Hernia

Question 1

why are inguinal hernias more common in men

Answer 1

due to how testes develop, pass through inguinal canal

Question 2

what is the usual presentation of a femoral hernia

Answer 2

elderly lady, presenting acutely

Question 3

what makes up the posterior wall, floor, anterior wall and roof of the inguinal cana;

Answer 3

posterior wall= transversalis fascia

floor= inguinal ligament, lacunar ligament

anterior wall= aponeurosis of the external oblique, internal oblique

roof= tranversalis fascia, internal oblique, transverse abdominus

Question 4

what does the inguinal canal contain

Answer 4

spermatic chord

Question 5

what does the spermatic chord contain

Answer 5

3 arteries: testicular/ gonadal, cremasteric atery, artery to the ductus deferens (vas deferens)

3 nerves- ilio-inguinal, genital branch of genito femoral, sympathetic

3 other things- pampiform venous plexus, vas deferns, lymphatics

Question 6

what are the risk factors for hernias

Answer 6

male, age, obesity, chronic cough, previous hernia, collagen disorder, AAA, previous appendicitis

Question 7

what type of hernia is most common in men

Answer 7

right sided indirect inguinal hernia

Question 8

where is an indirect hernia in relation to inferior epigastric vessels

Answer 8

lies lateral to it

Question 9

which hernia goes through the ingiunal and emerges form the inguinal ring

Answer 9

indirect

Question 10

where is a direct hernia in relation to the inferior epigastric vessels

Answer 10

medial to them

Question 11

what is the path of a direct hernia

Answer 11

bulges through abdominal wall

Question 12

how do you distinguish direct from indirect hernias

Answer 12

reduce hernia, cover deep inguinal ring, get patient to cough- if direct will bulge back out

Question 13

what is the litchenstein method

Answer 13

mesh sutured in place around spermatic chord- open surgery

Question 14

what are the complications of hernia repair

Answer 14

recurrence 
urinary retention 
bleeding/ haemotoma 
chronic pain 
numbness
testicular atrophy. ishaemic orchitis (testicals shrivel up)
wound infection

Question 15

what is an emergency presentation of a hernia

Answer 15

irreducible, strangulation, obstruction

Question 16

who gets femoral hernias

Answer 16

elderly women who have had lots of children (multi-parous)

Question 17

what does the femoral canal connect

Answer 17

inferior iliac spine to the pubic tubercle

Question 18

what makes up the medial, lateral, anterior and posterior borders of the femoral canal

Answer 18

lacunar ligament, femoral vein, inguinal ligament, pectinate ligament

Question 19

what are the contents of the femoral canal

Answer 19

fat, lymphatics, lymph node of cloquet

Question 20

what are the differences between emergency and elective repair of femoral hernias

Answer 20

low approach- elective, incision on top of inguinal ligament, can also be laparoscopic

high approach- emergency, cut in through abdomen

Question 21

where is an iguinal hernia in relation to the pubic tubercle

Answer 21

above and medial

Question 22

where is a femoral hernia in relation to the pubic tubercle

Answer 22

below and lateral

Question 23

what are the differential diagnosis of a hernia

Answer 23

hydrocele (collection of fluid), undescended testical, saphena varix, inguinal lymphadenopathy, femoral artery aneurysm

Question 24

what is an epigastric hernia

Answer 24

defect in linia alba between xiphisternum and umbilicus, more common in males 4:1

Question 25

what is a paraumbilical hernia

Answer 25

defect around ubilicus

Question 26

what is the risk factor for a paraumbilical hernia

Answer 26

obesity, pregnancy, ascites

Question 27

what are the rsik factors for inscisional hernia

Answer 27

obesity, age, site, infection, smoking, malnutrition, steroids, poor technique, recurrence of incision

Question 28

what is a paediatric hernia

Answer 28

umbilical hernia (true) or inguinal (3-5% of full term boys)

Question 29

how does an obturator hernia present

Answer 29

medial thigh pain in elderly females, small bowel obstruction, obturator nerve compression