Hernias

Question 1

What is a hernia?

Answer 1

An abnormal protrusion of a viscus outwit its normal body cavity

Question 2

What is the most common hernia type?

Answer 2

Inguinal

Question 3

In which group are femoral hernias most common?

Answer 3

Women

Men almost never get femoral hernias

Question 4

What are natural hernias?

Answer 4

These go through what are effectively natural holes:

Inguinal, femoral, umbilicus, oesophageal hiatus, obturator

Question 5

What hernias can arise from a “weak area”?

Answer 5

Mostly iatrogenic causes

Incisional, parastomal, epigastric, paraumbilical

Question 6

What are the predisposing factors for abdominal hernias?

Answer 6

Type II collagen disorder +

Heavy lifting, coughing, constipation prostatism, pregnancy or obesity

Question 7

What is a reducible hernia?

Answer 7

A hernia which can be pushed back in

Should not need surgical intervention

Question 8

What is an irreducible hernia, and how might this be further classified?

Answer 8

A hernia which cannot be pushed back in

Obstructed (strangulated) or incarcerated

Question 9

What will occur in strangulation due to a hernia?

Answer 9

Compromise of blood supply
Low pressure venous system is occluded first, then arterial supply
Gangrene develops
Will be friable to touch and easily bleed

Question 10

What is the cause of an incisional hernia?

Answer 10

Forms in a previous scar, usually from surgery

Question 11

Which group of patients will get paraumbilical hernias?

Answer 11

Adults, commonly obese

Question 12

What causes an epigastric hernia?

Answer 12

Congenital weakness the line alba

Question 13

In which group are epigastric hernias most likely to present?

Answer 13

Males

Usually late teens or early adulthood

Question 14

In which group do umbilical hernias present?

Answer 14

Children

Usually within the first year of life

Question 15

At what age would you consider operating on an umbilical hernia?

Answer 15

3 years

Most will have resolved by this stage

Question 16

Why are paediatric inguinal hernias particularly worrying?

Answer 16

The inguinal canal in children is much smaller, and so there is a much higher chance of obstruction and strangulation

Question 17

In which group are paediatric inguinal hernias most likely to present?

Answer 17

Male
Less than 1 year old
More common in pre-term and LBW infants

Question 18

Where are femoral hernias found?

Answer 18

Below and lateral to the pubic tubercle

Usually flatten the groin crease

Question 19

Where are inguinal hernias found?

Answer 19

Above the pubic tubercle

Usually increase the groin crease

Question 20

What are the causes of scrotal swelling?

Answer 20

Inguino-scrotal hernia
Hydrocele
Epididymal cyst
Testicular swelling

Question 21

Where would a direct inguinal hernia be found at operation?

Answer 21

Medial to the inferior epigastric vessels

Question 22

Where would an indirect inguinal hernia be found at operation?

Answer 22

Lateral to the inferior epigastric vessels

Question 23

In which group are indirect inguinal hernias more likely to present?

Answer 23

Young men

Question 24

In which group are direct inguinal hernias more likely to present?

Answer 24

Older men

Question 25

With which type of inguinal hernia is there more likely to be complications?

Answer 25

Indirect

Question 26

When would you operate on an inguinal hernia?

Answer 26

Hernia at risk of complications, even if asymptomatic
Hernia with previous symptoms of obstruction
Hernia interfering with lifestyle

Question 27

What are the complications of an inguinal hernia?

Answer 27

Haematoma
Acute urinary retention 
Wound infection 
Chronic neurogenic pain 
Hernia recurrence 
Testicular pain and atrophy

Question 28

What types of operations can be carried out on inguinal hernias?

Answer 28

Suture
Open mesh
Laparoscopic (Intraperitoneal or extraperitoneal)

Question 29

What is a herniotomy, and with which type off hernia would you always chose this type of surgical repair?

Answer 29

Excision of peritoneal sac

Congenital hernias

Question 30

What s a herniorraphy?

Answer 30

Repair of the defect of the wall

Question 31

What is the importance of the processus vaginalis in the development of paediatric inguinal hernias?

Answer 31

The processus vaginalis is an outputting from the peritoneum into which the testes descend
If the processes vaginalis fails to fuse, there is an opening for fluid and hernias to enter

Question 32

What are the possible outcomes from a patient processus vaginalis?

Answer 32

Scrotal hernia 
Inguinal hernia 
Hydrocele of the cord
Hydrocele of the tunica vaginalis 
Communicating hydrocele