Hernias

Question 1

what is a hernia?

Answer 1

an abnormal protrusion of a viscus outwith its normal body cavity

Question 2

what hernias arise from natural openings?

Answer 2

inguinal
femoral
umbilicus
oesophageal hiatus
obturator

Question 3

what hernias arise from weak areas?

Answer 3

incisional (caused by surgery)
parastomal
epigastric
paraumbilical

Question 4

what are the 6 predisposing factors to abdominal hernias?

Answer 4

heavy lifting
coughing
constipation
prostatism
pregnancy
obesity
(all cause raised intrabdominal pressure)

Question 5

what is prostatism a symptom of?

Answer 5

compression/obstruction of the urethra

Question 6

what is the main way that hernias are classified?

Answer 6

reducible or irreducible

Question 7

what is a reducible hernia?

Answer 7

a hernia that can easily be pushed back into place

Question 8

what is an irreducible hernia?

Answer 8

a hernia that won’t push back into place

Question 9

what is the 2 subgroups of irreducible hernias?

Answer 9

obstructed hernias

incarcerated hernias

Question 10

what is the difference between obstructed and incarcerated hernias?

Answer 10

obstructed hernia: neck is narrow enough to occlude bowel lumen
incarcerated: bowel isn’t affected

Question 11

if an obstructed hernia isn’t treated quickly enough what can happen?

Answer 11

strangulated hernia can form

Question 12

what is a strangulated hernia?

Answer 12

the neck has compromised the bowel blood supply

Question 13

in a strangulated hernia which supply is usually compromised first?
(arterial or venous)

Answer 13

venous usually compromised first because of it’s lower pressure
(venous congestion causes purple appearance)

Question 14

who gets paraumbilical hernias and who gets true umbilical hernias?

Answer 14

adults (and obese)- paraumbilical

children-umbilical

Question 15

what does an epigastric hernia usually arise from?

Answer 15

congenital weakness of the linea alba

Question 16

when do epigastric hernias usually present?

Answer 16

late teens/early adult

Question 17

what age do congenital umbilical hernias usually resolve by?

Answer 17

age 3

Question 18

if a congenital umbilical hernia hasn’t resolved by the age of 3 what should be done?

Answer 18

surgery

Question 19

what is the processus vaginalis?

Answer 19

a bit of peritoneum that that descends with the testes during fetal development

Question 20

what usually happens to the processus vaginalis?

Answer 20

communication between processus vaginalis and peritoneal cavity close and the processus vaginalis becomes the tunica vaginalis

Question 21

what is it called when communication between the processus vaginalis and peritoneal cavity doesn’t close? (and what can this lead to)

Answer 21

patent processus vaginalis

can lead to hernias

Question 22

what is the difference between a scrotal hernia and an inguinal hernia in infants?
(caused by patent processus vaginalis)

Answer 22

scrotum hernia- peritoneum comes all the way to the bottom of the scrotum
inguinal hernia- similar but peritoneum only goes half way to the bottom of the scrotum

Question 23

what is hydrocele of the spermatic cord in infants?

Answer 23

presence of a non-communicating pocket of peritoneal fluid that failed to be obliterated, in the testes close to the spermatic cord

Question 24

what is a communicating hydrocele in infants?

Answer 24

a pocket of fluid within the scrotum sac that can communicate with the peritoneal cavity

Question 25

what is hydrocele of the tunica vaginalis in infants?

Answer 25

presence of a non-communicating pocket of peritoneal fluid that failed to be obliterated, in the testes in the area of the tunica vaginalis

Question 26

what is the typical patient of a femoral hernia?

Answer 26

thin elderly female

Question 27

what can you see on inspection of a femoral hernia?

Answer 27

loss of groin crease

Question 28

what natural opening does peritoneum protrude into in a femoral hernia?

Answer 28

defect through femoral canal

Question 29

what are the anterior, medial, lateral and posterior boundaries of the femoral canal?

Answer 29

anterior- inguinal ligament medial- lacunar ligament lateral- femoral vein posterior- pectinate ligament

Question 30

what does the inguinal ligament run from?

Answer 30

anterior superior iliac spine | pubic tubercle

Question 31

where is the femoral hernia in relation to the pubic tubercle?

Answer 31

inferior and lateral to the pubic tubercle

Question 32

what do you usually see on inspection of an inguinal hernia?

Answer 32

increased groin crease

Question 33

where is an inguinal hernia in relation to the pubic tubercle?

Answer 33

superior and medial to the pubic tubercle

Question 34

what are the 4 major causes of scrotal swellings?

Answer 34

inguino-scrotal hernia hydrocele epidydymal cyst testicular swelling

Question 35

what is a direct inguinal hernia?

Answer 35

occurs medial to the inferior epigastric vessels, abdominal contents herniate through weak spot in fascia of the posterior wall of the inguinal canal

Question 36

what is an indirect inguinal hernia?

Answer 36

occurs laterally o the inferior epigastric vessels, abdominal contents protrude through deep inguinal ring

Question 37

what type of inguinal hernia goes into the scrotum?

Answer 37

indirect

Question 38

what type of hernias are congenital inguinal hernias?

Answer 38

indirect hernias

Question 39

where does the inguinal canal run from?

Answer 39

deep ring to superficial ring

Question 40

where is the deep inguinal ring?

Answer 40

mid-inguinal point

Question 41

where is the superficial ring?

Answer 41

superior and medial to pubic tubercle

Question 42

what make up the anterior, the floor, the roof and the posterior boundaries of the inguinal canal?

Answer 42

anterior- external oblique aponeurosis floor- inguinal and lacunar ligament roof- conjoint tendon posterior- transversalis fascia and conjoint tendon

Question 43

what are the boundaries of Hesselbach's triangle?

Answer 43

inferior- inguinal ligament lateral- inferior epigatric vessels medial- lateral border of rectus sheath

Question 44

how are indirect hernias controlled?

Answer 44

controlled by digital pressure over the internal ring

Question 45

when do you operate on a hernia?

Answer 45

1. if hernia is at risk of complications even if no symptoms 2. hernia with previous symptoms of obstruction 3. hernia interfering with lifestyle

Question 46

what surgical repair technique is use on congenital hernias?

Answer 46

herniotomy

Question 47

what is the surgical technique which repairs the defect of the wall?

Answer 47

herniorrhaphy