hernias

Question 1

typical features of abdominal wall hernia

Answer 1

• soft lump protruding
• lump may be reducible
• lump may protrude on coughing or standing
• aching, pulling or dragging sensation

Question 2

3 key complications of hernias

Answer 2

incarceration
obstruction
strangulation

Question 3

3 key complications of hernias - incarceration

Answer 3

hernia is irreducible and bowel is trapped in herniated position

incarceration can lead to obstruction and strangulation of the hernia

Question 4

3 key complications of hernias - obstruction

Answer 4

hernia causes blockage of faeces through bowel

Question 5

3 key complications of hernias - stranglulation

Answer 5

hernia is non-reducible and base of hernia becomes so tight it cuts of blood supply, causing ischaemia

surgical emergency - bowel will die as well as mechanical obstruction

Question 6

what feature of hernia to always comment on when assessing

Answer 6

size of neck/defect –>narrow or wide

wide at lower risk of complications

assessing this helps formulate risk assessment and Mx plan

Question 7

Richter’s hernia

Answer 7

only part of bowel wall and lumen herniate through defect ,
with other side of section of bowel remaining in peritoneal cavity

can become strangulated and progress quickly to ischameia and necrosis

should be operaed on immediately

Question 8

Maydl’s Hernia

Answer 8

two different loops of bowel are contained within the hernia

Question 9

General Mx options - conservative management

Answer 9

leaving hernia alone

most appropriate when hernia has a wide neck and in patients which are not good surgical candidates

Question 10

General Mx options - tension free repair

Answer 10

place mesh over defect and suture it to muscles and tissue on either side of defects

Question 11

General Mx options - tension repair

Answer 11

suture muscles and tissue on either side of defect back together

rarely done - been largely replaced by tension free repairs

Question 12

indirect inguinal hernia

Answer 12

bowel herniates through inguinal canal

Question 13

differential diagnoses for lump in inguinal region

Answer 13

inguinal hernia 
femoral hernia 
lymph node
saphena varix 
femoral aneurysm 
abscess
undescended testis

Question 14

how can indirect inguinal hernias be differentiated from direct inguinal hernia

Answer 14

when indirect hernia is reduced and pressure applied to deep inguinal ring the hernia will remain reduced

Question 15

direct inguinal hernia

Answer 15

due to weakness in abdo wall at Hesselbach’s triangle

hernia protrudes directly through abdo wall

pressure over deep inguinal ring will not stop herniation

Question 16

Hesselbach’s triangle boundaries

Answer 16

rectus abdominis muscle
inferior epigastric vessels
inguinal ligament

Question 17

femoral hernias

Answer 17

herniation of abdo contents through femoral canal

occurs below inguinal ligamant

Question 18

femoral hernias are at high risk of

Answer 18

incarceration
obsctruction
strangulation

due to narrow femoral ring

Question 19

incisional hernias

Answer 19

occur at site of incision from prev surgery

due to weakness where muscles and tissues were closed after surgical incision

Question 20

Spigelian Hernia

Answer 20

occurs between lateral border of rectus abdominis and linea semilunaris

USS for diagnosis

Question 21

Obturator hernias

Answer 21

where abdo or pelvic contents herniate through obturator foramen

due to defect in pelvic floor

Question 22

Obturator hernias presentation

Answer 22

irritation to obturator nerve: pain in groin or medial thigh

Question 23

Hiatus hernia

Answer 23

herniation of stomach up through diaphragm

Question 24

hiatus hernia type 1

Answer 24

sliding

Question 25

hiatus hernia type 2

Answer 25

rolling

Question 26

hiatus hernia type 3

Answer 26

combo of sliding and rolling

Question 27

hiatus hernia type 4

Answer 27

large with additional abdo organs entering thorax

Question 28

sliding hiatus hernia

Answer 28

stomach slides up through diaphragm with gastro-oesophageal junction passing up into thorax

Question 29

rolling hiatus hernia

Answer 29

separate portion of stomach e.g. fundus folds around and enters through diaphragm

Question 30

hiatus hernia presenation

Answer 30

dyspepsia 
heart burn 
reflux 
burping
bloating

Question 31

hiatus hernia Mx

Answer 31

conservatie with medical Mx of GORD

surgery - Nissen fundoplication