Hernias

Question 1

inguinal hernia RF, ddx, WU

Answer 1

• h/o AAA, smoking, ascites, inc intraabd pressure
• hydro/varicocele, ectopic testis, lipoma, hematoma, sebaceous cyst, hidradenitis, psoas abscess, lymphoma, mets, epididymitis, testicular torsion, femoral hernia
• US if unsure

Question 2

direct inguinal hernia

Answer 2

• Hesselbach’s triangle (inguinal lig, inf epigastric, rectus abdominis)
• watch for signs of sepsis if incarcerated
• if sx, surg (high post-op recurrence

Question 3

indirect inguinal hernia

Answer 3

• MC (patent processus vaginalis, inguinal canal)
• bulge in scrotum
• higher risk of strangulation (surg, watch for post-op pain synd from ilioinguinal nerve damage)

Question 4

pantaloon hernia

Answer 4

combined direct/indirect inguinal hernia (both straddle inf epigastric vessels)

Question 5

femoral hernia

Answer 5

• femoral canal (just below inguinal lig): femoral vein (lateral), lacunar lig (medial), Cooper’s lig (inferior)
• more common in females presenting incarcerated/strangulated = surg

Question 6

umbilical hernia

Answer 6

• umbilical ring usually closes by 5 y.o.
• incisional (surg w/ mesh)
• epigastric (between umb & xiphoid, tx if sx)
• spigelian (lateral ventral: mid/low abd pain & swelling, get CT, surg b/c high risk of strangulation)

Question 7

Other hernias (4)

Answer 7

• internal (post-op)
• obturator (obturator canal)
• Littre (contains Meckel’s diverticulum: small bowel)
• Richter (lumen remains patent/ small amt of tissue protrudes)