Hernias

Question 1

Cause

Answer 1

Raised intra abdominal pressure

Question 2

Femoral hernia - aetiology

Answer 2

Thin, elderly females

Question 3

Femoral hernia - anatomy

Answer 3

Below and lateral to the pubic tubercle

Question 4

Femoral hernia - management

Answer 4

Surgery

Question 5

Inguinal hernia - risk factors

Answer 5

Males, increasing age, chronic cough, obesity, AAA, previous hernia

Question 6

Inguinal hernia - anatomy of the inguinal canal

Answer 6

Designed to allow the passage of the spermatic cord

The floor is composed of the inguinal ligament

Question 7

Inguinal hernia - anatomy of the inguinal ligament

Answer 7

Goes from the ASIS -> pubic tubercle

Question 8

Inguinal hernia - deep inguinal ring

Answer 8

Opening of the inguinal canal

Question 9

Inguinal hernia - superficial inguinal ring

Answer 9

Exit of the inguinal canal

Question 10

Inguinal hernia - anatomy

Answer 10

Above and medial to the pubic tubercle

Question 11

Inguinal hernia - direct

Answer 11

Cover deep inguinal ring
Get patient to stand up and cough 
Hernia will pop back out straight away 
Commoner in older men
Medial to inferior epigastric vessels

Question 12

Inguinal hernia - indirect

Answer 12

Cover deep inguinal ring 
Get patient to stand up and cough 
Hernia will not bulge back through as pressure is applied
Commoner in younger men, congenital
Lateral to inferior epigastric vessels

Question 13

Hernia - post op requirements

Answer 13

No driving for 1 week

No heavy lifting for 1 month

Question 14

Paediatric inguinal hernia

Answer 14

More likely to be indirect
More common in males
Premature babies
Operate urgently

Question 15

Incisional hernia - cause

Answer 15

Occurs at a site of weakness (i.e. site of previous surgery)

Raised intra abdo pressure

Question 16

Epigastric hernia - cause

Answer 16

Congenital weakness of the line alba

males

Question 17

Paraumbilical hernia - cause

Answer 17

Defect around umbilicus

Increased intra abdominal pressure

Question 18

Umbilical hernia - cause

Answer 18

Occurs in children

Usually resolves spontaneously

Question 19

Emergency presentation of hernia

Answer 19

Strangulation
Irreducible
Obstruction

Question 20

Which hernia is IN the inguinal canal

• indirect inguinal hernia
• direct inguinal hernia

Answer 20

Indirect inguinal hernia

Question 21

if hernia is in the scrotum is must be direct/indirect?

Answer 21

Indirect

Question 22

Why do femoral hernias need to be treated more urgently than inguinal hernias?

Answer 22

The femoral canal has very tough borders and is strong so there is not much room for expansion. If there is a femoral hernia there is therefore a higher risk of obstruction or strangulation

Question 23

direct/indirect inguinal hernias strangulate more easily?

Answer 23

Indirect strangles more easily

Question 24

Classic description of someone with a femoral hernia

Answer 24

Elderly thin female who was previously overweight in earlier years. This means that femoral canal was stretched when younger and now bowel falls into the femoral canal easier

Question 25

If you can get above a groin lump, this means it is a hernia true or false?

Answer 25

False

- if you can get above a groin lump, it is coming from the scrotum

Question 26

Causes of IVDU swellings (2)

Answer 26

Abscess

Pseudoaneurysm