Session 4 - Abdominal Hernias

Question 1

What is a hernia?

Answer 1

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

Question 2

A hernia consists of what 3 parts?

Answer 2

1. The sac - a pouch of peritoneum
2. Contents of the sac - a structure found within the abdominal cavity, commonly loops of bowel or omentum
3. Covering of the sac - consists of the layers of the abdominal wall through which the hernia has passed

Question 3

Abdominal hernias protrude through weaknesses in the abdominal wall. Give examples of possible weaknesses.

Answer 3

Inguinal canal
Femoral canal
Umbilicus
Previous incisions (scar tissue itself very strong but tissue surrounding scar is not)

Question 4

What are the boundaries of the inguinal canal?

Answer 4

Anterior wall - aponeurosis of the external oblique (reinforced by internal oblique laterally)
Posterior wall - transversalis fascia
Roof - transversalis fascia, internal oblique and transversus abdominis
Floor - inguinal ligament (reinforced medially by the lacunae ligament)

Question 5

What is the inguinal ligament?

Answer 5

Runs from the anterior superior iliac spine to the pubic tubercle. Is formed from the external abdominal oblique aponeurosis and is continuous with the fascia lata of the thigh. Forms the floor of the inguinal canal.

Question 6

What is a reducible hernia?

Answer 6

One which can be pushed back into the abdomen by putting manual pressure on it.

Question 7

What is an irreducible/incarcerated hernia?

Answer 7

One which cannot be pushed back into the abdomen by applying manual pressure.

Question 8

Irreducible hernia can be further classified into what two categories?

Answer 8

Obstructed hernia

Strangulated hernia

Question 9

What is a obstructed hernia?

Answer 9

Irreducible hernia in which the lumen of the herniated part of intestine is obstructed.

Question 10

What is a strangulated hernia?

Answer 10

An irreducible hernia in which the blood supply of the hernia contents is cut off, this leading to ischaemia.

Question 11

What is a pantaloon hernia?

Answer 11

When a patient suffers a direct and indirect inguinal hernia on the same side simultaneously.

Question 12

What are the borders of Hesselbach’s triangle?

Answer 12

Superior - inferior epigastric artery
Medial - rectus abdominis muscle
Inferior - inguinal ligament

Question 13

Where are direct and indirect inguinal hernias found in relation to the epigastric vessels?

Answer 13

Direct inguinal hernia - medial to inferior epigastric vessels
Indirect inguinal hernia - lateral to the inferior epigastric vessels

Question 14

What are the inferior epigastric vessels?

Answer 14

Inferior epigastric artery

Inferior epigastric vein

Question 15

What is a direct inguinal hernia?

Answer 15

Hernia protruding through a weakness in transversalis fascia within Hesselbach’s triangle. May exit via the superficial inguinal ring. Not capable of extending into the scrotum.

Question 16

What is an indirect inguinal hernia?

Answer 16

Hernia passing though the deep inguinal ring, then the inguinal canal and the superficial inguinal ring. Can potentially descend into the scrotum.

Question 17

Indirect inguinal hernias are the result of what developmental defect?

Answer 17

Failure of the processus vaginalis to obliterate

Question 18

Are inguinal hernia more common in males or females?

Answer 18

Males

Question 19

Are femoral hernias more common in males or females?

Answer 19

Females

Question 20

Describe the route of a femoral hernia.

Answer 20

In through femoral ring, down the femoral canal, out through the saphenous opening.

Question 21

What are the two type of congenital umbilical hernia?

Answer 21

Omphalocele

Gastrochisis

Question 22

What is an acquired infantile umbilical hernia?

Answer 22

Hernia where abdominal contents protrudes through a weakness in scar of umbilicus.

Question 23

What is an acquired adult umbilical hernia?

Answer 23

Hernia which protrudes through an area in the region of the umbilicus called the linea alba.

Question 24

What is the difference between an omphalocele and gastrochisis?

Answer 24

Omphalocele - abdominal viscera contained within a parietal peritoneum and amniotic membranous sac.
Gastrochisis - abdominal viscera not covered by a membrane

Question 25

What is an epigastric hernia?

Answer 25

Hernia protruding through the linea alba, between the Xiphoid process and the umbilicus.

Question 26

What are some of the symptoms of herniation?

Answer 26

Varied, based on what happens when loop of bowel gets trapped.

Pain
Vomiting
Sepsis

Question 27

In relation to the inguinal ligament, how do inguinal hernias differ from femoral hernias?

Answer 27

Inguinal hernias go over the inguinal ligament, femoral hernias go under it.

Inguinal hernias will appear above the groin crease, femoral hernias will appear below it.