4. Oblique (Indirect) inguinal hernia

Question 1

ETIOLOGY & TYPES of Oblique inguinal hernia

Answer 1

1 - Congenital hernia :

2- Infantile hernia (operative finding only)

3-Adult (acquired) oblique inguinal hernia

Question 2

Congenital hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

Answer 2

• Pathogenesis
• Clinical picture
• Age of presentation

Question 3

Pathogenesis of Congenital hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

Answer 3

persistent patency of the whole processus vaginalis.

Question 4

Clinical picture of Congenital hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

Answer 4

It reaches down the scrotum from the start.

The testis is inseparate from the hernial sac and its contents.

Question 5

Age of presentation of Congenital hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

Answer 5

Although congenital, it may appear in adult life

Question 6

Infantile hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

Answer 6

Pathogenesis

Its problem

Question 7

Pathogenesis of Infantile hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

Answer 7

Combined inguinal hernial sac + infantile hydrocele (2 sacs).

Question 8

problem of Infantile hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

Answer 8

At operation, the tunica is liable to be opened in mistake for the true sac.

Question 9

Adult (acquired) oblique inguinal hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

Answer 9

Pathogenesis

Types

Question 10

Pathogenesis of Adult (acquired) oblique inguinal hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

Answer 10

• Raised intra abdominal pressure

* Weak abdominal wall.

Question 11

Types of Adult (acquired) oblique inguinal hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

Answer 11

a) Bubonocele
b) Funicular
c) Complete (scrotal) hernia

Question 12

Pathogenesis of Bubonocele Type of Adult (acquired) oblique inguinal hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

Answer 12

The hernial sac is limited to the inguinal canal and is seen as a bulge or swelling in the inguinal region and does not come out through the external ring.

Question 13

Pathogenesis of Funicular Type of Adult (acquired) oblique inguinal hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

Answer 13

The hernia passes out through the external ring and starts to descend into the scrotum, reaching only its neck.

Question 14

Pathogenesis of Complete (scrotal) hernia Type of Adult (acquired) oblique inguinal hernia in ETIOLOGY & TYPES of Oblique inguinal hernia

Answer 14

• The hernia descends to the bottom of the scrotum, as a continuation of funicular type.
• The testis is separate from the hernial sac and its contents

Question 15

Difference between Adult Scrotal hernia and Congenital hernia by

Answer 15

History

Examination

Question 16

History of Adult Scrotal hernia

Answer 16

The hernia descends to the bottom of the scrotum, as a continuation of funicular type.

Question 17

History of Congenital hernia

Answer 17

It reaches down the scrotum from the start.

Question 18

Examination of Adult Scrotal hernia

Answer 18

The testis is separate from the hernial sac and its contents

Question 19

Examination of Congenital hernia

Answer 19

The testis is inseparate from the hernial sac and its contents.

Question 20

PATHOLOGY of Oblique inguinal hernia

Answer 20

1. The defect :
2. The sac :
3. The contents :
4. The coverings :

Question 21

Pathogenesis of The defect in PATHOLOGY of Oblique inguinal hernia

Answer 21

Stretched deep inguinal ring.

Question 22

Pathogenesis of The sac in PATHOLOGY of Oblique inguinal hernia

Answer 22

Congenital sac

acquired sac

Question 23

in Pathogenesis of The sac in PATHOLOGY of Oblique inguinal hernia, Congenital sac present within

Answer 23

The spermatic cord contents

Question 24

in Pathogenesis of The sac in PATHOLOGY of Oblique inguinal hernia, acquired sac present within

Answer 24

The spermatic cord coverings antero-lateral to the vas and vessels.

Question 25

The contents in PATHOLOGY of Oblique inguinal hernia

Answer 25

Small intestine, omentum or both.

