Hernias

Question 1

What are hernias?

Answer 1

They are abdnormal protrusions of a cavity’s contents through a weakness in the wall of the cavity.

Question 2

What are the classes of hernia?

Answer 2

Reducible - The hernia can be pushed back into the abdomen.
Incarcerated/Irreducible hernias - When a hernia cannot be manipulated back to the abdomen.
Strangulated hernia - Vascular supply to the contents contained within the hernia is compromised, leading to ischaemic and gangrenous tissue.

Question 3

Describe an epigastric hernia?

Answer 3

It is defined as a fascial defect in the linea alba between the xiphoid process and the umbilicus.
Main presentation is a midline lump which is usually asymptomatic. Management is conservative or surgical.

Question 4

Describe a paraumbilical hernia?

Answer 4

They occur due stretching of the wall (obesity, ascites, multiple pregnancy, all causing increased intraabdominal pressure).
Frequently comes with pain. They have a high incidence of strangulation so management is almost always surgical.

Question 5

Describe the inguinal canal?

Answer 5

It is 4cm long, starts at deep inguinal ring and ends at the superficial inguinal ring.
It transmits the spermatic cord and ilioinguinal nerve in the male and the round ligament of the uterus and ilioinguinal nerve in the female.

Question 6

Describe what happens in a direct inguinal hernia?

Answer 6

The bowel pushes through a weak area in the floor of the inguinal canal called the hesselbach triangle.

Question 7

Describe what happens in an indirect inguinal hernia?

Answer 7

Bowel enters the inguinal canal via the deep inguinal ring and pushes out through the superficial inguinal ring.

Question 8

How is an inguinal hernia diagnosed?

Answer 8

Usually groin swelling is noticeable which disappears when lying down.