Hernias

Question 1

What is an abnormal protrusion of a viscus outwith its normal body cavity?

Answer 1

Hernia

Question 2

Name 4 hernias, most common first?

Answer 2

1. Inguinal
2. Umbilical
3. Incisional
4. Femoral

Question 3

What may arise from natural openings or weak areas, caused by stretching or surgical inscision?

Answer 3

Abdominal wall hernias

Question 4

What type of hernias are inguinal, femoral, umbilicus, oesophageal hiatus and obturator?

Answer 4

Natural abdominal wall hernias

Question 5

What are incisional, parastomal, epigastric and paraumbilical herias a type of?

Answer 5

Weak area abdominal wall hernia

Question 6

What is the physiological predisposing factor of abdominal hernias?

Answer 6

Raised intra-abdominal pressure

Question 7

What can pregnancy and obesity lead to?

Answer 7

Abdominal hernias

Question 8

What predisposing factor of abdominal hernias can leads to bilateral inguinal hernia?

Answer 8

Prostatism

Question 9

Can constipation, coughing and heavy lifting cause abdominal hernias?

Answer 9

Yes

Question 10

What may hernias be classified as?

Answer 10

Reducible or irreducible

Question 11

If the hernia is irreducible, what may happen to its contents?

Answer 11

Incarcerated or strangulated

Question 12

What denotes compromise of the blood supply of the contents and its development increases morbidity and mortality?

Answer 12

Strangulation

Question 13

With strangulation hernias, what system is occluded first?

Answer 13

Low pressure venous system, then arterial supply

Question 14

When the arterial supply of a hernia becomes occluded, what can develop?

Answer 14

Gangrene

Question 15

In predisposed patients, to prevent an incisional hernia, what surgical measures are taken?

Answer 15

Tension sutures plus “mass closure” of the linea alba

Question 16

If you have a malignancy are you more likely to develop an incisional hernia?

Answer 16

Yes

Question 17

What two aetiological causes related to after an operation can be predisposing factors for incisional hernias?

Answer 17

Post-operative wound infection

Post-operative wound haematoma

Question 18

What does an ileus do that increases the chance of an incisional hernia?

Answer 18

Raises the intra-abdominal pressure

Question 19

What class of drug can be a predisposing factor for incisional hernias?

Answer 19

Steroids

Question 20

Is a vertical or transverse incision more likely to cause an incisional hernia?

Answer 20

Vertical

Question 21

What type of hernia is common in adult, obese patients?

Answer 21

Paraumbilical

Question 22

What to epigastric hernias arise from?

Answer 22

Congenital weakness of the linea alba

Question 23

What type of hernia usually contains extraperitoneal fat?

Answer 23

Epigastric

Question 24

What type of hernia has a male:female ration of 3:1 and occurs usually in late teens/early adult hood?

Answer 24

Epigastric hernia

Question 25

How do you repair an epigastric hernia?

Answer 25

With sutures or mesh

Question 26

What type of hernia is an umbilical hernia?

Answer 26

Congenital

Question 27

By what age has an umbilical hernia usually resolved, and what action is taken if it hasn't by then?

Answer 27

Age 3, if > 3 operate

Question 28

What male:female ratio does a paediatric inguinal hernia have?

Answer 28

9:1

Question 29

What type of hernias are more common in pre-term and low birth weight infants?

Answer 29

Paediatric inguinal hernias

Question 30

What side are paediatric inguinal hernias commonly found on and what is there a 20% chance of developing?

Answer 30

Right side, developing a contralateral hernia

Question 31

With paediatric inguinal hernias, what is there an increased risk of aged

Answer 31

Strangulation

Question 32

What type of hernia is common in a thin, elderly female?

Answer 32

Femoral hernia

Question 33

What sign is there, of a femoral hernia?

Answer 33

Loss of groin crease

Question 34

What is the anatomical defect of a femoral hernia?

Answer 34

Defect through the femoral canal

Question 35

What are the 4 boundaries of the femoral canal?

Answer 35

Anterior - inguinal ligament Medial - lacunar ligament Lateral - femoral vein Posterior - pectinate ligament

Question 36

What hernias are below and lateral to the pubic tubercle and usually flatten the groin crease?

Answer 36

Femoral hernias

Question 37

What hernia is present in a thin, elderly female with small bowel obstruction and no previous surgery?

Answer 37

Femoral hernia

Question 38

What type of hernia occurs above the pubic tubercle and increases the groin crease?

Answer 38

Inguinal hernia

Question 39

Name a type of inguinal hernia?

Answer 39

Inguino-scrotal

Question 40

With scrotal swellings, if you cannot get above the swelling what does it suggest?

Answer 40

Hernia

Question 41

What are 4 causes of scrotal swellings?

