obturator hernia present?

Answer 19

Median paresthesia of the LL

Question 20

What is Hesselbach’s triangle?

Answer 20

Natural weakness in groin area predisposed to herniation.

Borders:
1. Inferior epigastric vessels
2. Inguinal ligament
3. Rectus abdominis

Question 21

What is the arcuate line?

Answer 21

Site of weakness in abdominal wall (spigelian hernias common)
IEAs perforate to supply ant abdo wall.

Above - abdominis sandwiched in internal oblique aponeurosis
Below - abdominis sandwiched btw tranversalis fascia & aponeurosis of the 3 flat side muscles