Ventral hernia

Question 1

What are the four abdominal quadrants?

Answer 1

Upper left, Upper right, Lower left, Lower right

Question 2

How is the abdomen divided into regions?

Answer 2

Divided into 9 regions by two pairs of planes: Vertical planes (midclavicular planes) and Horizontal planes (transpyloric plane, intertubercular plane)

Question 3

What does the right hypochondrium contain?

Answer 3

Liver

Question 4

What does the epigastric region contain?

Answer 4

Liver, stomach, pancreas

Question 5

What is contained in the right lumbar region?

Answer 5

Ascending colon

Question 6

What does the umbilical region contain?

Answer 6

Small intestine, transverse colon

Question 7

What does the right iliac region contain?

Answer 7

Ileocecal junction, appendix

Question 8

What is the hypogastric region known for containing?

Answer 8

Small intestine, urinary bladder (full), pregnant uterus

Question 9

What is the linea alba?

Answer 9

A fibrous band separating the rectus sheath from its counterpart on the opposite side, extending from the xiphoid process to the symphysis pubis

Question 10

Where does lymph drainage above the umbilicus go?

Answer 10

Upward to the anterior axillary (pectoral group of nodes)

Question 11

Where does lymph drainage below the umbilicus go?

Answer 11

Downward and laterally to the superficial inguinal nodes

Question 12

What are the nerve supplies to the anterior abdominal wall derived from?

Answer 12

Anterior rami of lower six thoracic and first lumbar nerves

Question 13

What is a reducible hernia?

Answer 13

Contents can be returned to body cavity of origin

Question 14

What characterizes an irreducible (incarcerated) hernia?

Answer 14

Contents of a hernial sac cannot be pushed back into the peritoneal cavity

Question 15

What is a strangulated hernia?

Answer 15

Blood vessels are compressed, leading to ischemia

Question 16

What are the types of external hernias based on location?

Answer 16

• Inguinal (Direct/Indirect/Dual or Pantaloon) * Ventral (many types) * Femoral * Obturator * Lumbar (Dorsal) * Perineal * Sciatic * Gluteal

Question 17

What are the types of internal hernias?

Answer 17

• Hiatal * Diaphragmatic * Peritoneal recesses and lesser sac * Postoperative

Question 18

What are the indications for hernia repair?

Answer 18

• Complicated hernias (emergency) * Small defect relative to the size of the hernia * Repeated or recent attacks of irreducibility * Females expected to become pregnant * Pain

Question 19

What are the contraindications for hernia repair?

Answer 19

• Recent myocardial infarction/angina * COPD * Cirrhosis, ascites * Congestive heart failure * End-stage malignancy

Question 20

What is an incisional hernia?

Answer 20

Occurs at sites of old surgical incisions anywhere on the abdomen

Question 21

What are risk factors for incisional hernias?

Answer 21

• Old age * Male sex * Obesity * Bowel surgery * Suture type * Chest infection * Abdominal distension * Wound infection

Question 22

What are common clinical features of incisional hernias?

Answer 22

• Pain and swelling in the vicinity of previous scar * Bulging more prominent on standing and coughing * Attacks of subacute intestinal obstruction

Question 23

What is the treatment for smaller defects in incisional hernias?

Answer 23

Open umbilical hernia repair

Question 24

What is the treatment for larger defects in incisional hernias?

Answer 24

Mesh repair (open or laparoscopic)

Question 25

What is the clinical assessment for hernias?

Answer 25

Should include looking for ascites, constipation, obstructive uropathy, benign prostatic issues, COPD, cough

Question 26

What are elective procedures?

Answer 26

Procedures that are not urgent and can be scheduled in advance

Question 27

What is conservative management in elderly patients not fit for surgery?

Answer 27

Management focusing on non-surgical options due to poor general condition

Question 28

What is the onlay technique for incisional hernia treatment?

Answer 28

Placement of mesh over the anterior fascia after primary closure of the fascial defect

Question 29

What is an advantage of the onlay technique?

Answer 29

No direct contact with viscera

Question 30

What is a disadvantage of the onlay technique?

Answer 30

Large subcutaneous dissection leading to more chances of seroma formation

Question 31

What is the inlay technique for incisional hernia treatment?

Answer 31

Interposition of prosthetic mesh between the fascial edges

Question 32

What is a significant drawback of the inlay technique?

Answer 32

Very high recurrence rates

Question 33

What does the sublay or underlay technique involve?

Answer 33

Placement of prosthetic mesh below the fascial components

Question 34

What is the retromuscular technique?

Answer 34

Placement of mesh under the rectus muscle above the posterior rect sheath

Question 35

What is the advantage of the retromuscular technique?

Answer 35

Intraabdominal forces hold the prosthesis against the muscles

Question 36

What is a Spigelian hernia?

Answer 36

Occurs along the semilunar line where muscular fibers transition to the posterior aponeurosis

Question 37

What are pelvic hernias?

Answer 37

Hernias located in the pelvic area, including obturator, sciatic, and perineal hernias

Question 38

What are lumbar hernias?

Answer 38

Hernias located in the lumbar region, including superior, inferior, and incisional types

Question 39

What is the male to female ratio for lumbar hernias?

Answer 39

2:1

Question 40

What are common causes of acquired lumbar hernias?

Answer 40

Back or flank trauma, poliomyelitis, back surgery, infected kidney, drainage of lumbar abscess, iliac crest usage for bone grafts

Question 41

What are indications for hernia repair?

Answer 41

Complicated hernias, small defect relative to the size of the hernia, repeated or recent attacks of irreducibility, females expecting to become pregnant, pain

Question 42

What are contraindications for hernia repair?

Answer 42

Recent myocardial infarction/angina, COPD, cirrhosis, ascites, congestive heart failure, end-stage malignancy

Question 43

What are common presenting signs of a ventral hernia?

Answer 43

Bulge in the abdominal wall, pain, discomfort

Question 44

What is the differential diagnosis in ventral hernia?

Answer 44

Includes other abdominal wall defects and conditions causing abdominal pain

Question 45

What should be included in the diagnostic work-up for ventral hernia?

Answer 45

Physical examination, imaging studies

Question 46

What are the medical and surgical options for ventral hernia treatment?

Answer 46

Observation, surgical repair techniques

Question 47

What are potential complications of ventral hernia repair?

Answer 47

Infection, recurrence, seroma formation, chronic pain