Hernias

Question 1

What is a direct inguinal hernia?

Answer 1

A hernia that occurs due to a weakness in the abdominal wall

Question 2

Where does a direct inguinal hernia protude through?

Answer 2

Hasselbach’s triangle

Question 3

What are the borders of hasselbach’s triangle?

Answer 3

Lateral edge of rectus abdominus
Inferior epigastric vessels (superiorly)
Inguinal ligament (inferiorly)

Question 4

What is an indirect inguinal hernia?

Answer 4

An inguinal hernia that protrudes through the deep inguinal ring

Question 5

What populations are indirect and direct hernias typically seen in?

Answer 5

Indirect - young males, as they are typically congenital

Direct - older males, due to abdominal wall laxity, or conditions that increase intra-abdominal pressure

Question 6

What are the risk factors for developing an inguinal hernia?

Answer 6

Male
Increasing age
Raised intra-abdominal pressure (chronic cough, chronic constipation, heavy lifting)
High BMI

Question 7

What are the features of an inguinal hernia?

Answer 7

Groin swelling
Pain
Palpable mass

Question 8

What features should be assessed on examination of a groin lump?

Answer 8

Cough impulse
Location
Reducibility
If in the scrotum - is it separate from the testes

Question 9

How can a direct hernia be differentiated from an indirect hernia?

Answer 9

A direct hernia is indicated by protusion despite occlusion of the deep inguinal ring

If there is no protusion on occlusion of the deep inguinal ring, it is likely an indirect hernia

Question 10

Where is the deep inguinal ring found?

Answer 10

At the midpoint of the inguinal ligament (between ASIS and pubic symphysis)

Question 11

What investiagations may be performed for a suspected inguinal hernia?

Answer 11

WCC - may be raised if there is strangulation
Blood gas - raised lactate
Ultrasound (first choice of imaging)
CT
Abdominal X-ray if obstruction suspected