Inguinal Hernia

Question 1

Inguinal Hernia Presentation

Answer 1

• 80% of hernias
• Swelling that appears with lifting
• Indirect hernias cause dragging sensation
• Impulse on coughing
• May be reducible
• At first reducible, then hernia enlarges and forms adhesions, harder to reduce
• Can become strangulated
• Examine both standing and lying and ask to cough

Question 2

Inguinal Hernia Indirect vs Direct

Answer 2

Indirect

• Bowel goes through deep ring first, so is able to enter spermatic chord
• Goes through spermatic chord and into scrotum
• 80%

Direct

• Goes through medial to inferior epigastric artery, so does not exit through deep inguinal ring
• Therefore bowel does not go through spermatic chord; goes alongside it

Question 3

Inguinal Hernia Differentials

Answer 3

• Femoral hernia: usually on inside of thigh
• Hydrocele (can get above hydrocele on examination)
• Lymph node
• Abscess
• Saphena varix
• Varicocele

Question 4

Inguinal Hernia Ix

Answer 4

• Diagnosis usually clinical

- USS

Question 5

Inguinal Hernia Management

Answer 5

• If small; reassurance
• Safety net
• If large; surgery
• In incarcerated; surgery

Question 6

Inguinal Hernia Complications

Answer 6

• Recurrence
• Infarction
• Infection