Hernias

Question 1

What is a hernia?

Answer 1

A protrusion of a viscus or part of a viscus through the wall designed to contain it

Question 2

What three layes is a hernia composed of?

Answer 2

1. A sac (of peritoneum)
2. Coverings of the sac
3. Contents

Question 3

What may be common contents for a hernia, especially in relation to the gastro-intestinal system?

Answer 3

• Small bowel
• Omentum

Question 4

Name some regions where adult hernias may originate from

Answer 4

• Inguinal
• Femoral
• Epigastric
• Paraumbilical
• Incisional

Question 5

Groin hernias can be which two main types of hernia?

Answer 5

1. Inguinal
2. Femoral

Question 6

Most grouin hernias are _________ hernias

Answer 6

Inguinal

Question 7

Why are inguinal hernias more common in males?

Answer 7

The testicles must pass through the inguinal canal during development meaning this canal is wider in females and therefore susceptible to herniation

Question 8

In which gender and age profile are femoral hernias most common?

Answer 8

Old women

Question 9

The inguinal canal has a posterior wall, anterior wall, roof and floor, what are each of these areas composed of?

Answer 9

• Posterior wall - Transversalis fascia
• Floor - inguinal and lacunar ligaments
• Anterior wall - aponeurosis of external oblique, internal oblique
• Roof - transversalis fascia, internal oblique, transversus abdominus

Question 10

The muscles of the abdominal wall are supplied by which artery?

Answer 10

Inferior epigastric artery

Question 11

Where can the location of the inguinal ring be located on the surface of the skin?

Answer 11

2cm up from the mid-point of the inguinal ligament

Question 12

What are the components of the spermatic cord?

Answer 12

• 3 arteries - testicular artery, artery to vas deferens (deferential artery), cremasteric artery
• 3 nerves - nerve to cremaster, testicular nerves (sympathetics), ilioinguinal nerve (technically outside cord)
• 3 other things - vas deferens (ductus deferens), pampiniform plexus, lymphatic vessels

Question 13

What are the risk factors for inguinal hernias?

Answer 13

• Male
• Obesity
• Age (increasing)
• Chronic cough
• A previous hernia

Question 14

What are the two types of inguinal hernia?

Answer 14

1. Direct
2. Indirect

Question 15

What is a direct inguinal hernia?

Answer 15

Occurs medially to inferior epigastric vessels

The abdominal contents herniate through a weak spot in fascia of the posterior wall of the inguinal canal

Question 16

Which gender and age group are likely to get a direct hernia?

Answer 16

Older men

Question 17

What is an indirect inguinal hernia?

Answer 17

They occur laterally to the inferior epigastric vessels

They will protrude through the deep inguinal ring and into the scrotum via the inguinal canal

Question 18

Which developmental process may have failed to result in the development of an inguinal hernia?

Answer 18

Failure of embryonic closure of the processus vaginalis

Question 19

Of the two inguinal hernias, which will take the same path as the spermatic cord?

Answer 19

Indirect

Question 20

In relation to a hernia, what does the term “incarceration” mean?

Answer 20

Something becoming stuck

An incarcerated hernia cannot be put back in place with manual force alone

Question 21

Which surgical procedure will often be used for emergencies involving inguinal hernias?

Answer 21

Open hernia surgery

Lichtenstein method

The content are put back in place and mesh is insterted to prevent re-protrusion

Question 22

Which surgical procedure is more likely to be used for elective hernia repair?

Answer 22

Laparoscopic surgery

There is less short and long term pain and the rate of infection is lower than open surgery

Question 23

Which nerve may be damaged during open hernia surgery and what may be the effect of this?

Answer 23

Ilioinguinal nerve

Chronic pain which may last for up to a few years

Question 24

What other complications can result from hernia surgery?

Answer 24

• Recurrence
• Urinary retention (in men)
• Bleeding/haematoma
• Chronic pain
• Numbness
• Testicular atrophy
• Wound infection

Question 25

Why would a hernia ever be the cause of bowel obstruction?

Answer 25

Some hernias can irreducible and may lead to strangulation of the bowel stopping blood supply This will cause bowel obstruction

Question 26

Which gender and age are most likely to get femoral hernias?

Answer 26

Elderly woman | (who may have had many children)

Question 27

Of the two hernias, inguinal and femoral, which is more likely to have acute presentation?

Answer 27

Femoral | (around 40%)

Question 28

The femoral canal has 4 borders, what are these?

Answer 28

1. Anterior - Inguinal ligament 2. Posterior - Pectineal line and ligament 3. Medial - Lacunar ligament 4. Lateral - Femoral vein

Question 29

What is mainly present within the femoral canal?

Answer 29

Fat and lymph nodes

Question 30

In relation to the anatomical borders of the femoral canal, what is it that gives rise to the development of femoral hernias?

Answer 30

There are three firm structures, each creating a border (anterior, posterior and medial borders) There is one weak structure - the femoral vein - which means that any pressure is most directed at this weaker area

Question 31

Why is it hard to push a femoral hernia back in?

Answer 31

The three firm structure composing the rest of the femoral canal provide resistance to this

Question 32

In simple terms, how can this issure be corrected in surgery?

Answer 32

The inguinal ligament is sutured to the pectineal ligament eliminating the weak structure and forming a femoral canal with only three borders

Question 33

How can the positioning of inguina and femoral hernias be differentiated based on their locations in relation to the pubic tubercle?

Answer 33

* Inguinal - above and lateral to the pubic tubercle * Femoral - below and lateral to the pubic tubercle

Question 34

What gives rise to an epigastric hernia?

Answer 34

Any defect in the linea alba between the xiphisternum and umbilicus

Question 35

A paraumbilical hernia is formed due to what?

Answer 35

The umbilicus being a point of weakness

Question 36

What are the risk factors for a paraumbilical hernia?

Answer 36

* Obesity * Ascities * Pregnancy

Question 37

Name a type of acquired hernia

Answer 37

Incisional hernia (other hernias may be acquired through trauma)

Question 38

What is a clinical sign of an inguinal hernia in an infant?

Answer 38

The silk sign Whent he hernia is palpated over the cord structures the sensation is similar to that of rubbing two layers of silk together

Question 39

Why do umbilical hernias resolve in infants (usually) by the age of 4, yet this does not happen in adults?

Answer 39

Children will grow allowing the hernia to resolve itself

Question 40

Why are inguinal hernias always repaired in infants?

Answer 40

They will worsen and there will be a high rate of incarceration

Question 41

Which surgical procedure is used to repair an inguinal hernia in infants?

Answer 41

Herniotomy There hernia sac is ligated without any repair of the inguinal canal This means no mesh is used

Question 42

Which rare hernia is a cause of small bowel obstruction in elderly females?

Answer 42

Obturator hernia Medial thigh pain may be experienced due to obturator nerve disruption