hernias

Question 1

What is the definition of a hernia?

Answer 1

The protrusion of a structure through the wall of cavity in which
it is usually contained.

Question 2

With relation to the pubic tubercle, how do you differentiate
between inguinal and femoral hernias?

Answer 2

The neck of an inguinal hernia appears superior and medial to the
pubic tubercle. The neck of a femoral hernia appears inferior and
lateral to it.

Question 3

With relation to the inferior epigastric vessels, how do you
differentiate between indirect and direct inguinal hernias?

Answer 3

Indirect inguinal hernias occur lateral to the inferior epigastric
vessels; direct inguinal hernias occur medial to these vessels.

Question 4

Using embryology, explain how indirect inguinal hernias occur.

Answer 4

D u rin g foetal developm ent, the testes descend from the p osterior
abdominal wall into the scrotum follow ing the processus vaginalis
via an attachment called the gubernaculum s. If the connection
to the peritoneal cavity fails to close, then a patent processus
vaginalis is present through which indirect inguinal hernias can
occur.

Question 5

Give two risk factors for inguinal hernias.

Answer 5

Prematurity, m ale sex, chronic cough, constipation, obesity, heavy
lifting, other physical activity, e.g. sports.

Question 6

What is the difference between an obstructed and a strangulated
inguinal hernia?

Answer 6

An obstructed inguinal hernia is one thro u g h which contents o f
the G I tract can n o t pass. A strangulated inguinal hernia implies
ischaemia o f the portion of bow el affected.

Question 7

Give two complications following inguinal herniotomy surgery.

Answer 7

Recurrence, wound site infection, mesh infection, hydro-coele,
intestinal dam age, bladder dam age, spermatic cord dam age,
testicular infarction secondary to blood vessel dam age.