Session 2 Hernias

Question 1

What is a hernia

Answer 1

A protrusion of part of the abdominal wall contents beyond the normal confines of the abdominal wall

Question 2

Parts of a hernia

Answer 2

Contents of sac, the sac, coverings of the sac

Question 3

General signs and symptoms of hernia

Answer 3

Increased intra abdominal pressure
Swelling
Discomfort
Nausea and vomiting
Necrotic bowel (peritonitis)

Lots of pain if incarcerated

Question 4

4 common hernias

Answer 4

Inguinal
Femoral
Umbilical
Incisional

Question 5

What is inguinal canal

Answer 5

Oblique passage through the lower part of the abdominal wall

Question 6

Inguinal canal men vs women

Answer 6

Men abdomen to scrotum

Women uterus to labium majus

Question 7

Inguinal canal embyology

Answer 7

Processus vaginalis proceeds descent of testes

Testes are initially retroperitoneal

Gubernaculum guides descent of testis

Question 8

Processus vaginalis key points

Answer 8

Can obliterate at different points

Question 9

Walls of Inguinal canal

Answer 9

Anterior wall- aponeurosis of external oblique
Posterior- transversalis fascia

Question 10

Floor and roof and medial Inguinal canal

Answer 10

Floor is Inguinal ligament
Roof is internal oblique and transverse abdominus
Medial is lacunar ligament

Question 11

Indirect hernia’s key points

Answer 11

Small bowel enters Inguinal canal via deep ring

Herniates to varying degrees relating to obliteration of Processus vaginalis

Lies lateral to inferior epigastric vessels

Question 12

Direct Inguinal hernias key points

Answer 12

Protrudes through weakness in Hesselbachs triangle

Lie medial to inferior epigastric vessels

Question 13

Hesselbachs triangle borders

Answer 13

Lateral abdominal rectus
Supero lateral inferior epigastric vessels
Inferior Inguinal ligament

Question 14

Anatomy of femoral triangle

Answer 14

NAVEL

Nerve artery vein empty space (femoral canal) lymphatics

Question 15

Borders of femoral triangle

Answer 15

Sartorial, Inguinal ligament, adductor longus

Question 16

Strangulated hernia process

Answer 16

Incarcerated, stuck, irreducible, blood supply compromised, ischaemic , tissue of constants of hernia becomes necrotic, breaks down, strangulated hernia

Question 17

What happens in umbilical hernia

Answer 17

Hernia goes through umbilical ring - defect in linea Alba, should close

Question 18

Umbilical hernia salient clinical points

Answer 18

Not usually painful, most close alone, unusual to have incarceration or strangulation, surgery very effective

Question 19

What are para umbilical hernias

Answer 19

Affect adults,
Hernia through defect in linea alba near umbilicus

Obesity and female = risk factor

Risk of strangulation

Question 20

What are incisional hernias

Answer 20

Herniate through previous incision, majority remain asymptomatic

Question 21

Risk factors for incisional hernias

Answer 21

Previous surgery, emergency surgery

Obesity

Mid line

Wound infection

Question 22

Features of red

Answer 22

Red is midline - through linea alba, extendable, lots of post op pain

Question 23

Features of green

Answer 23

Paramedian

Poor cosmetics, can damage nerves and structures e.g. falciform ligament

Question 24

Features of yellow blue and turquoise

Answer 24

Yellow- gridiron, appendectomy

Blue- kocher, open cholecystectomy (gall bladder removal)

Turquoise- pfannenstiel (obstetric and urology)