Groin Lumps

Question 1

Causes of groin lumps

Answer 1

Hernias - inguinal (direct, indirect), femoral
Lymphadenopathy - inguinal lymph node enlargement
Vascular- saphena varix, femoral artery aneuryusm
Other- lipoma of inguinal/femoral canal, femoral vein anuerysm/varicosity, cryptorchidism, hydrocele of the cord, psosas abscess

Question 2

Features of inguinal hernia

Answer 2

reducible, cough impulse, above pubic tubercle

Question 3

Features of femoral hernia

Answer 3

Below pubic tubercle
MC in women

Question 4

Features of lymphadenopathy

Answer 4

Multiple, tender or hard

Question 5

Features of saphena varix

Answer 5

compressible, blue, disappears when lying down

Question 6

Features of femoral artery anuerysm

Answer 6

pulsatile, expansile, bruits

Question 7

features of cord hydrocele

Answer 7

cystic, transilluminates, separate from testes

Question 8

features of psoas abscess

Answer 8

feburle, deep seated, associated back pain

Question 9

Pathway and features of indirect inguinal hernia

Answer 9

Through deep ring, into canal, possibly into scrotum
Lateral to epigastric vessels
Young males, scrotal swelling, cough impulse, reducible

Question 10

Pathway and features of direct inguinal hernias

Answer 10

Through posterior wall, medial to vessels
Common in older adults, less likely to reach scrotum

Question 11

Pathway and features of femoral hernia

Answer 11

Below inguinal ligament, through femoral canal. Inferior and lateral to epigastric vessels
Small, MC in females, high risk of strangulation

Question 12

define direct inguinal hernia

Answer 12

Protrusion of abdominal and/or pelvic contents directly through the posterior wall of hte inguinal canal

Question 13

define indirect inguinal hernia

Answer 13

protrusion of abdominal and/or pelvic contents into the inguinal canal through the deep inguinal ring

Question 14

Define scrotal hernia

Answer 14

Large, indirect inguinal hernia that descends through the inguinal canal into the scrotum

Question 15

Def uncomplicated inguinal hernia

Answer 15

an inguinal hernia that is completely reducible and not associated with signs of bowel obstruction or strangulation

Question 16

def complicated inguinal hernia

Answer 16

an inguinal hernia that is either irreducible (incarcerated) or associated with mechanical bowel obstruction and/or strangulation

Question 17

MC type of inguinal hernia

Answer 17

Indirect

Question 18

Epid of indirect inguinal hernia

Answer 18

male infants (premature birth) and older men

Question 19

Epid of direct inguinal hernia

Answer 19

older men

Question 20

Causees of indirect inguinal hernia

Answer 20

COngenital - incomplete obliteration of processus vaginalis during fetal development

Question 21

Cause of direct inguinal hernias

Answer 21

acquired - due to weakening of hte trnasversalis fascia - conditions resulting in increased intrabdominal pressure (COPD, pulmonary disease with chronic coughing, constipation). Associated with long term glucocorticoid use

Question 22

Location of indirect inguinal hernia

Answer 22

Herniates through external and internal ring
Outside of the Hesselbach triangle
Lateral to the inferior epigastric blood vessels
Surrounded by the external spermatic fascia, cremasteric muscle fibers, and internal spermatic fascia

Question 23

location of direct inguinal hernia

Answer 23

Only herniates through external ring
Within the Hesselbach triangle
Medial to the inferior epigastric blood vessels and lateral to the rectus abdominis
Only surrounded by the external spermatic fascia

Question 24

Clincal feature associated withj indirect inguinal hernias

Answer 24

COmmunicating hydrocele

Question 25

Dx of hernias

Answer 25

Ultrasound

Question 26

Epid of femoral hernias

Answer 26

Less common type of hernia More common in women

Question 27

Cause of femoral hernia

Answer 27

Acquired due to increased intrabdominal pressure- obesity or weakened pelvis floor - multiparity

Question 28

Location femoral hernia

Answer 28

Herniates through the femoral ring into the femoral canal Below the inguinal ligament Lateral to the pubic tubercle Medial to the femoral vein

Question 29

should you attempt to manually reduce a inguinal hernia if there are signs of strangulation

Answer 29

no

Question 30

def incarcerated hernia

Answer 30

Irreduicible Skin overlying the hernia is normal

Question 31

def obstructed hernia

Answer 31

symptoms of mechanical bowel obstruction

Question 32

def strangulated hernia

Answer 32

sudden, severe groin pain caused by constriction and ischemia or hernial contents Signs of sepsis or shock Featues of bowel obstruction if the hernia contains intestinal loops Skin over hernia: warm, erythematous, tender

Question 33

causes of femoral lymphadenopathy

Answer 33

STI, Lower extermity infection, ca

Question 34

Causes of femoral AV fistula

Answer 34

Iatrogenic- for percutaneous CV procedures Trauma - penetrating injury to the lower extermity

Question 35

Clin F of femoral AV fistuals

Answer 35

Initally asx Vibratory sensation, bruit, pulses in the groin Lower extremity ischemia Chronic fistulas: limb edema, high output HF, arterial degeneration Fatigue

Question 36

IX/ DX for femoral AV fistual

Answer 36

dopper US

Question 37

Clin f of psoas abscess

Answer 37

fever LBP, flank pain Painful, painless mass psoas sign anorexia, weight loss

Question 38

Dx test for psoas abscess

Answer 38

CT

Question 39

Risk factors for incisional hernia

Answer 39

laparotomy post op wound infection smoking, dm, obesity, immunosuppression, malnourishment, older age Emergency abdo surg pregnancy

Question 40

Causes of umbilical hernias

Answer 40

Congential Incerased intrabdominal pressure

Question 41

20% of which patient will develop umbilica hernia

Answer 41

cirrhosis

Question 42

causes of hiatal hernia

Answer 42

Lax diaphragmatic esophageal hiatus Advanced age Smoking Obesity Genetic predisposition (rare) [1] Prolonged periods of increased intra-abdominal pressure Pregnancy Ascites Chronic cough Chronic constipation

Question 43

When to consider surgical management of hernias

Answer 43

Symptomatic, enlarging, incarcerated, strangulated

Question 44

Herniorrhaphy

Answer 44

surgical repair of a hernia, traditionally involving the closure of the hernial defect, often without mesh (in contrast to herniorrhaphy + hernioplasty, which uses mesh).

Question 45

Early perioperative complications after inguinal/femoral hernia repair

Answer 45

wound seroma/hematoma, urinary retention, and superficial incisional surgical site infection

Question 46

Late perioperative complications after inguinal/femoral hernia repair

Answer 46

persistent groin pain, sexual dysfunction, deep incisional/mesh infection, recurrent hernia, and mesh migration and erosion.

Question 47

MC complication post hernia repair

Answer 47

Seroma/ hematoma