Hernias

Question 1

What is the definition of a hernia?

Answer 1

protrusion of a viscus (organ) or part or a viscus through a defect of the walls of its containing cavity into an abnormal position

Question 2

what is an irreducible hernia?

Answer 2

cannot be pushed back into right place

Question 3

What is incarceration

Answer 3

contents of hernial sac are stuck inside by adhesions

Question 4

what is reduction en masse

Answer 4

pushing the strangulated hernia and hernial sac back into the abdomen cavity giving the appearance of fixing it yet it is still strangulated

Question 5

What is the most common type of hernia

Answer 5

inguinal hernia

Question 6

Where do femoral hernias occur?
What sex are they more common in?
What is the treatment?

Answer 6

Below and lateral to the pubic tubercle
women
surgical repair

Question 7

Which hernia carries a high risk of strangulation?

Answer 7

femoral hernia

Question 8

How do paraumbilical hernias present?

What is the treatment

Answer 8

asymmetrical bulge of omentum or bowel directly above or below the umbilicus
more common in women
Rx: mayo repair - repair of rectus sheath

Question 9

Where do epigastric hernias occur? who are they most common in?

Answer 9

Lump in the midline between umbilicus and the xiphisternum

Most common in men aged 20-30 years

Question 10

what is an incisional hernia? what is treatment?

Answer 10

follow breakdown of muscle closure after surgery

mesh repair

Question 11

What is a spegelian hernia

Answer 11

lateral ventral hernia

through linea semilunaris at lateral edge of rectus sheath below and lateral to umbilicus

Question 12

What is gastroschisis?
Is it associated w congenital abnormalities?
What is the treatment?

Answer 12

1. protrusion of abdo contents through a defect in the anterior abdomen wall to the right of the umbilicus w no covering
   sac
2. not associated w congenital abnormalities
3. urgent surgical repair

Question 13

what is exomphalos?
is it associated w congenital abnormalities?
what is rx?

Answer 13

Abdo contents protrude through the umbilical ring, covered w a transparent sac formed by the amniotic membrane and peritoneum
ASSOCIATED w congenital abnormalities
surgical repair

Question 14

What causes congenital inguinal hernias? who is at risk? what is rx?

Answer 14

patent processus vaginalis
premature males
surgical repair

Question 15

what causes true umbilical hernias? who is at risk? what is rx?

Answer 15

persistent defect in transversalis fascia, umbilical ring

risk: afro-caribbean,
rx. conservative - most resolve by 3

Question 16

which sex are inguinal hernia s more common in and by how much?

Answer 16

male, around 95% of pts are male

Question 17

What are the features of inguinal hernias?

Answer 17

groin lump - disappears on pressure or when the pt lies down
discomfort and ache- worse w activity
strangulation (rare)

Question 18

What is the management of inguinal hernias? which method provides lowest recurrence rate

Answer 18

Rx even if asymptomatic!
Conservative management if few sx
make sure pts are medically fit- advise on diet (weight)and stop smoking
Mesh repair (Lichtenstein) - lowest recurrence rate
Laparoscopic repair

Question 19

What are the boundaries of Hasselbach’s triangle? how do they distinguish between indirect and direct inguinal hernias?

Answer 19

medial: rectus abdokminis
lateral: inferior epigastric vessels
inferior: inguinal ligament

hernias occurring within the triangle tend to be direct and those outside - direct

Question 20

how are inguinal hernias diagnosed?

Answer 20

clinically w a reducible swelling at the level of the inguinal canal
or US or herniogram

Question 21

how can large inguinal hernias present?

Answer 21

may extend down into the male scrotum

won’t transilluminate and not possible to get above the swelling