Hernias

Question 1

What are the contents of the inguinal canal in a female?

Answer 1

Round ligament of the uterus + ilioinguinal nerve

Question 2

What are the contents of the inguinal canal in a mail?

Answer 2

Spermatic cord + ilioinguinal nerve

Question 3

What are the contents of the spermatic cord?

Answer 3

3 arteries: vas, testicular, cremasteric
3 fascial layers: extenral spermatic, cremasteric, internal spermatic
3 nerves: traversing ilioinguinal, sympathetics, genitofemoral
3 other things: pampiniform plexus of veins, vas deferens, lymphatics

Question 4

The inguinal canal is located between what 2 structures?

Answer 4

Deep inguinal ring to superficial inguinal ring

Question 5

The opening of the inguinal canal is located laterally to what structure?

Answer 5

Inferior epigastric artery

Question 6

What are the contents of the femoral triangle?

Answer 6

NAVL
femoral nerve
femoral artery
femoral vein
lymphatics deep inguinal LN

Question 7

What is the superior border, medial border and lateral border of the femoral triangle?

Answer 7

Superior border inguinal ligament
Medial border adductor longus
Lateral border sartourius

Question 8

What is the relevance of the mid inguinal point?

Answer 8

Where are you can palpate the femoral pulse

Question 9

What is the relevance of the midpoint of the inguinal ligament?

Answer 9

Location of deep inguinal ring

Question 10

What is the definition of a hernia?

Answer 10

Abnormal protrusion of a body part through a wall that should normally contain it

Question 11

What is the definition of a irreducible hernia?

Answer 11

Can’t be shoved back in

Question 12

What is the definition of a incarcerated hernia?

Answer 12

Stuck in its sack

Question 13

What is the definition of a strangulated hernia?

Answer 13

Blood supply cut off

Question 14

Our inguinal hernia is more common on the right or left side?

Answer 14

Right

remember open appendectomy is a risk factor

Question 15

Can inguinal hernia is cause obstruction of small or large bowel?

Answer 15

SBO

Question 16

How can inguinal and femoral hernia is be differentiated on examination?

Answer 16

Femoral hernia below inguinal ligament and pubic tubercle

Inguinal hernia above pubic tubercle

Question 17

What is an indirect inguinal hernia?

Answer 17

Goes IN the canal, through deep ring int inguinal canal, out superficial ring into scrotum

Question 18

What is a direct inguinal hernia?

Answer 18

Through defect in abdominal wall, directly out superficial ring

Question 19

Does direct or indirect inguinal hernia have a higher risk of obstruction / strangulation

Answer 19

Indirect

Question 20

Does a direct or indirect hernia pop out on coughing?

Answer 20

Direct pops out on coughing

Question 21

If the hernia is in the scrotum, it must be a direct or indirect inguinal hernia?

Answer 21

Indirect

Question 22

Name 3 risk factors for inguinal hernia

Answer 22

Pregnancy 
Weightlifting
Chronic cough
Ascites
Constipation
Past abdominal wall surgery
Male
Smoker

Question 23

Direct and indirect inguinal hernia is have the same management - true or false

Answer 23

True

Question 24

How are inguinal hernia is diagnosed in the non-acute setting?

Answer 24

Clinical diagnosis

Question 25

How are inguinal hernia is investigated in the emergency setting?

Answer 25

CT

Question 26

All inguinal hernias are operated on - true or false

Answer 26

False Risk of chronic pain so only operate if hernia causes pain If not; conservative Mx

Question 27

What is the standard type of inguinal hernia repair?

Answer 27

Lichtenstein open mesh repair

Question 28

Where are femoral hernias located in relation to the pubic tubercle?

Answer 28

Below + lateral to the pubic tubercle

Question 29

Does inguinal or femoral hernia is have a higher risk of incarceration/ strangulation?

Answer 29

Femoral | since femoral canal isn't as stretchy as inguinal canal

Question 30

Femoral hernias are always operated on - true or false?

Answer 30

True

Question 31

How are femoral hernias investigated in the acute setting?

Answer 31

CT

Question 32

How are femoral hernia is diagnosed in the non-acute setting?

Answer 32

Clinical diagnosis

Question 33

In a inguinal hernia, can you palpate 'get above' the lump?

Answer 33

No

Question 34

In a femoral hernia, can you palpate 'get above' the lump?

Answer 34

No

Question 35

In inguinal lymphadenopathy in the scrotum, can you palpate 'get above' the lump?

Answer 35

No

Question 36

In a varicocele/ hydrocele, can you palpate 'get above' the lump?

Answer 36

Yes

Question 37

In a testicular tumour, can you palpate 'get above' the lump?

Answer 37

Yes

Question 38

In a epididymal cyst, can you palpate 'get above' the lump?

Answer 38

Yes

Question 39

Triad fever + back pain + limp =

Answer 39

Psoas abscess

Question 40

Which specialty does drainage of a psoas abscess?

Answer 40

Interventional radiology

Question 41

Define a sinus

Answer 41

Blind ended tract from an epithelial surface | one opening

Question 42

A groin sinus only occurs in what group of people?

Answer 42

PWIDs

Question 43

Give 3 causes of a groin swelling in a IVDU

Answer 43

``` Abscess (groin/psoas) Aneurysm Infected DVT Pseudoaneurysm Lymphadenitis ```

Question 44

If you suspect a groin aneurysm, what test is done for diagnosis?

Answer 44

CT angiogram