Hernias

Question 1

What is the treatment of an inguinal hernia in an infant?

Answer 1

Surgical correction of the affected side with exploration of the unaffected side to search for/repair a sac not identified by clinical means

Question 2

Which is more common in adults: direct or indirect hernias?

Answer 2

Indirect

Question 3

Direct hernias are lateral to

Answer 3

the deep inguinal ring and deep epigastric vessels

Question 4

What conditions may predispose to a direct hernia?

Answer 4

Chronic cough, prostatic obstruction

Question 5

What are indirect inguinal hernias formed by?

Answer 5

unobliterated processus vaginalis of the peritoneum

Question 6

Why are bowel movements still possible in Richter hernia?

Answer 6

because only a portion is projecting into the hernia (and becoming gangrenous). The bowel lumen is only partially occluded. Viability of the bowel wall must be confirmed before it is returned to the peritoneum

Question 7

Which nerves may be injured during surgery to repair an inguinal hernia?

Answer 7

ilioinguinal, genitofemoral, ilial hypogastric, lateral femoral cutaneous

Question 8

The femoral vein lies (medial/lateral) to the femoral canal

Answer 8

lateral

Question 9

What are the contents of the inguinal canal?

Answer 9

males: spermatic cord and ilioinguinal nerve
females: round ligament and ilioinguinal nerve

Question 10

Tender irreducible mass immediately below and lateral to the pubic tubercle:

Answer 10

strangulated femoral hernia

Question 11

Which is more likely to strangulate: femoral vs inguinal hernias?

Answer 11

femoral

Question 12

Strangulation of bowel may occur at the __________, classically following weight loss.

Answer 12

obturator fossa
weight loss results in loss of fat pad that covers the area where the obturator membrane is deficient. CT scan with contrast can show level of obstruction of obturator nerve

Question 13

Pain down the medial side of the thigh is caused by compression of what nerve?

Answer 13

obturator

Question 14

An epigastric hernia is due to a defect where?

Answer 14

in the linea alba between the umbilicus and the xiphisternum

Question 15

An epigastric hernia usually contains _____________ rather than omentum or bowel.

Answer 15

preperitoneal fat

Question 16

Where does a Spigelian hernia occur?

Answer 16

lateral to the linea semilunaris (curved side of rectus abdominus)

Question 17

Severe burning pain radiating down the lateral thigh following a hernia repair occurs due to damage to what?

Answer 17

the lateral femoral cutaneous nerve

Question 18

What is the most common site for Spigelian hernia to occur?

Answer 18

1/3 the distance between the umbilicus and the pubic symphysis. This is the arcuate line where the posterior rectus sheath becomes deficient

Question 19

Prior to having an inguinal hernia repaired, a patient sshould undergo

Answer 19

rectal examination and colonoscopy (carcinoma may be causing straining that caused the hernia). This is esp important in cases where there has been a change of bowel habits.