Hernias

Question 1

What is a femoral hernia?

Answer 1

Intra-abdominal contents herniate into the femoral canal through the femoral ring

Question 2

List 5 risk factors for femoral hernias

Answer 2

Female (3:1)
Age
Obesity
Multiparity
Increased intra-abdominal pressure e.g. chronic constipation, cough, straining during micturition

Question 3

Describe the epidemiology of femoral hernias

Answer 3

Much LESS common than inguinal
but more likely to get incarcerated as are situated in a tighter place
F > M
Account for 5% of abdominal hernias

Question 4

Describe presentation of a femoral hernia

Answer 4

Globular lump in the groin
Enlarges with coughing
Clinical dx

Question 5

Location of femoral hernias

Answer 5

INFEROLATERAL to pubic tubercle

Question 6

What investigation may be used for femoral or inguinal hernias if there is diagnostic uncertainty?

Answer 6

US
(difficult to palpate in obese)

Question 7

Describe the management of non-complicated femoral hernias

Answer 7

Refer due to high risk of strangulation (50% strangulate within a month)
Elective surgical repair with mesh hernioplasty

Question 8

Describe management of complicated femoral hernias

Answer 8

Herniorrhaphy (non-mesh repair)

Question 9

Name 4 complications of hernias

Answer 9

Pain
Incarceration
Strangulation
Bowel obstruction

Question 10

Define hernial incarceration

Answer 10

Irreducible

Question 11

Define hernial strangulation

Answer 11

Ischaemic necrosis of contents of hernial sac as blood supply compromised by incarceration

Question 12

In which type of hernia is there greater risk of strangulation?

Answer 12

Femoral

Question 13

Describe presentation of strangulated hernia

Answer 13

Tender, irreducible, warm hernia
Systemic Sx
Features of bowel obstruction
Severe pain

Question 14

Describe management of strangulated hernias

Answer 14

DO NOT attempt to reduce
Laparotomy

Question 15

What is the most common type of hernia?

Answer 15

Inguinal

Question 16

How are inguinal hernias diagnosed?

Answer 16

CLINICAL DIAGNOSIS

Question 17

What is an inguinal hernia?

Answer 17

Protrusion of intra-abdominal contents through inguinal canal

Question 18

What is a direct inguinal hernia?

Answer 18

protrusion directly through the POSTERIOR WALL of the inguinal canal
ACQURIED

Question 19

What is an indirect inguinal hernia?

Answer 19

Protrusion THROUGH the DEEP inguinal RING, following the path of the inguinal canal
usually congenital

Question 20

What is the most common type of inguinal hernia?

Answer 20

Indirect

Question 21

Describe the aetiology of inguinal hernias

Answer 21

Congenital: abdo contents enter the inguinal canal through a patent processus vaginalis
Acquired: increased intra-abdo pressure + weakness of abdo muscles

Question 22

Describe the location of direct inguinal hernias

Answer 22

Within Hesselbach triangle
Medial to inferior epigastric blood vessels + lateral to the rectus

Question 23

Describe the location of indirect inguinal hernias

Answer 23

Outside Hesselbach triangle
Lateral to inferior epigastric blood vessels

Question 24

List 5 risk factors for inguinal hernias

Answer 24

Male
Prematurity
Age
Obesity
Heavy lifting

Question 25

Describe the epidemiology of inguinal hernias

Answer 25

COMMON Peak age in adults: 55-85y M > F

Question 26

How may inguinal hernias present?

Answer 26

Groin lump Increases in size on coughing/ straining Decreases when lying Discomfort + ache (severe pain uncommon)

Question 27

How do you distinguish between direct and indirect inguinal hernias?

Answer 27

Reduce the hernia + occlude the deep internal ring with 2 fingers. Ask patient to cough/ stand. If hernia is restrained= indirect. If protrudes= direct

Question 28

Describe management of uncomplicated inguinal hernias

Answer 28

Elective repair: Hernioplasty (mesh repair) Herniorrhaphy (non-mesh repair)

Question 29

When is emergency surgery performed for inguinal hernias?

Answer 29

If obstructed or strangulated Laparotomy with bowel resection may be indicated if bowel is gangrenous

Question 30

What is the term used for presence of co-existing direct and indirect inguinal hernias?

Answer 30

pantaloon hernia

Question 31

How do you differentiate between inguinal and femoral hernias?

Answer 31

Inguinal: superior + medial to pubic tubercle Femoral: inferior + lateral to pubic tubercle (+ medial to femoral pulse)

Question 32

Describe the anatomy of the inguinal ligament. What runs within the ligament?

Answer 32

Runs between ASIS + pubic tubercle. Inguinal canal

Question 33

What passes through the inguinal canal?

Answer 33

Ilioinguinal nerve + Males: spermatic cord Females: round ligament

Question 34

Describe the anatomy of the deep and superficial rings within the inguinal canal

Answer 34

Deep (entry): just above midpoint of inguinal ligament Superficial (exit): just above + medial to pubic tubercle

Question 35

What is an irreducible hernia?

Answer 35

Can't be pushed back into place

Question 36

What is a hernia?

Answer 36

protrusion of a viscus through a defect of the walls of its containing cavity into an abnormal space

Question 37

What is an obstructed hernia?

Answer 37

Bowel contents can't pass through the no longer patent, compressed bowel lumen

Question 38

What is a strangulated hernia?

Answer 38

Compression around the hernia prevents blood flow into the hernial contents causing ischaemia to the tissues within

Question 39

What is a reducible hernia?

Answer 39

Contents of hernia can be manipulated back into its original position through the defect from which it emerges