Answer 41

1. Inguino-scrotal hernia (indirect) 2. Hydrocoele 3. Epididymal cyst 4. Testicular swelling

Question 42

How should you examine a patient for an inguinal hernia?

Answer 42

Examine the patient upright

Question 43

If the hernia is to scrotum, what does it suggest?

Answer 43

Indirect

Question 44

If a hernia is above and medial to the pubic tubercle, what is it?

Answer 44

Inguinal

Question 45

If a hernia is below and lateral to the pubic tubercle, what does it suggest?

Answer 45

Femoral

Question 46

When examining inguinal hernias, what should you ask the patient to do?

Answer 46

Pressure over the deep inguinal ring and get patient to cough

Question 47

When trying to differentiate clinically between indirect and direct, where should you place a little finger?

Answer 47

In the canal (behind cord)

Question 48

When differentiating between direct and indirect hernias at operation, what does medial to inferior epigastric vessels suggest?

Answer 48

Direct

Question 49

When differentiating between direct or indirect hernias during operation, what does lateral to inferior epigastric vessels suggest?

Answer 49

Indirect

Question 50

What type of inguinal hernia is this: lateral to the inferior epigastric vessels and with the cord, may reach to the scrotum (inguino-scrotal), congenital hernias are indirect and MF ratio is 10:1?

Answer 50

Indirect inguinal hernia

Question 51

What hernia is this: psoterior bulge through transversalis fascia, medial to inferior epigastric (branch of ext iliac) and often bilateral?

Answer 51

Direct inguinal hernia

Question 52

Where is the deep inguinal ring located?

Answer 52

Mid-inguinal point

Question 53

Where is the superficial inguinal ring located?

Answer 53

Above and medial to pubic tubercle

Question 54

What are the four bondaries for the inguinal canal?

Answer 54

Anterior - external oblique aponeurosis Floor - inguinal and lacunar ligament Roof - conjoint tendon coming over Posterior - transversalis fascia and conjoint tendon (med)

Question 55

What is Hesselbach's triangle boundaries?

Answer 55

1. Inguinal ligament inferiorly 2. Inferior epigastric vessels laterally 3. Lateral border of rectus sheath medially

Question 56

Who are indirect inguinal hernias more common in?

Answer 56

Young men

Question 57

How are indirect inguinal hernias controlled?

Answer 57

By digital pressure over the internal ring

Question 58

What hernias are poorly controlled by digital pressure, more common in older men and have a 0.3% per annum strangulate?

Answer 58

Direct inguinal hernias

Question 59

What are the three factors for operating on an inguinal hernia?

Answer 59

1. Hernia at risk of complications even if no symptoms (e.g. femoral) 2. Hernia with previous symptoms of obstruction 3. Hernia interfering with life-style

Question 60

What complication of an inguinal hernia occurs in relation to the wound or scrotum?

Answer 60

Haematoma

Question 61

What complications of inguinal hernias are related to testicles?

Answer 61

Testicular pain and atrophy

Question 62

What are chronic neurogenic pain, hernia recurrence, wound infection and acute urinary retention complications of?

Answer 62

Inguinal hernias

Question 63

What are the three types of inguinal hernia operations?

Answer 63

1. Suture (bassini) 2. Open mesh (Lichtenstein) 3. Laparoscopic (intraperitoneal - TAPS, extraperiotneal - TEPS)

Question 64

What is herniotomy?

Answer 64

Excision of peritoneal sac

Question 65

What is herniorraphy?

Answer 65

Repair of the defect of the wall

Question 66

What surgical repair method is used for congenital hernias?

Answer 66

Herniotomy

Question 67

What is an embryonic development outpouching of the peritoneum?

Answer 67

Processus vaginalis

Question 68

What does inguinal hernia in children result from?

Answer 68

Patent processus vaginalis, failed to obliterate after the descent of the testis through it.

Question 69

Why do femoral hernias almost always require surgical management?

Answer 69

Due to risk of strangulation

Question 70

In obturator hernias, where does the abdominal contents protrude through?

Answer 70

The obturator foramen

Question 71

What patients are obturator hernias more common in?

Answer 71

Females getting older and losing weight

Question 72

What hernia is the Howship-Romberg sign typical of?

Answer 72

Obturator hernia (pain in medial thigh is provoked by thigh extension, medial rotation and abduction)

Question 73

What hernia is uncommon and occurs below the level of the umbilicus/arcuate line, as there is a lcak of posterior retus sheath here, between the rectus muscle medially and semilunar line laterally?

Answer 73

Spigelian

Question 74

What hernias are small, but there risk of strangulation is high, therefore are almost always surgically repaired unless contra-indicated?

Answer 74

Spigelian

Question 75

What is an inguinal hernia laying medial to the epigastric vessels?

Answer 75

Direct

Question 76

What is an inguinal hernia laying lateral to the epigastric vessels?

Answer 76

Indirect