Hernias

Question 1

What is a hernia?

Answer 1

• Hernias occur as a result of weakening in the abdominal wall
• They present as protrusion, bulge or projection of an organ or part of an organ through the body wall that contains it

Question 2

What are the different types of hernias?

Answer 2

=> Inguinal
- More common in males, occur above and medial to the pubic tubercle

=> Femoral

• More common in females
• Occur below and lateral to the pubic tubercle

=> Incisional
=> Umbilical
=> Epigastric

=> Obturator hernia
- More common in females and typically presents as bowel obstruction

=> Spigelian hernia

=> Richter hernia

=> The term groin hernias can be used in reference to either inguinal hernias or femoral hernias

Question 3

What are Inguinal hernias?

Answer 3

Bulging of the small intestine through the abdominal wall

Question 4

What 3 muscles make up the abdominal wall?

Answer 4

=> Inside out:

• Transverse abdominus
• Internal oblique
• External oblique

Question 5

What are the risk factors of inguinal hernias?

Answer 5

• History of hernias
• Old age
• Gender (male)
• Chronic cough
• Chronic constipation
• Weak abdominal wall
• Smoking

Question 6

What are the 2 types of Inguinal Hernias?

Answer 6

• Direct

- Indirect

Question 7

What is the pathophysiology of Indirect Inguinal Hernias?

Answer 7

• Most common
• Protrusion of hernia through the deep and superficial ring
• Lateral to the inferior epigastric artery and spermatic cord

Question 8

What are the clinical features of Inguinal Hernias?

Answer 8

• Visible lump
• Heavy discomfort around gut (especially groin)
• Pain on exertion
• Constipation
• Lump enlarges when coughing

Question 9

What is the pathophysiology of Direct Inguinal Hernias?

Answer 9

• Medial to inferior epigastric artery and spermatic cord

- Only protrudes the superficial inguinal ring

Question 10

Where can direct inguinal hernias occur?

Answer 10

Only within the Hesselbach triangle

=> Boundaries of the Hesselbach Triangle:

• MEDIALLY = Rectus Abdominus
• LATERALLY = Inferior epigastric vessels
• INFERIORLY = Inguinal ligament

Question 11

What is the management of Inguinal Hernias?

Answer 11

• Hernias associated with a few symptoms are treated conservatively
• First time hernias are treated via open inguinal surgery repair
• Recurrent hernias are treated with a laproscopic approach
• Manual work should be stopped until 2-3 weeks following surgery

Question 12

What gender are Femoral Hernias more common in?

Answer 12

Female

=> High risk of strangulation

Question 13

What are the clinical features of Femoral Hernias?

Answer 13

• Lump in groin
• Abdominal pain
• Vomiting

Question 14

Where do Femoral Hernias occur?

Answer 14

=> Within the femoral triangle. Boundaries:

• Adductus Longus
• Sartorius
• Inguinal ligament

Question 15

What are Incisional Hernias?

Answer 15

Type of hernias caused by incompletely healed surgical wounds

Question 16

What are the risk factors of Incisional Hernias?

Answer 16

• Gender (female)
• Recent surgery
• Obesity
• Midline incision
• Age (elderly)