Hernias

Question 1

What is hernia?

Answer 1

Weakness in the abdominal wall and some of the abdominal contents protrude through that weakness.

Hernias are named based on the location of the hernia.

Question 2

What types of hernia are there?

Answer 2

Umbilical hernia
Hiatal hernia
Inguinal hernia
Incisional hernia
Epigastric hernia
Femoral hernia

Question 3

How are hernias further classified and what does each classification mean?

Answer 3

Reducible
- you can apply pressure to hernia and push the contents that have gone through the weakness in the abdominal wall back into the abdominal cavity. This will cause the hernia to temporarily go away.

Incarcerated
- when you apply pressure to hernia but you are unable to push back the contents, so the hernia is resisting and the contents are stuck.

Strangulated
- hernia content does not receive blood supply, causing tissues to die, which can lead to sepsis which is life threatening.
- MEDICAL EMERGENCY

Question 4

Risk factors for hernia?

Answer 4

• heavy lifting
• abdominal exercises
• chronic cough
• abdominal wt gain
• pregnancy
• abdominal surgery

Question 5

How are hernias diagnosed?

Answer 5

Clinical diagnosis
USS

Question 6

General presentations of hernia?

Answer 6

• localised mass/bump around the affected area of the abdomen
• +/-mild discomfort
• localised, soft, well distinguished mass
  • increases with Valsalva (e.g. coughing, straining)
  • reducible vs. irreducible

(symptoms vary for different types of hernia)

Question 7

How does strangulated hernia present?

Answer 7

• fever
• n+v
• sudden, quick intensifying pain
• skin erythema
• inability to pass gas or stool
• abdominal tenderness, distention
• firm mass
• high pitched bowel sounds (indicated obstruction? can progress to minimal/absent)

Question 8

How are hernias managed?

Answer 8

Strangulation or obstruction →admit urgently to hospital

Irreducible or partially reducible →refer urgently for surgical repair

Fully reducible
- symptomatic
- refer routinely for surgical repair

• asymptomatic
  - observation
  - if it’s umbilical hernia in children age 4 or 5, then refer for surgery

    - elective surgery (if pt is bothered by the appearance)

Question 9

What is inguinal hernia?

Answer 9

A bulge that occurs in your groin region, the area between the lower part of your abdomen and your thigh.

Question 10

What are the two types of inguinal hernia? What is the difference?

Answer 10

Indirect
- Inguinal canal is not closed, which then allows some of the abdominal contents to go down through the inguinal ring and cause a hernia.

Direct
- Inguinal canal is closed, but there is weakness in the inguinal abdominal wall, where abdominal contents are able to protrude that.

(Inguinal canal allows testicles in a male to descend down into the scrotum, and is normally closed).

Question 11

What is hiatal hernia? What can it lead to?

Answer 11

The top part of the stomach pushes up through the hiatus (opening of the diaphragm) into your chest, forming a hernia.

Hiatal hernia can lead to reflux and oesophagitis.

Question 12

How does hiatal hernia present?

Answer 12

• heart burn
• regurgitation
• cough
• chest pain
• epigastric tenderness