Hernias

Question 1

Define a hernia

Answer 1

A protrusion of an organ or part of an organ though a deficit in the walls of its containing cavity into an abnormal position

Question 2

Give some features which help define a lump as a hernia

Answer 2

Occur at weak spots
Reduce on lying down or with manipulation
Have an expansile cough impulse

Question 3

What can occur if a hernia is not treated?

Answer 3

Strangulation

Incarceration

Question 4

Describe strangulation

Answer 4

Bload vessels become constricted, preventing blood flow into the tissue. This leads to construction and necrosis.

Question 5

What symptoms occur with strangulation?

Answer 5

Red and painful lump which is tense an irreducible 
Associated with:
- vomiting
- abdo distention
- colicky abdominal pain
- constipation

Question 6

Define incarceration

Answer 6

Hernia cannot be reduced unless there is significant external effort.

Question 7

Describe the inguinal canal

Answer 7

4cm passage lying between the muscles of the anterior abdominal wall.
Runs parallel and superior to the inguinal ligament

Question 8

What is the inguinal ligament?

Answer 8

The inferior border of the aponeurosis of the external oblique muscle.

Question 9

Where does the inguinal ligament attach?

Answer 9

ASIS to pubic tubercle

Question 10

What are the contents of the inguinal canal in males?

Answer 10

Ilioinguinal nerve
Spermatic cord
Ext. spermatic fascia
Cremasteric fascia
Transversus abdominus and internal spermatic fascia

Question 11

What is found in the spermatic cord?

Answer 11

3 arteries: testicular, ductus deferens, cremasteric
3 nerves: genital branch of the genitofemoral nerve, cremasteric, autonomic
3 others: pampiniform plexus, lymphatics, ductus deferens

Question 12

What are the borders of the inguinal canal?

Answer 12

MALT
Roof = transverses abdomens and internal oblique fibres
Ant = aponeurosis of ext and int oblique
Floor = ilioinguinal ligament and lacunar ligament
Post = transcersalis fascia and medially conjoint tendon

Question 13

How can you distinguish between a direct and indirect inguinal hernia clinically?

Answer 13

Occlude the deep inguinal ring with two fingers and ask the pt to cough or stand.
Indirect = hernia cannot protrude
Direct = hernia can protrude

Question 14

Define a direct inguinal hernia

Answer 14

Hernia protrudes into the inguinal canal through a weakened patch in the transversalis fascia (Hasselbach’s Triangle).

Question 15

What are the borders of hasselbach triengle?

Answer 15

Inferior = medial half of inguinal ligament
Medially = lateral border of rectus abdomens
Laterally = medial border of inferior epigastric artery

Question 16

Describe an indirect inguinal hernia

Answer 16

Hernia protrudes through the deep inguinal ring within the diverging arm the transversalis fascial sling.

Question 17

What is the main reason that indirect inguinal hernias arise?

Answer 17

There is a failure of embryonic closure of the deep inguinal ring after the testicle has passed through it

Question 18

Where can you find the deep inguinal ring?

Answer 18

Mid point of the inguinal ligament which is 1.5cm above the femoral pulse

Question 19

What will be the difference in coverings between direct and indirect inguinal hernias?

Answer 19

Indirect will be covered by internal spermatic fasciaDirect will not.

Question 20

Describe a femoral hernia

Answer 20

Protrusion of abdominal viscera into the femoral canal, appearing as a mass in the femoral triangle.

Question 21

Give the borders of the femoral canal

Answer 21

Medial = lacunar ligament
Lateral = femoral vein
Anterior = inguinal ligament
Posterior = pubic ramus and pectineus

Question 22

Give the borders of the femoral triangle

Answer 22

Superior = inguinal ligament
Medial = lat border of adductor longus
Lateral = med border of sartorius
Roof = fascia lata
Floor = pectinous, iliopsoas, adductor longus

Question 23

What are the contents of the femoral triangle?

Answer 23

Femoral nerve
Femoral artery
Femoral vein
Femoral canal

Question 24

What is contained in the femoral sheath?

Answer 24

Artery, vein and canal

Question 25

What does the femoral canal contain?

Answer 25

Lymphatic vessels and lymph nodes

Question 26

Describe epigastric hernias

Answer 26

Hernias that occur in the epigastric region.

Question 27

What are the main risk factors for epigastric hernias?

Answer 27

Pregnancy

Obesity

Question 28

Describe umbilical hernias

Answer 28

Occur though the umbilical ring

Question 29

Why do umbilical hernias occur?

Answer 29

• Increased intra-abdominal pressure

- Weakness and incomplete closure of the anterior abdominal wall after ligation of the umbilical cord at birth

Question 30

What is the epigastric region?

Answer 30

The midline between the xiphoid process and the umbilicus, through the linea alba