Hernia

Question 1

what is a hernia

Answer 1

abnormal protrusion of a cavity’s contents through a weakness in the wall of a cavity

Question 2

causes of a hernia

Answer 2

anatomical
inherited collagen disorders
sites where surgical incisions are made

Question 3

example of anatomical causes of a hernia

Answer 3

sites where structures exit through an opening in the cavity

Question 4

types of hernia

Answer 4

epigastric
spigelian
femoral
inguinal 
incisional
umbilical

Question 5

classification of hernia

Answer 5

reducible
incarcerated or irreducible
strangulated

Question 6

describe reducible hernia

Answer 6

hernia can be easily pushed back into abdomen

Question 7

describe incarcerated or irreducible hernia

Answer 7

hernia cannot be manipulated back to abdomen

Question 8

describe strangulated hernia

Answer 8

vascular supply to contents contained within hernia is compromised, resulting in ischaemic and gangrenous tissue

Question 9

treatment of hernias

Answer 9

conservative/non-surgical management

surgical

Question 10

define epigastric hernia

Answer 10

fascial defect in the linea alba betune the xiphoid process and the umbilicus

Question 11

clinical features of epigastric hernia

Answer 11

midline lump
asymptomatic - may present with pain
+incarcerated or strangulated = symptoms dependent on organ involved

Question 12

epidemiology of paraumbilical hernia

Answer 12

occurs in all age group

Question 13

aetiology of paraumbilical hernia

Answer 13

stretching of abdominal wall by obesity
multiple pregnancy
ascites

Question 14

clinical features of paraumbilical hernia

Answer 14

pain

Question 15

complications of paraumbilical hernia

Answer 15

do not resolve spontaneously

high incidence of incarceration and strangulation

Question 16

treatment of paraumbilicial hernia

Answer 16

always surgical

Question 17

aetiology of adult umbilical hernia

Answer 17

persistent elevation of intra-abdominal pressure

Question 18

clinical features of adult umbilical hernia

Answer 18

pain

Question 19

treatment of adult umbilical hernia

Answer 19

always surgical

Question 20

complications of adult umbilical hernia

Answer 20

do not resolve spontaneously

high incidence of incarceration and strangulation

Question 21

length of the inguinal canal

Answer 21

4cm

Question 22

describe the pathway the inguinal canal

Answer 22

stars at deep inguinal ring and ends in superficial inguinal ring

Question 23

boundaries of inguinal canal - anterior

Answer 23

external oblique and internal oblique muscle

Question 24

boundaries of inguinal canal - floor

Answer 24

ligament

Question 25

boundaries of inguinal canal - roof

Answer 25

transversals fascia | internal oblique and transverses abdominis

Question 26

boundaries of inguinal canal - posterior

Answer 26

transversals fascia and conjoint tendon

Question 27

function of inguinal canal - male

Answer 27

transmits the spermatic cord and ilioinguinal nerve

Question 28

function of inguinal canal - female

Answer 28

transmits the round ligament of the uterus and ilioinguinal nerve

Question 29

where does spermatic cord enter inguinal canal

Answer 29

through the deep inguinal ring in posterior wall

Question 30

where does spermatic cord exit inguinal canal

Answer 30

through superficial inguinal ring on the anterior wall

Question 31

contents of spermatic cord

Answer 31

3 coverings | 6 contents

Question 32

coverings of spermatic crd

Answer 32

internal spermatic fascia cremasteric fascia external spermatic fascia

Question 33

contents of spermatic cord

Answer 33

``` vas deferens 3 arteries pampiniform plexus (veins) lymphatics nerves remains of processes vaginalis ```

Question 34

arteries of spermatic cord

Answer 34

testicular artery artery to Vas cremasteric

Question 35

nerves of spermatic cord

Answer 35

genital branch of genitofemoral nerve | sympathetic twigs

Question 36

lateral edge of hesselbach triangle

Answer 36

inferior epigastric artery

Question 37

medial edge of hesselbach triangle

Answer 37

lateral border of rectus muscle

Question 38

inferior edge of hesselbach triangle

Answer 38

inguinal ligament

Question 39

types of inguinal hernia

Answer 39

direct inguinal hernia indirect inguinal hernia - most common right sided hernias more common

Question 40

describe direct inguinal hernia

Answer 40

bowel pushes through weak area in floor of inguinal canal - the hesselbach triangle

Question 41

describe indirect inguinal hernia

Answer 41

bowel inters the inguinal canal via the deep inguinal ring and pushes out through the superficial inguinal ring

Question 42

epidemiology of inguinal hernia

Answer 42

males

Question 43

pathology of inguinal hernia

Answer 43

multifactorial - patent processus vaginalis and pathological change in connective tissue

Question 44

clinical presentation of inguinal hernia

Answer 44

groin swelling that disappears when lying down, located above and medial to pubic tubercle palpable cough impulse

Question 45

tests of inguinal hernia

Answer 45

ultrasound - if in doubt about diagnosis

Question 46

treatment of inguinal hernia

Answer 46

non surgical | surgical - open or laparoscopic

Question 47

epidemiology of femoral hernia

Answer 47

older age 20% of hernias in woman 5% of hernias in men

Question 48

clinical presentation of femoral hernia

Answer 48

strangulation in 40% of hernias

Question 49

borders of femoral ring - anterior

Answer 49

inguinal ligament

Question 50

borders of femoral ring - posterior

Answer 50

iliopectineal ligament

Question 51

borders of femoral ring - medial

Answer 51

lacunar ligament

Question 52

borders of femoral ring - lateral

Answer 52

femoral vein

Question 53

treatment of femoral hernia

Answer 53

surgical

Question 54

aetiology of incisional hernia

Answer 54

iatrogenic - most common complication of laparotomy

Question 55

predisposing factors of incisional hernia

Answer 55

``` wound complications inherited collagen abnormlaites advanced age smoking morbid obesity malignancy surgical technique ```

Question 56

management if incisional hernia

Answer 56

conservative or surgical