Hernia

Question 1

definition of hernia?

Answer 1

Protrusion of a viscus or part of a viscus through the walls of its containing cavity into an abnormal position.

Question 2

definition of reducible hernia?

Answer 2

Sac can return to the abdominal cavity either spontaneously or w manipulation.

Question 3

definition of irreducible hernia?

Answer 3

Sac cannot be reduced despite pressure or manipulation

Question 4

definition of strangulated hernia?

Answer 4

Blood supply of contents is compromised due to pressure at the neck of the hernia.

Question 5

Maydl’s hernia?

Answer 5

Herniating double loop of bowel. Strangulated portion may reside as a single loop inside the abdomen.

Question 6

what is Littre’s hernia?

Answer 6

any Hernial sac containing strangulated Meckel’s diverticulum.

Question 7

what is Amyand’s hernia?

Answer 7

Inguinal hernia containing strangulated Appendix

Question 8

what is a pantaloon hernia?

Answer 8

type of inguinal (related to the groin) hernia that involves a direct and indirect hernia on the same side of the groin.

(simultaneous direct and indirect hernia)

Question 9

herniotomy?

Answer 9

Excision of hernial sac

Question 10

what is a herniorrhaphy?

Answer 10

Suture repair of hernial defect

Question 11

what is a hernioplasty?

Answer 11

Mesh repair of hernial defect

Question 12

pathophysiology of congenital hernia?

Answer 12

patent processus vaginalis

• should obliterate following descent of the testes
• if it stays,, may fill with fluid -> hydrocele or bowel / omentum -> indirect hernia

Question 13

causes of acquired hernia?

Answer 13

things that increase intra abdominal pressure

Chronic cough: COPD, asthma

 Prostatism

 Constipation

 Severe muscular effort: e.g. heavy lifting

 Previous incision/repair

 Ascites / obesity

 Appendicectomy

Question 14

what is an indirect hernia?

Answer 14

80% of hernias: commoner in young

Congenital patent processus vaginalis

Emerge through deep ring

Same 3 coverings as cord and descend into the scrotum

Can strangulate

Question 15

what is a direct hernia?

Answer 15

20%: commoner in elderly

acquired

emerge through hesselbachs triangle

rarely descend into scrotum/ strangulate

Question 16

ix of hernia if type is uncertain?

Answer 16

US

Question 17

features of hernia in children?

Answer 17

lump in groin which may descend into scrotum

exacerbated by crying

commonly obstruct

Question 18

features of hernia in adults?

Answer 18

lump in groin, exacerbated by straining / coughing

may be clear precipitating event e.g. heavy lifting

dragging pain radiating to groin

may present w obstruction/ strangulation

Question 19

impt features to ask about hernia?

Answer 19

reducible?

episodes of obstruction/ strangulation?

predisposing factors: cough, straining, lifting?

occupation and social circumstances?

Question 20

mx of hernia?

Answer 20

non surgical:

reduce risks: cough, constipation

lose weight

truss (hernia support belt)

surgical:

tension free mesh repair

lap if bilateral/ recurrent

open if primary unilateral

children only require sac excision (herniotomy)

Question 21

complications of hernia surgery?

Answer 21

Early:

Haematoma / seroma formation: 10%

Intra-abdominal injury (lap)
Infection: 1%
Urinary retention

Late:

Recurrence

ischaemic orchitis

chronic groin pain/ parasthesia

Question 22

definition of femoral hernia?

Answer 22

Protrusion of viscus through the femoral canal

Question 23

why are femoral hernias more common in females?

Answer 23

Femoral canal larger in females due to shape of pelvis

and changes in its configuration due to childbirth

Question 24

features of femoral hernia?

Answer 24

painless groin lump

• neck inferior and lateral to pubic tubercle
• cough impulse
• often irreducible

commonly presents w obstruction/ strangulation

• tender, red and hot

abdo pain, distension, vomiting, constipation

Question 25

mx of femoral hernia?

Answer 25

urgent surgery 50% risk of strangulation within 1 mo elective: Lockwood approach Emergency: McEvedy Approach (high approach in inguinal region to allow inspection and resection of non viable bowel then herniotomy and herniorrhaphy)

Question 26

definition of incisional hernia?

Answer 26

hernia arises through a previously acquired defect

Question 27

risk factors of incisional hernia?

Answer 27

preop: increased age, obesity, malnutrition, comorbidities, drugs: steroids, chemo, radio intra-op: surgical technique: too small suture bites/ inappropriate suture material incision type e.g. midline placing drains through wounds post-op: - increased intra-abdo pressure: chronic cough/ straining, post op ileus infection haematoma

Question 28

mx of incisional hernia?

Answer 28

surgery not appropriate for all patients - must balance risk of operation and recurrence w risk of obstruction/ strangulation usually broad necked-\> low risk of strangulation conservative: manage risk factors e.g. constipation, cough weight loss elasticated corset or truss surgical: preop- optimise cardioresp function nylon mesh repair: open or lap

Question 29

Answer 29

umbilical hernia - congenital - defect in umbilical scar

Question 30

risk factors of umbilical hernia?

Answer 30

afro-caribbean trisomy 21 congenital hypothyroidism

Question 31

mx of umbilical hernia?

Answer 31

usually resolves by 2-3 yrs of age mesh repair if no closure may recur in adulthood: pregnancy, gross ascites

Question 32

what does paraumbilical hernia herniate through?

Answer 32

defect through linea alba just above or below umbilicus - acquired: usually middle aged obese men small defect -\> strangulation (often omentum)

Question 33

risk factors of paraumbilical hernia?

Answer 33

chronic cough straining

Question 34

mx of paraumbilical hernia?

Answer 34

May (double breast linea alba w sutures)/ mesh repair

Question 35

what is a spigelian hernia?

Answer 35

hernia through linea semilunaris hernia lies between layers of abdo wall palpable mass more likely to be colon ca

Question 36

what is an obturator hernia?

Answer 36

old aged F\>M sac protrudes through obturator foramen pain on inner aspect of thigh or knee frequently present obstructed/ strangulated

Question 37

what is a lumbar hernia?

Answer 37

middle aged M\> F typically follow loin incisions herniates through superior/ inferior lumbar triangles

Question 38

what is a sciatic hernia?

Answer 38

hernia through lesser sciatic foramen usually presents as SBO + gluteal mass

Question 39

what is a gluteal hernia?

Answer 39

hernia through greater sciatic forament usually presents as SBO+ gluteal mass

Question 40

inguinal vs femoral hernias?

Answer 40