Inguinal hernia and hydrocoele

Question 1

What fails to close in boys?

Answer 1

processus vaginalis

Question 2

what is the processus vaginalis?

Answer 2

diverticulum of peritoneum

Question 3

What fails to close in girls which leads to inguinal hernia?

Answer 3

fail to obliterate the canal of nuck

Question 4

what distinguishes between a hernia and hydrocoele?

Answer 4

degree of patency of the persistent processus vaginalis

Question 5

what is an inguinal hernia?

Answer 5

protrusion of intra-abdominal contents through a patent processus vaginalis

Question 6

what is a hydrocoele?

Answer 6

collection of fluid formed by the omentum in the space between the tunica vaginalis and testis

Question 7

incidence

Answer 7

2%

Question 8

incidence in prematurity

Answer 8

20%

Question 9

boy:girl ration

Answer 9

5:1

Question 10

which side is more common?

Answer 10

60% right sided
30% left sided
10% bilateral

Question 11

why is there a higher incidence on the right?

Answer 11

right testis descends later than the left so processus more likely to remain patent

Question 12

presentation of hernia

Answer 12

groin swelling extend toward scrotum or labia
first few weeks/months of life
evident on strain/crying

Question 13

if hernia is reduced what may examination reveal?

Answer 13

thickening of spermatic cord on affected side

Question 14

hydrocoele presentation

Answer 14

scrotal swelling after birth
fluctuate in size
non specific viral illness

Question 15

diagnosing inguinal hernia

Answer 15

history - intermittent groin swelling
easily reducible
thickened spermatic cord

Question 16

are hydrocoeles reducible?

Answer 16

no

Question 17

3 differences between hydrocoele and inguinal hernia

Answer 17

irreducible
transilluminate
do not extend into groin

Question 18

what can be done to distinguish hydrocoele and hernia?

Answer 18

inguinoscrotal USS

patency of PV

Question 19

why is surgical repair of inguinal hernia importnat?

Answer 19

risk of incarceration

Question 20

risk of incarceration and 6 and 2 rule

Answer 20

higher in younger infants
<6 weeks fix in 2 days
<6 months fix in 2 weeks
>6 months = fix 2 months

Question 21

when is hydrocoele surgery done?

Answer 21

after 2 years old

Question 22

why is hydrocoele surgery done?

Answer 22

fluid around testis may elevate temperature and affect fertility

Question 23

inguinal hernia - first incision

Answer 23

skin crease incision in groin

Question 24

inguinal hernia op - where is first incision dissected down to?

Answer 24

external oblique

Question 25

how is the inguinal canal entered - inguinal hernia surgery

Answer 25

open external oblique

split cremaster muscle overlying spermatic cord

Question 26

what is the hernia sac separated from?

Answer 26

vas and testicular vessels

Question 27

what is the hernia sac?

Answer 27

PPV

Question 28

what level is the hernia sac tied off?

Answer 28

internal inguinal ring

Question 29

major surgical complication

Answer 29

incarceration

Question 30

incarceration signs/symptoms

Answer 30

inguinal scrotal pain 
tenderness and erythema 
poor feeding 
bile stained vomit 
abdominal distention 
increased irritability

Question 31

what is important to do with a stuck inguinal hernia?

Answer 31

reduce as quick as possible

progressive damage to incarcerated bowel and compromised testis blood supply

Question 32

recurrence

Answer 32

4%

Question 33

what causes recurrence?

Answer 33

failure of adequate ligation of hernial sac at internal ring

neonates - chronic lung disease