Inguinal Hernias

Question 1

types?

Answer 1

• direct
  
  • hernia protrudes through posterior wall of inguinal canal
• indirect
  
  • hernia protrudes through deep inguinal ring & into inguinal canal (most common)

Question 2

which type is most at risk of strangulation?

Answer 2

indirect

Question 3

where exactly do direct hernias occur?

Answer 3

Hasselbach’s triangle, which is bounded by 3 structures:

• laterally: inferior epigastric vessels
• inferiorly: inguinal ligament
• superiorly: lateral border of rectus sheath

Question 4

epidemiology?

Answer 4

M>F

Question 5

signs?

Answer 5

• cough impulse
• reducible –> HR
• incarcerated–> pyrexia

Question 6

Ix?

Answer 6

clinical diagnosis although imaging can be used to aid diagnosis (USS, CT or MRI)

EXAMINE LYING DOWN & STANDING UP!

Question 7

Mx?

Answer 7

• asymptomatic - conservatively
• symptomatic - operative management
  
  • reducible–> routine referral
  • irreducible or female–> urgent referral
  • strangulated –> emergency admission

Question 8

DDx?

Answer 8

• femoral hernia
• lymphadenopathy
• groin abscess- IVDU
• femoral aneurysm
• undescended testes