Surgery

Question 1

Definition of a hernia

Answer 1

Abnormal protrusion of a tissue or organ through the wall that normally contains it

Question 2

Types of hernia

Answer 2

Incisional 
Hiatus
Diaphragmatic
Umbilical
Femoral
Inguinal - direct and indirect

Question 3

What distinguishes a direct and indirect inguinal hernia?

Answer 3

Direct - medial to inferior epigastric vessels, bulges through abdo wall, doesn’t go down to scrotum

Indirect - lateral to inferior epigastric vessels, follows spermatic cord pathway, can enter scrotum in males or labia in females, can be due to failure of processus vaginalis to regress

Question 4

Signs/symptoms of inguinal hernia?

Answer 4

Visible lump, heavy discomfort around gut, pain/ache on exertion, constipation, lump enlarges on coughing

Question 5

Risk factors of inguinal hernia

Answer 5

History of hernia, older age, male sex, caucasian, chronic cough, chronic constipation, weak abdominal wall, smoking

Question 6

Where can you locate the femoral artery?

Answer 6

Mid-inguinal point - ASIS to pubic symphysis (more medial)

(Mid point of the inguinal ligament is ASIS to pubic tubercle and signifies deep ring location

Question 7

Where are femoral hernias found?

Answer 7

Inferior to inguinal ligament (inguinal are above) and lateral to pubic tubercle
High rate of complications

Question 8

Risk factors of femoral hernias

Answer 8

Male, older age, smoking, premature, chronic cough, connective tissue disorders, weaker RFs - pregnancy, heavy lifting, ascites, constipation

Question 9

What are hernia complications?

Answer 9

Irreducible/incarcerated
Obstructed
Strangulated

Question 10

Differentials for hernias/groin masses

Answer 10

Lymphadenopathy
Psoas Abscess
Femoral Aneurysm
Saphena Varix
Lipoma
Hydrocoele
Undescended testis