Hernias

Question 1

Ing hernia px

Answer 1

Lump in groin
Aching or dragging, esp end of day
Pain and bulge when strain
Most comm abdo hernia

Question 2

hernia ix

Answer 2

US
CT
MRI
Herniography

Question 3

ing hernia mx

Answer 3

Repair if symps or irreducible or obstruc
Obs if eld or immobile and only mild symps
Open or laparoscopic surg

Question 4

Indirect ing

Answer 4

Us yng pt
Congenital
Lat to infer epigastric A
Often desc into scrotum
Strangulation more likely
Mx- herniotomy for kid, open mesh rep, laparoscopic rep

Question 5

Direct ing

Answer 5

Us adults
Acquired abdo wall weakness
Medial to infer epigastric A
Rarely desc into scrotum
Rarely strangulate
Mx- open mesh or laparoscopic
Direct hernias pass through hesselbachs triangle in transv fascia- bounds are ing lig, infer epig A, rectus musc.

Question 6

Ing canal contents

Answer 6

Spermatic cord or round lig in fem
Ilioing N
Spermatic cord contents-
Testic A, cremasteric A and A to vas def
Br of genitofem N, autonomic Ns to testes, ilioing N
Ext spermatic fascia, cremasteric fascia, int spermatic fascia

Question 7

Deep ing ring

Answer 7

Through transversalis fascia
1-2cm above ing lig
Midway btw pubic tubercle and ASIS- mid lig pt
Fem A is mid ing pt btw ASIS and PS

Question 8

superfic ing ring

Answer 8

V shaped defect in ext obl aponeurosis

Above and medial to pubic tubercle

Question 9

Femoral hernia px

Answer 9

High risk strangulation due to neck of sac having bony and lig strucs on three sides.
Below and lat to pubic tubercle, medial to fem pulse.
Can be asymp til incarceration or strangulation.
Can be mistaken for upper med thigh swelling.

Question 10

Femoral hernia diffs

Answer 10

Low ing hernia
Fem canal lipoma
Femoral LN
Saphena varix
Fem A
Psoas abcess

Question 11

Femoral hernia mx

Answer 11

All need repiar due to risk strang. Truss not an option.

Once reduced, fem canal should be narrowed tp prev recurr- low or high surgical appr.

Question 12

femoral canal

Answer 12

Medial to fem V, in fem sheath
Fem ring opening- bounds are ing, lacunar and pectineal ligs, and fem V.
Surg rep risks obt A br of infer epig A.

Question 13

Umb hernia classif

Answer 13

True- through umbillical cicatrix, us congenital, close bef age 3, more in afro caribb.
Paraumb- through periumb tiss, always acq, comm in obese and preg.

Question 14

Epig hernias

Answer 14

Defects in linea alba btw xihisternum and umb where it is penetrated by Ns and BVs.

Question 15

Umb hernia px

Answer 15

Can be painful
Occas strangulate
True- small, central, cont fat
Para- var size, distort umb, may cont bowel or omentum

Question 16

Epig hernia px

Answer 16

Can be large
Midline
Often only cont fat
Mod risk strang

Question 17

Umb and epig mx

Answer 17

Congenital umb only repair if persist til 2-3yr
Repair if symps and high risk complics
Us laparoscopic

Question 18

Incisional hernia RF

Answer 18

Wound infec
Steroid use
Anaemia
Malnutrit
Midline laparotomy approach
Peak 5yr post op