Surgical Abdo

Question 1

Define hernia

Answer 1

Protrusion of a viscus or part of a viscus into an abnormal position through a defect in its containing cavity

Question 2

What is Hesselbach’s triangle? What is it’s significance?

Answer 2

Med: rectus abdominus muscle
Inferior: inguinal ligament
Lateral: inferior epigastric artery

It is where direct hernias come through, i.e. medial to inguinal ligament

Question 3

What are the contents of the inguinal canal?

Answer 3

ilioinguinal nerve and spermatic cord (M) or round ligament (F)

Question 4

Where are the deep and superficial inguinal ring located?

Answer 4

The deep inguinal ring is located just above the mid-point of the inguinal ligament.

The superficial ring lies just above and medial to the pubic tubercle

Question 5

What causes an inguinal hernia?

Answer 5

Either:
Increased intra-abdominal pressure
Weakness of the abdominal muscles

Chronic cough
Constipation
Heavy lifting
Advanced age
Obesity

Question 6

Give 4 distinguishing features of an inguinal hernia

Answer 6

Above and medial pubic tubercle
Cough impulse
Reducible
Bowel sounds

Question 7

Indirect hernia ?

Answer 7

Comes through the inguinal canal , in younger patients usually because of a patent processus vaginalis or in elderly a weak posterior wall of the canal

Question 8

Direct inguinal hernia ?

Answer 8

Comes through Hesselbach’s triangle

Question 9

Complications of hernias?

Answer 9

Incarceration (becomes trapped in place)

Strangulation

Question 10

Management of hernias ?

Answer 10

Conservative or surgical

Conservative:
Manage risk factors; i.e cough, constipation, weight loss
Elasticated corset

Surgical:
Open repair - Lichtenstein Tension Free Mesh
Lap - TEP (totally extra peritoneal) or TAPP (transabdominal pre peritoneal) mesh

Question 11

When would you choose an open vs a lap approach to hernia repair?

Answer 11

Open better for primary unilateral repairs

Lap allows better bilateral repair and improved cosmetics. Preferred for recurrent hernias

Question 12

Complications of hernia repair?

Answer 12

Early:
Bleeding
Damage to neighboring structures, such as nerves 
Infection 
Urinary retention 

Late:
Recurrence
Ischaemic orchitis
Chronic groin pain

Question 13

Management of femoral hernias ?

Answer 13

Elective: Lockwood Low Approach

Emergency: McEvedy High Approach

Question 14

What is FAP

Answer 14

Familial adenomatous polyposis
APC gene on 5q21; autosomal dominant

1000s of adenomas by teenage years, 100% develop cancer

Tx with prophylactic colectomy

Question 15

What is Gardener’s syndrome?

Answer 15

Variant of FAP

Gardener's syndrome (TODE)
Thyroid tumours
Osteomas
Dental abnormalities
Epidermal cysts

Question 16

What are the familial colorectal cancer syndromes?

Answer 16

Familial Adenomatous Polyposis
Gardener’s syndrome
Hereditary non-polyposis colorectal cancer
Peutz-Jeghers syndrome