Hernias

Question 1

pathophysiology of a hernia

Answer 1

weakness + discontinuity in a cavity wall - usually muscle / fascia
- allows an organ e.g. bowel to pass through that cavity wall where it would normally be contained

Question 2

clinical features of a hernia

Answer 2

soft lump

• may be reducible
• may protrude on coughing (raising intra abdominal pressure) or standing (pulled out by gravity)
• can’t ‘get above’ the lump

Question 3

what are the 3 big complications of a hernia

Answer 3

incarceration
obstruction
strangulation

Question 4

what is incarceration

Answer 4

hernia cannot be reduced back

• bowel is trapped in herniated position
• can lead to obstruction + strangulation

Question 5

what is obstruction

Answer 5

hernia causes blockage in the passage of faeces through the bowel
- presents with signs of bowel obstruction e.g. vomiting, abdominal pain, absolute constipation

Question 6

what is strangulation

Answer 6

hernia is non-reducible and base is so tight that blood supply is cut off

• severe pain + tenderness at hernia site
• surgical emergency as bowel will die if not reversed

Question 7

what is Hesselbacks triangle ? what are the boundaries ?

Answer 7

hesselbacks triangle = inguinal canal:

• Rectus abdominis – medial border
• Inferior epigastric vessels – lateral border
• Inguinal ligament – inferior border

Question 8

difference in anatomy between a

• direct inguinal hernia
• indirect inguinal hernia

Answer 8

direct = protrudes through Hesselbacks triangle
- passes medial to inferior epigastric artery

indirect = protrudes through inguinal ring
- passes lateral to inferior epigastric artery

Question 9

what age group gets direct inguinal hernias

Answer 9

older adults

Question 10

what age group gets indirect inguinal hernias

Answer 10

children/young people

Question 11

what causes a direct inguinal hernia

Answer 11

defect/ weakness in transversalis fascia of Hesselbacks triangle

Question 12

what causes an indirect inguinal hernia

Answer 12

failure of processus vaginalis to close

Question 13

where is a femoral hernia located

Answer 13

protrudes below inguinal ligament, lateral to pubic tubercle

Question 14

surgical options for inguinal hernias

Answer 14

open inguinal hernia repair – often for first time hernias

laparoscopic – recurrent / bilateral hernias

Question 15

what is a hiatus hernia

Answer 15

herniation of stomach through diaphragm

Question 16

how many types of hiatus hernia are there

Answer 16

type 1 - ‘sliding’: stomach + oesophagus slide up through diaphragm
type 2 - ‘rolling’: separate part of stomach e.g. fundus folds around + enters diaphragm opening
type 3 - combination of rolling + sliding
type 4 - large hernia, stomach + other abdo organs pass through diaphragm

Question 17

what is a Richters hernia

Answer 17

only a portion of bowel wall herniates through defect

• progress very rapidly to ischaemia + necrosis
• can occur in any abdominal hernia