Hernias

Question 1

define hernia

Answer 1

abnormal protrusion of a viscus through the walls of the containing cavity

Question 2

define fistula

Answer 2

abnormal communication between two epithelial surfaces

Question 3

define sinus

Answer 3

blind-ended tract between an epithelial surface and a cavity lined with granulation tissue

Question 4

define stoma

Answer 4

artificial opening of an internal tube that has been brought to the surface

Question 5

what is the most common type of hernia?

Answer 5

indirect inguinal hernia

Question 6

what is the most common type of hernia in women?

Answer 6

indirect inguinal hernia

NOT femoral

Question 7

what could be the cause of an irreducible hernia?

Answer 7

incarceration
obstruction
strangulation

Question 8

what are the contents of the inguinal canal?

Answer 8

ilio-inguinal nerve

spermatic cord in men
round ligament of the uterus in women

Question 9

what are the contents of the spermatic cord?

Answer 9

3 layers of fascia: external spermatic, internal spermatic, cremasteric

3 arteries: gonadal, cremasteric, artery to vas deferens

3 nerves: ilioinguinal nerve, sympathetic branches, genital branch of the genitofemoral nervee

3 other things: pampiniform plexus, vas deferens, lymphatics

Question 10

what are the boundaries of hesselbachs triangle?

Answer 10

medially: rectus sheath
inferiorly: inguinal ligament
superiorly: inferior epigastric artery

Question 11

what is the clinical significance of hesselbach’s triangle?

Answer 11

inguinal hernia arising within the traiangle is direct

lateral to the triangle = indirect

Question 12

what are the boundaries of the inguinal canal?

Answer 12

anterior: aponeurosis of external oblique, internal oblique for lateral 1/3
roof: internal oblique and transversus abdominis fibres
posterior: transversalis fascia laterally, conjoint tendon medially
floor: inguinal ligament

Question 13

what are the boundaries of the femoral canal?

Answer 13

anterior: inguinal ligament
posterior: pectineus and pectineal ligament
medial: lacunar ligament
lateral: femoral vein

Question 14

what are the complications of a surgical hernia repair?

Answer 14

general: bleeding, infection, VTE, anaesthetic complications
specific: recurrence of hernia, ischaemic orchitis

Question 15

what is the difference between the mid inguinal point and the midpoint of the inguinal ligament?

Answer 15

mid-inguinal point = between ASIS and pubic symphisis. surface marking of femoral artery

midpoint of inguinal ligament = between ASIS and pubic tubercle. surface marking for deep inguinal ring

Question 16

what features of a lump should you try to elicit during examination?

Answer 16

site
size
tenderness
warmth
consistency
cough impulse
is it reducible

Question 17

where is the sapheno-femoral junction?

Answer 17

2-3cm inferolateral to the pubic tubercle, or just medial to the femoral artery

Question 18

where in relation to the pubic tubercle will an inguinal hernia arise?

Answer 18

superior and medial

Question 19

where in relation to the pubic tubercle will a femoral hernia arise?

Answer 19

inferior and lateral

Question 20

why should you examine the whole abdomen if a patient has a hernia?

Answer 20

check for:
abdominal masses e.g. tumour
ascites
bowel obstruction

which would increase intra-abdo pressure and increase risk of hernia

Question 21

how could you distinguish between an indirect and direct inguinal hernia on examination?

Answer 21

reduce the hernia
apply pressure over the deep inguinal ring
ask pt to cough
if hernia reappears = direct
if hernia only reappears once pressure over deep ring is removed = indirect

Question 22

what is the anatomical difference between indirect and direct inguinal hernias?

Answer 22

direct - protrudes through a weakness in the transversalis fascia. arises medial to the inferior epigastric artery.
indirect - goes through the inguinal canal and protrudes through the deep inguinal ring. arises lateral to the inferior epigastric artery

Question 23

what are the differentials for a groin lump?

Answer 23

hernia
lymphadenopathy
psoas abcess
femoral nerve neuroma
saphena varix
femoral artery aneurysm/pseudoaneurysm
lipoma
sebaceous cyst
hydrocele
ectopic testes

Question 24

what could cause a hernia?

Answer 24

bowel obstruction
bowel strangulation
increased intra abdominal pressure
surgery

Question 25

what would you ask for in the history of a patient with a hernia to identify a cause?

Answer 25

abdo pain
staining when passing stools
chronic cough
heavy lifting - ask about work
previous operations

to rule out other causes - fever, weight loss, rectal bleeding, hx cancer