Hernias

Question 1

3 important complications of hernias

Answer 1

1. irreducibility
2. obstruction
3. strangulation

Question 2

List the most common sites for hernias

Answer 2

1. indirect inguinal (50%)
2. direct inguinal (25%)
3. incisional (8-10%)
4. femoral (5%)
5. umbilical (3-8%)

Question 3

Risk factors for hernia

Answer 3

• increased intra abdominal pressure
  
  • obesity, chronic cough, asthma, COPD, pregnancy, constipation, bladder outlet obstruction, ascites, heavy lifting
• congenital abnormality
• previous hernia repair
• loss of tissue strength + elasticity (hiatus hernia, ageing, repetitive stress)

Question 4

Classifications of hernias

Answer 4

1. Complete - hernia sac + contents protrude through defect
2. Incomplete - partial protrusion through defect
3. Internal hernia - sac herniating into or involving intra abdominal structure
4. External hernia - sac protrudes completely through abdominal wall
5. Strangulated hernia - vascular supply od protruded viscus is compromised - requires EMERGENCY repair
6. Incarcerated hernia - irreducible hernia, not necessarily strangulated
7. Richter’s hernia - only PART of the bowel cirfumference is incarcerated or strangulated, so may be less obstructed

Question 5

Contents of the spermatic cord

Answer 5

1. ductus deferens
2. artery of ductus deferens
3. cremasteric artery
4. testicular artery
5. cremasteric vein
6. pampiniform plexus
7. genital branch of genitofemoral nerve
8. sympathetic + visceral afferent nerves
9. lymphatics
10. tunica vaginalis

Question 6

Clinical features of hernia

Answer 6

• mass of variable size
• tenderness worse at end of the day
  
  • relieved with supine position or with reduction
• abdominal fullness
• vomiting
• constipation
• transmits palpable impulse with coughing/straining

Question 7

What are some signs of strangulation?