Part II. Clinical

Question 1

What is a hiatal hernia?

Answer 1

Protrusion of part of stomach into mediastinum via esophageal hiatus

Question 2

When and why do hiatal hernias occur most often?

Answer 2

After middle age presumably because diaphragm weakens and/or esophageal hiatus widens

Question 3

What is a sliding hiatal hernia?

Answer 3

When the esophagus, stomach cardia and parts of the stomach fundus slide through esophageal hiatus

Question 4

Sliding hiatal hernia is exacerbated by what?

Answer 4

Lying down or bending over

Question 5

Sliding hiatal hernia is often associated with what other symptom?

Answer 5

Food/acid reflux

Question 6

Which is more common, sliding hiatal hernia or paraesophageal hiatal hernia?

Answer 6

Sliding hiatal hernia

Question 7

What is a paraesophageal hiatal hernia?

Answer 7

When pouch of peritoneum (often containing part of fundus) extends through esophageal hiatus

Question 8

Is acid reflux an issue with paraesophageal hiatal hernia? Why?

Answer 8

No, because cardiac sphincter is not involved

Question 9

What testicular finding is sometimes associated with indirect inguinal hernia?

Answer 9

Hydrocele - Excess fluid present in a persistent processus vaginalis

Question 10

What is the examiner looking for when they palpate the spermatic cord and ask the patient to turn their head and cough?

Answer 10

Inguinal hernia which would press against examiner’s finger when patient coughs

Question 11

What are inguinal hernias?

Answer 11

Protrusion of parietal peritoneum and viscera through inguinal canal

Question 12

What percentage of abdominal hernias are inguinal?

Answer 12

75%

Question 13

Which type of hernia is usually reducible by appropriate manipulation?

Answer 13

Inguinal hernia

Question 14

What is the most common of all inguinal hernias?

Answer 14

Indirect inguinal hernia

Question 15

Are indirect inguinal hernias more common in men or women?

Answer 15

Men

Question 16

Where does the indirect inguinal hernia occur?

Answer 16

In Lateral Inguinal Fossa (lateral to Inferior Epigastric AV), enters Deep Inguinal Ring and traverses Inguinal Canal into spermatic cord

Question 17

Where does the direct inguinal hernia occur?

Answer 17

In Medial Inguinal Fossa (medial to Inferior Epigastric AV), traverses only medial (lower) part of Inguinal Canal and exits Superficial Inguinal Ring adjacent to spermatic cord

NOTE: Parallels spermatic cord but located outside of spermatic fascial coverings

Question 18

What does the hernial sac of an indirect inguinal hernia contain?

Answer 18

peritoneum plus all three fascial coverings of spermatic cord

Question 19

What does the hernial sac of a direct inguinal hernia contain?

Answer 19

peritoneum and transversalis fascia

Question 20

Are femoral hernias more common in men or women?

Answer 20

Women

Question 21

What are femoral hernias

Answer 21

Protrusions inferior to the inguinal ligament that pass through femoral ring and canal and extend into upper medial thigh