Hernias

Question 1

Definiteion of a hernia

Answer 1

An abnormal protrusion of a viscus outwith its normal body cavity

Question 2

What is the most common type of hernia

Answer 2

Inguinal

Question 3

How might abdoninal wall hernias arise?

Answer 3

From natural opening or weak areas, caused by stretching or sirgical incision

Question 4

Name some predisposing factors for abdominal hernias?

Answer 4

Heavy lifting
Coughing
Constipation	
Prostatism – commonly bilateral inguinal
Pregnancy
Obesity

Question 5

What do predispising factors for abdominal hernias all have in common?

Answer 5

They raise the intraabdominal pressure

Question 6

How can we classify hernias?

Answer 6

Reducible (going back in and flatten) or irreducible (may obstruct)

Question 7

What happens to the contents of an irreducible hernia?

Answer 7

May become incarcerated or strangulated

Question 8

What is strangulation and describe the appearance

Answer 8

It denotes compromiseof the blood supply of the contents
and its development increase morbidity and mortality
Purple looks like its going to burst

Question 9

Name some of the causes of incisional hernias

Answer 9

Age
Obesity
general debiliility
Post op wound infection 
post op haematoma 
raised intra abdominal pressure

Question 10

What type of hernias do children get

Answer 10

True umbilical hernias

Question 11

What type of hernias do adults get?

Answer 11

Para - umbilical hernia

Question 12

What treatment do we give for umbilical hernias

Answer 12

If the defect is very small, we can put some stitches in it

More than 2cm then we need some mesh in place to firm up the area

Question 13

What age group of people are prone to epigastric hernia

Answer 13

Teenagers - mid 20s usually males

Question 14

What do we do for umbilical hernias for under 3 year olds

Answer 14

Leave them - they usually resolve themselves

Question 15

If the child is more than 3 and the hernia has not resolved, what do we do?

Answer 15

Operate

Question 16

What is the risk of an inguinal hernia in a child

What do we do for inguinal hernias

Answer 16

Obstructing or strangling the bowel

Operate in the next couple of months unless obstructing or strangling the bowel

Question 17

What causes hernias in kids?

Answer 17

Potent Processus Vaginalis

Question 18

What side is a hernia more common in?

Answer 18

Right

Question 19

What is a Herniotomy

Answer 19

Where you cut off the hernia

Question 20

Who is most likely to get a femoral hernia

Answer 20

Thin elderly female

Question 21

What is the main symptom for a femoral hernia?

Answer 21

Loss of groin crease

Question 22

Describe the anatomy of the femoral hernia

Answer 22

Defect through the femoral canal
below and lateral to the pubic tubercle
Usually flatten the groin crease

Question 23

How much more likely is it that a female wil develop a femoral hernia?

Answer 23

10 times more likely

Question 24

Describe the anatomy of an inguinal hernia

Answer 24

Above pubic tubercle - increases the groin crease

Question 25

If you can feel above the scrotal swelling? what is the most likely diagnosis?

Answer 25

epididymal cyst

ie. not a hernia

Question 26

Name 4 causes of scrotal swellings

Answer 26

Inguino-scrotal hernia (indirect)
hydrocoele
Epididymal cyst
Testicular swelling

Question 27

How do you examine a patient for an inguinal hernia?

Answer 27

Examine the patient upright
Find the pubic tubercle - above and medial = inguinal.
below and lateral = femoral
Ask the patient to cough

Question 28

how do you differentiate clinically between indirect and direct inguinal hernias?

Answer 28

Pressure over the deep inguinal ring get patient to cough

Place the little finger in the canal

Question 29

How do you differentiate at operation between direct and indirect inguinal hernias?

Answer 29

Medial to inferior epigastric vessels = direct

Lateral to inferior epigastric vessels = indirect

Question 30

Describe an indirect inguinal hernia

Answer 30

Lateral to the inferior epigastric vessels and with the cord
May reach to the scrotum
Congenital hernias are indirect
10 times more likely in males

Question 31

Describe a direct inguinal hernia

Answer 31

Posterior bulge through transversalis fascia
Medial to the inferior epigastric (branch of external iliac)
Often bilateral

Question 32

What type of hernia is often bilateral?

Answer 32

Direct inguinal hernia

Question 33

Who is most likely to develop an indirect inguinal hernia?

Answer 33

Young men

Question 34

who is most likely to develop a direct inguinal hernia

Answer 34

Older men

Question 35

Describe digital pressure in both types of ingiunal hernias

Answer 35

Indirect - controlled by digital pressure over the internal ring
Direct - poorly controlled by digital pressure

Question 36

When should we operate on inguinal hernias?

Answer 36

If there are risks of complications even with no symptoms (femoral)
previous symptoms of obstruction
If it interferes with lifestyle

Question 37

Name some of the complications with inguinal hernias

Answer 37

Haematoma
Acute urinary retention
Wound infection
Testicular pain and atrophy

Question 38

What 3 types of operations can be performed on inguinal hernias?

Answer 38

Suture (eg. Bassini) 
Open mesh (Lichtenstein)
Laparoscopic  (intra or extra)

Question 39

When can a post op hernia patient drive again?

Answer 39

1 week after

Question 40

When can a post op hernia patient heavy lift again?

Answer 40

1 month (1 hand only)

Question 41

What surgical procedures can be carried out to repair a hernia

Answer 41

Hernioctomy (excision of peritoneal sac)
Herniorraphy (repair of the defect of the wall)
Congenital - Herniotomy

Question 42

How do you consent a patient for an inguinal hernia operation

Answer 42

Warn them of wound infection
Placing a mesh
Recurrence rate of <5%
15% chance of neurogenic pain post op