Hernias

Question 1

What is a hernia?

Answer 1

A weakness and discontinuity in a cavity wall, usually of the muscle or fascia

Question 2

What are the complications of hernias?

Answer 2

• Incarceration
• Obstruction
• Strangulation

Question 3

What is the inguinal canal?

Answer 3

Allows the spermatic cord to travel from inside the abdominal cavity to outside within the scrotum

Question 4

What is a direct inguinal hernia?

Answer 4

Failure of closure of the internal inguinal ring and degeneration of processus vaginalis
- Pathway from abdomen -> internal inguinal ring -> inguinal canal -> scrotum

Question 5

What forms Hesselbach’s triangle?

Answer 5

RIP

R - Rectum Abdominis
I - Inferior epigastric vessels
P - Poupart’s ligament/inguinal ligament

Question 6

What is an indirect inguinal hernia?

Answer 6

Weakness in the abdominal wall around Hesselbach’s triangle

- Hernia protrudes directly through abdominal wall

Question 7

How do you differentiate between direct and indirect inguinal hernia?

Answer 7

Direct inguinal hernia will remain reduced

Indirect inguinal hernia will not be reduced

Question 8

Where can inguinal hernias extend into?

Answer 8

Scrotum

Question 9

What is a femoral hernia?

Answer 9

Weakness around the opening of the femoral canal, below the inguinal ligament

Question 10

Why is a femoral hernia more at risk of incarceration, obstruction and strangulation?

Answer 10

Has a narrow base to the hernia

Question 11

What is the difference in positioning of inguinal and femoral hernias?

Answer 11

1. Inguinal hernias are located above and medial to pubic tubercle
2. Femoral hernias are located below and lateral to pubic tubercle

Question 12

What is an incisional hernia?

Answer 12

Occurs at the site of incision from a previous surgery

- Due to inadequate closure of the muscle and tissues after an incision

Question 13

What causes an umbilical hernia?

Answer 13

Defect in the muscle around the umbilicus

Question 14

Who are epigastric hernias common in?

Answer 14

Men aged 20-30yrs

Question 15

What is a spigelian hernia?

Answer 15

Herniation through the abdominal wall between the lateral border of rectus abdominis and linea semilunaris

Question 16

What is hiatus hernia?

Answer 16

Herniation of the stomach through the diaphragm

Question 17

What is a type 1/sliding hiatus hernia?

Answer 17

Stomach slides up along with the oesophagus through the diaphragm

Question 18

What is a type 2/rolling hiatus hernia?

Answer 18

A separate portion of the stomach (e.g. fundus) folds around and enters through the diaphragm opening with the oesophagus

Question 19

What is an obturator hernia?

Answer 19

Abdominal/pelvic contents herniate through the obturator foramen through a defect in the pelvic floor

Question 20

What are clinical features of an obturator hernia?

Answer 20

Howship-Rhomberg sign
- Pain extending from the inner thigh to the knee when the hip is internally rotated due to compression of the obturator nerve

Bowel obstruction

Question 21

What is diastasis recti?

Answer 21

Gap between the rectus abdominis muscle

- Linea alba is strecthed and broad

Question 22

What is a richter’s hernia?

Answer 22

Portion of the bowel herniates through the defect

- Can occur in any abdominal hernia

Question 23

What indicates that a hernia is at risk of strangulation?

Answer 23

• Episodes of hernia pain that was previously asymptomatic

- Irreducible hernia

Question 24

What indicates that a hernia is strangulated?

Answer 24

• Pain
• Fever
• Increase in size
• Erythema of overlying skin
• Peritonitic features (guarding and localised tenderness)
• Bowel obstruction (distention, nausea, vomiting)
• Bowel ischaemia (bloody stools)