Question 26

The coverings in PATHOLOGY of Oblique inguinal hernia

Answer 26

a) In the inguinal region | b) In the scrotum

Question 27

The coverings of a hernia In the inguinal region in PATHOLOGY of Oblique inguinal hernia

Answer 27

Skin superficial fascia external oblique aponeurosis cremasteric muscle and fascia internal spermatic fascia

Question 28

The coverings of a hernia In the scrotum in PATHOLOGY of Oblique inguinal hernia

Answer 28

Skin, Dartos muscle Colles' fascia The three cord coverings

Question 29

CLINICAL PICTURE of Oblique inguinal hernia

Answer 29

History Examination

Question 30

History in CLINICAL PICTURE of Oblique inguinal hernia

Answer 30

* Painless inguinal or inguinoscrotal swelling (unless complicated). * Before appearance of the hernia, the patient may complain of stitching pain (Pre eruptive pain)

Question 31

Pre eruptive pain in History in CLINICAL PICTURE of Oblique inguinal hernia

Answer 31

stitching pain before appearance of the hernia

Question 32

Examination in CLINICAL PICTURE of Oblique inguinal hernia

Answer 32

General examination Local examination

Question 33

General examination in CLINICAL PICTURE of Oblique inguinal hernia

Answer 33

* Other features of weak mesenchyme * Chest examination * P/R

Question 34

Other features of weak mesenchyme in General examination in CLINICAL PICTURE of Oblique inguinal hernia

Answer 34

varicose veins, varicocele, flat foot

Question 35

Chest examination in General examination in CLINICAL PICTURE of Oblique inguinal hernia

Answer 35

For COPD

Question 36

P/R in General examination in CLINICAL PICTURE of Oblique inguinal hernia

Answer 36

For Benign prostatic hyperplasia "BPH"

Question 37

Local examination in CLINICAL PICTURE of Oblique inguinal hernia

Answer 37

1. Site 2. Size 3. Shape 4. Surface 5. Special character 6. Special tests : 7. Edge: well defined. 8. Consistency: Soft or doughy. 9. Descent: Downwards, forwards and medially. 10. Reduction :

Question 38

site in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

Answer 38

Inguinal or inguino-scrotal (by scrotal neck test).

Question 39

Size in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

Answer 39

Variable and decrease on lying flat & increase on straining

Question 40

Shape in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

Answer 40

Usually oblong.

Question 41

Surface in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

Answer 41

Usually smooth

Question 42

Special character in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

Answer 42

* Reducible (unless complicated) | * gives expansile impulse on cough

Question 43

Special tests in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

Answer 43

Internal and external ring tests

Question 44

Edge in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

Answer 44

well defined.

Question 45

Consistency in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

Answer 45

Soft or doughy

Question 46

Descent in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

Answer 46

Downwards, forwards and medially

Question 47

Reduction in Local examination in CLINICAL PICTURE of Oblique inguinal hernia

Answer 47

upwards, Backwards and laterally

Question 48

Differential Diagnosis of Oblique inguinal hernia

Answer 48

Inguino-scrotal swellings especially direct and femoral hernia

Question 49

Investigations of Oblique inguinal hernia

Answer 49

1) Investigations to detect underlying cause of increased abdominal pressure: 2) Routine preoperative investigations

Question 50

Investigations to detect underlying cause of increased abdominal pressure in Investigations of Oblique inguinal hernia

Answer 50

a. Chest x-ray & pulmonary function test. b. Abdominal U.S. c. Trans-rectal U.S

Question 51

Abdominal U.S in Investigations to detect underlying cause of increased abdominal pressure in Investigations of Oblique inguinal hernia

Answer 51

may show * Ascites * splenomegaly

Question 52

Trans-rectal U.S in Investigations to detect underlying cause of increased abdominal pressure in Investigations of Oblique inguinal hernia

Answer 52

to detect B.P.H.

Question 53

Routine preoperative investigations in Investigations of Oblique inguinal hernia

Answer 53

a. Blood picture "CBC" b. Blood chemistry. c. P.T & P.T.T. d. ECG.