Hernias

Question 1

what are the 1st and 2nd most common cause of bowel obstruction?

Answer 1

1st: adhesions
2nd: abdominal hernias

Question 2

what clinical finding is enough means to diagnose a hernia?

Answer 2

pain/bulge with palpable mass

Question 3

contents return to the abdomen spontaneously or with light manual pressure

Answer 3

reducible

Question 4

contents are stuck and can’t be pushed back into abdomen

Answer 4

incarcerated (irreducible)

Question 5

a patient presents with a dull ache with intermittent protrusion

Answer 5

reducible hernia

Question 6

a patient presents with acute, crampy abdominal pain, localized tenderness, N/V, obstruction, +/- fever

Answer 6

incarcerated/irreducible hernia

Question 7

when contents become trapped and blood supply becomes compromised leading to ischemia and necrosis

Answer 7

strangulated

Question 8

incarcerated and strangulated hernia are considered what?

Answer 8

surgical emergencies

Question 9

what does elevated lactic acid indicate?

Answer 9

strangulation

Question 10

what is the treatment for an umbilical hernia in children < 2 yrs?

Answer 10

heal spontaneously

watchful waiting + education

Question 11

what is the treatment for umbilical hernia in an adult?

Answer 11

surgical repair

Question 12

any hernia of the abdominal wall

Answer 12

ventral hernia

Question 13

what is the most common site of all hernias?

Answer 13

groin region

Question 14

what are the 3 different groin hernias?

Answer 14

indirect inguinal hernia
direct inguinal hernia
femoral hernia

Question 15

what is the most common hernia in both males and females?

Answer 15

indirect inguinal hernia

Question 16

what type of hernia is more commonly incarcerated than inguinal hernias?

Answer 16

femoral hernias

Question 17

protrudes at the internal inguinal rings, which is the site where the spermatic cord in males and the round ligament in females exits the abdominal cavity

Answer 17

indirect inguinal hernia

Question 18

what kind of hernia is more often found in the scrotum?

Answer 18

indirect inguinal hernia

Question 19

most indirect inguinal hernias are considered _____

Answer 19

congenital

Question 20

what size hernias have a higher risk for strangulation?

Answer 20

narrow hernias

Question 21

herniated sac protrudes through the inguinal wall, and is less likely to end up in the scrotum

Answer 21

direct inguinal hernia

Question 22

direct inguinal hernias protrude medial to the inferior epigastric vessels within the _____ _____

Answer 22

hesselbach triangle

Question 23

hernia located inferior to the inguinal ligament

Answer 23

femoral inguinal hernia

Question 24

which type of hernia is more common in females? which side is more common?

Answer 24

femoral inguinal hernia
right side

Question 25

how will an acute herniation present? (2)

Answer 25

sharp pain
swelling

Question 26

what physical fining indicates a direct inguinal hernia?

Answer 26

visible/palpable mass superior to pubic tubercle

Question 27

what physical fining indicates an indirect inguinal hernia?

Answer 27

scrotal mass/enlargement

Question 28

how is an inguinal hernia exacerbated? (3)

Answer 28

cough
straining
valsalva maneuver

Question 29

a mass touching the tip of finger indicates what type of inguinal hernia?

Answer 29

indirect inguinal hernia

Question 30

a mass touching the side of finger indicates what type of inguinal hernia?

Answer 30

direct inguinal hernia

Question 31

what is the imaging of choice to help differentiate hernias and identify small hernias causing pain without clinical evidence?

Answer 31

CT w/ contrast

Question 32

which diagnostic rules out perforation and may show bowel in scrotum?

Answer 32

abdominal xrays

Question 33

which diagnostic helps differentiate scrotal masses?

Answer 33

ultrasound

Question 34

what is the management for an inguinal hernia? (4)

Answer 34

daytime truss
avoid straining
manual reduction in supine position
sx consult

Question 35

what are 2 treatment options for an inguinal hernia?

Answer 35

herniorrhaphy OR hernioplasty
return to normal activities within 3-6 weeks