Abdominal hernia

Question 1

types of abdominal hernia

Answer 1

Inguinal
Femoral
Incisional
Epigastric
Umbilical

Question 2

What is a hernia

Answer 2

The protrusion of a viscus or part of a viscus through a weakening in its containing cavity.

Question 3

Types of inguinal hernia

Answer 3

Direct

Indirect

Question 4

Clinical presentation of inguinal H

Answer 4

Swelling in the groin that may appear with lifting, accompanied by pain.
Increase in swelling on cough.
Can reduce on reclination, larger requires manual reduction.

Question 5

Differences in clinical presentation between direct and indirect inguinal h

Answer 5

indirect more prone to cause pain in the scrotum and ‘dragging’ sensation

Question 6

Describe direct inguinal hernia

Answer 6

Caused by weakness in the abdominal wall
Located MEDIAL to inferior epigastric vessels
Protrudes directly through a weakness in the POSTERIOR WALL of the inguinal canal.

Question 7

Describe indirect inguinal hernia

Answer 7

Caused by a congenital weakness of the internal inguinal ring
(Protrusion through the internal inguinal ring along with the inguinal canal through the abdominal wall.)
Located LATERAL to inferior epigastric vessels
More common than direct

Question 8

Pathophysiology of inguinal hernia

Answer 8

High abdominal pressure causes the internal organs to push through a weakened section of the abdominal wall

Question 9

Aetiology of inguinal hernia

Answer 9

Con be congenital

Heavy lifting is a risk factor and can weaken the wall

Question 10

Epidemiology of direct inguinal hernia

Answer 10

More common in elderly and men

Question 11

Epidemiology of indirect inguinal hernia

Answer 11

Accounts for 80% of inguinal hernias

More common in men

Question 12

Diagnosis of inguinal hernia

Answer 12

Clinical diagnosis
Ultrasound (radiology)
Seek to identify if inguinal or femoral

Question 13

Treatment of inguinal hernia

Answer 13

Infancy = Repair soon after diagnosis
Adults = surgical repair in large hernias

Question 14

Complications of any hernia

Answer 14

Incarcerate or strangulate

Question 15

Clinical presentation of femoral hernia

Answer 15

Lump/mass in groin.
Tends to be irreducible.

Lateral and inferior to the pubic tubercle.
Increase in swelling on cough.
May be reducible on reclination or manually.

Question 16

Pathophysiology of femoral hernia

Answer 16

High abdominal pressure causes the internal organs to push through a weakened section of the abdominal wall

Question 17

Aetiology of femoral hernia

Answer 17

Idiopathic
OR due to a weakness in the femoral canal:
-located inferior and lateral to the pubic tubercle
-more common in females
-high risk of strangulation

Question 18

Epidemiology of femoral hernia

Answer 18

More common in middle-aged and elderly women

Question 19

Diagnosis of femoral hernia

Answer 19

Ultrasound

Seek to identify if inguinal or femoral

Question 20

Treatment of femoral hernia

Answer 20

Surgical hernia repair (treatment of choice)

Question 21

Pathophysiology of incisional hernia

Answer 21

Location depends on location of incision
Internal organs push through improperly healed section of abdominal wall
Risk of any abdominal operation

Question 22

Aetiology of incisional hernia

Answer 22

Weakness caused by a surgical repair that has not fully healed

Question 23

Epidemiology of incisional hernia

Answer 23

15% of abdominal operations result in this

Question 24

Diagnosis of incisional hernia

Answer 24

observation

Question 25

Treatment of incisional hernia

Answer 25

Urgent repair with reinforcing mesh

Question 26

What % of large hernias show recurrence of incisional hernia

Answer 26

50%

Question 27

Clinical presentation of epigastric hernia

Answer 27

Midline, above the umbilicus in the linea alba. Can be made to bulge by asking the patient to strain. Usually asymptomatic, can present with epigastric pain. Possible bloating, nausea and vomiting, often after meals

Question 28

Pathophysiology of epigastric hernia

Answer 28

Internal organs push through a weakened section of abdominal muscle

Question 29

Risk factor of epigastric hernia

Answer 29

Obesity

Question 30

Epidemiology of epigastric hernia

Answer 30

Most common in men between 20-50

Question 31

Diagnosis of epigastric hernia

Answer 31

Obese patients might need ultrasound or CT scanning

Question 32

Treatment of epigastric hernia

Answer 32

Surgical correction

Question 33

Clinical presentation of umbilical hernia

Answer 33

At the site of the umbilicus. Can be asymptomatic. Pain can occur if the abdominal wall contracts, worsened on straining.

Question 34

Pathophysiology of umbilical hernia

Answer 34

Congenitally can occur as a result of a developmental error. Organs develop outside of the abdominal cavity and enter through an opening in the umbilicus.

Question 35

Aetiology of umbilical hernia

Answer 35

Infancy - congenital Adult - 90% are acquired through multiple and difficult pregnancies Also ascites and obesity

Question 36

Epidemiology of umbilical hernia

Answer 36

10-30% of all hernias | More common in males and due to weakness of the umbilicus

Question 37

Diagnosis of umbilical hernia

Answer 37

Ultrasound can confirm

Question 38

Treatment of umbilical hernia

Answer 38

<1cm: usually closes spontaneously by 5 years >1.5cm: usually requires repair with preservation of the umbilicus (usually is self-resolving)

Question 39

What is the viscera

Answer 39

the internal organs in the main cavities of the body, especially those in the abdomen, e.g. the intestines

Question 40

Signs and symptoms of inguinal hernia

Answer 40

Mass in the groin Hernia accentuated by certain situations such as coughing or on standing Reducible Pain = hernia likely to be strangulated i.e. blood supply is comprimised

Question 41

Complications of inguinal hernia

Answer 41

Strangulation | Incarceration

Question 42

Types of hiatus hernia

Answer 42

Sliding | Rolling

Question 43

Causes of hiatus hernia

Answer 43

Weakness in the diaphragm that allows the stomach and intestines to move into the chest cavity. Risk factors that make this more likely such as obesity and constipation

Question 44

Signs and symptoms of hiatus hernia

Answer 44

``` GORD signs and symptoms: Heartburn Acid taste in mouth Water brash (excess salivation) Dysphagia Nocturnal asthma/chronic cough Laryngitis ```

Question 45

Investigations of hiatus hernia

Answer 45

Endoscopy | Barium study

Question 46

Treatment of hiatus hernia

Answer 46

GORD: Conservative - education, weight loss, raising head of bed at night and avoid precipitating factors such as smoking and large meals Medical - Antacids (aluminium hydroxide); H2 receptor antagonists (ranitidine); proton pump inhibitors (omeprazole) Surgical - Nissen's fundoplication

Question 47

Complications of hiatus hernia

Answer 47

Strangulation Gastric volvulus GORD complications: Barretts oesophagus etc

Question 48

Complications of femoral hernia

Answer 48

Strangulation | Fistula formation