s2. hernias

Question 1

what is a hernia?

Answer 1

protrusion of part of the abdominal contents beyond the abdominal wall

Question 2

signs and symptoms - unstuck and incarcerates

Answer 2

unstuck hernia

• fullness or swelling
• gets larger when intra-abdominal pressure increases
• aches

incarcerated

• pain
• cannot be moved/ pushed back in
• nausea and vomiting
• systemic problems if bowel has become ischaemic

Question 3

causes

Answer 3

weakness in abdominal wall

• congenitally related
• post surgery wounds not healed (incisional hernia)
• normal points of weakness e.g. inguinal/femoral canal, umbilicus

an increase in intra-abdominal pressure

• obesity
• weightlifting
• chronic constipation/ coughing

Question 4

3 parts of a hernia

Answer 4

sac- pouch of peritoneum
contents of sac- commonly loops of bowel/omentum
coverings of sac- layers of abdominal wall

Question 5

hernias in inguinal canal more common with who and which side?

Answer 5

7x more common in males

RIGHT side

Question 6

what is processes vaginalis? clinical relevance to hernia?

Answer 6

pouch of peritoneum

if it doesn’t close/ obliterate as it should, its an area for inguinal hernia to develop

Question 7

what forms floor of inguinal canal

Answer 7

inguinal ligament and lacunar ligament (medially)

Question 8

what forms roof of inguinal canal

Answer 8

internal oblique / transverse abdominus

Question 9

what forms posterior wall of inguinal canal?

Answer 9

transversals fascia

Question 10

what tendon is found medially in inguinal canal?

Answer 10

conjoint tendon (of internal oblique and transverus abdomens)

Question 11

what forms anterior wall of inguinal canal?

Answer 11

aponeurosis of external oblique

Question 12

inguinal canal runs from

Answer 12

ASIS to pubic tubercle

Question 13

relation of direct and indirect inguinal hernias to the inferior epigastric vessels

Answer 13

indirect is lateral to epigastric vessels

direct is medial to epigastric vessels

epigastric vessels to towards midline

Question 14

borders of Hesselbachs triangle

Answer 14

Medial – lateral border of the rectus abdominis muscle.
Lateral – inferior epigastric vessels.
Inferior – inguinal ligament.

Question 15

route of indirect inguinal hernia

Answer 15

passes through deep inguinal ring, inguinal canal then superficial inguinal ring
> depending on where processes vaginalis obliterated can potentially descent into scrotum

Question 16

route of direct inguinal hernia

Answer 16

bulges through Hesselbachs triangle

in the vicinity of superficial inguinal ring
NOT inside inguinal canal!!

Question 17

femoral hernia more common in who and why?

Answer 17

females

pelvic anatomy> femoral ring slightly bigger

Question 18

what is omphalocele?

Answer 18

failure of midgut to return to the abdomen during development

• viscera covered in peritoneum outside the abdominal cavity therefore not exposed to amniotic fluid.
• often associated with other genetic problems
• high mortality rate

Question 19

what is gastroschisis?

Answer 19

defect in anterior abdominal wall

• abdominal viscera not covered in peritoneum> exposed to amniotic fluid
• linked to problems with feeding and gut development
• better survival than omphalocele
• defect closed at birth but sometimes may not fit in abdominal cavity so has a staged surgery process

Question 20

difference between omphalocele and gastroschisis?

Answer 20

O- viscera covered in peritoneum, not in gastroshisis.

higher mortality rate with O than G.

Question 21

what is umbilical hernia

Answer 21

hernia at site of umbilicus.
close by age 3 without intervention
not usually painful

Question 22

what is a para umbilical hernia

Answer 22

goes through lines alba in region of umbilicus

acquired adult

Question 23

what is a strangulated hernia?

Answer 23

one where blood supply is disrupted. can lead to tissue necrosis.