Hernias

Question 1

what is a hernia?

Answer 1

protrusion of a viscous or part of a viscus through the wall which is designed to contain it

Question 2

what are the 3 layers of a hernia?

Answer 2

sac (peritoneum)
coverings of the sac
contents

Question 3

who are femoral/inguinal hernias more common in?

Answer 3

femoral = women
inguinal = men

Question 4

femoral hernias are an emergency, true or false?

Answer 4

true

Question 5

what is the inguinal canal?

Answer 5

4cm long intermuscular slit to allow passage of spermatic cord

Question 6

what are the components of the spermatic cord?

Answer 6

3 arteries
- testicular artery
- artery to vas cremasteric artery
3 nerves
- ilioinguinal
- genital branch of genito femoral
- sympathetic
3 other things
- pampiniform venous plexus
- vas deferens
- lymphatics

Question 7

what are the risk factors for inguinal hernia?

Answer 7

male
age
chronic cough
.

Question 8

what vessel runs up from femoral artery, behind inuinal canal to supply the abdominal wall?

Answer 8

inferior epigastric

Question 9

what is the significance of the inferior epigastric vessels in terms of hernias?

Answer 9

lateral to vessels = indirect

medial to vessels = direct

Question 10

indirect hernia = does not reappear, true or false?

Answer 10

true

direct will reappear if cover deep ring and ask patient to cough

Question 11

how are inguinal hernias repaired?

Answer 11

often not fixed if small or asymptomatic

can be repaired with surgery (20-70%)

Question 12

what are the 2 types of hernia repair surgery?

Answer 12

open
- Lichtenstein method
- spinal or local anaesthetic
- high rate of chronic pain due to nerve damage
laparoscopic
- less pain, faster recovery
- requires general anaesthetic

Question 13

what complications can occur with inguinal hernia repair?

Answer 13

recurrence
urinary retention
bleeding
chronic pain
numbness
testicular atrophy/ischaemic orchitis
wound infection

Question 14

what emergency situations can arise from an inguinal hernia?

Answer 14

irreducible
strangulate
obstruction (bowel)

Question 15

what is done in an emergency inguinal hernia?

Answer 15

reduction under analgesia

operative repair after resuscitation

Question 16

how do femoral hernias present?

Answer 16

usually elderly females who’ve had several children (multi-parous)

Question 17

where is the femoral canal?

Answer 17

anterior border = inguinal ligament
posterior border = pectineal ligament
medial border = lacunar ligament
lateral = ileopectineal????

Question 18

how can a femoral hernia be repaired?

Answer 18

inguinal ligament sutured to pectineal ligament
- low approach = elective
- high approach = emergency
laparoscopic repair

Question 19

where do inguinal/femoral hernias originate?

Answer 19

inguinal = above and medial to pubic tubercle
femoral = below and lateral to pubic tubercle

Question 20

why are femoral hernias more of an emergency?

Answer 20

higher risk of incarciration

Question 21

what is an epigastric hernia?

Answer 21

defect in linea alba between xiphisternum and umbilicus

more common in males

Question 22

what in an umbilical hernia?

Answer 22

true umbilical = more common in children (resolve by 4)

paraumbilical = adults, obesity, pregnant, ascites

Question 23

how are paraumbilical hernias repaired?

Answer 23

reduced and mesh inserted

Question 24

what are the risks for incisional hernia?

Answer 24

obesity
age
surgical site infection
smoking
post chest infection
.
.

Question 25

how do paediatric inguinal hernia present?

Answer 25

more common in pre-term babies
99% are indirect
groin swelling on crying
"silk sign"
often not easy to find on examination

Question 26

how are paediatric inguinal hernias repaired?

Answer 26

always repaired

herniotomy

Question 27

what is an obturator hernia?

Answer 27

hernir through obturator foramen (in pelvis)
medial thigh pain
elderly women bowel obstruction