Inguinal hernia

Question 1

What is an inguinal hernia?

Answer 1

Occurs when abdominal cavity contents enter into the inguinal canal

Question 2

What are the two types of inguinal hernia?

Answer 2

Direct and indirect

Question 3

What is a direct inguinal hernia?

Answer 3

Bowel enters the inguinal canal through a weakness in the hesselbachs triangle

Question 4

What is an indirect inguinal hernia?

Answer 4

Bowel enters the inguinal canal via the deep ring

Question 5

When do direct inguinal hernias usually occur?

Answer 5

secondary to abdominal wall laxity or an increase in intra-abdominal pressure

Question 6

When do indirect inguinal hernias usually occur?

Answer 6

incomplete closure of the processus vaginalis, an outpouching of peritoneum allowing for embryonic testicualr descent

Question 7

How are the direct and indirect hernia differentiated in surgery?

Answer 7

By identifying the inferior epigastric vessels as indirect will be lateral and direct will be medial to the vessels

Question 8

What are the risk factors for inguinal hernias?

Answer 8

Male, increasing age, raised intra-abdominal pressure, obesity

Question 9

What are the clinical features of a inguinal hernia?

Answer 9

lump in the groin which will disappear with minimal pressure or when the patient lies down

Question 10

What are the clinical features of an incarcerated hernia?

Answer 10

painful, tender, erythematous, bowel obstruction, strangulation (irreducible and tender lump, pain out of proportion to clinical signs)

Question 11

When examining a groin lump what should be checked?

Answer 11

Cough impulse, location (inguinal-superomedial to the pubic tubercle or femoral- inferolateral to the pubic tubercle) reducible, if it enters the scrotum, can you get above it

Question 12

How can you check if a hernia is indirect or direct while examining

Answer 12

Reduce the hernia and put pressure over the deep inguinal ring (mid point of the inguinal ligament) and ask the patient to cough, if the hernia protrudes then will be direct, if it does not then it is indirect- this is unreliable method

Question 13

What are the differential diagnosis for an inguinal hernia?

Answer 13

femoral hernia, saphena varis, inguinal lymphadenopathy, lipoma, groin abscess, internal iliac aneurysm, hydrocele, varicocele, testicular mass

Question 14

What investigations need to be done for a hernia?

Answer 14

Only need to be done to exclude other pathology- can do an ultrasound scan

Question 15

What is the management for an inguinal hernia?

Answer 15

surgical repair by laparoscopic or open mesh if have symptoms, if not conservative (risk of strangulation is 3% per year)

Question 16

What are the serious complications of a hernia?

Answer 16

Irreducible, incarcerated (cannot return to normal cavity) obstruction (bowel lumen obstructed) or strangulation (compromised blood supply and ischaemia)

Question 17

What are the post operative complications of a hernia repair?

Answer 17

pain, bruising, haematoma, infection, urinary retention, recurrence, chronic pain, damage to vas deferent and testicular vessels