Hernias

Question 1

Risk factors for hernias

Answer 1

Protein deficiencies
Males
Increasing age
Obesity
Chronic couging
Constipation
Lifting

Question 2

Contents of inguinal Canal

Answer 2

Spermatic cord
Round ligament
Nerves

Question 3

Anterior wall of inguinal canal

Answer 3

Aponeurosis of external oblique

Internal oblique

Question 4

Floor of inguinal canal

Answer 4

Inguinal ligament

Lacunar ligament

Question 5

Posterior wall of inguinal canal

Answer 5

Transversalis fascia

Question 6

Roof of inguinal canal

Answer 6

Transversalis fascia
Internal oblique
Transversus abdominus

Question 7

where does the deep inguinal ring lie

Answer 7

Just above midpoint of inguinal ligament

Question 8

Where does inguinal canal lie in relation to inferior epigastric vessels

Answer 8

Lateral

Question 9

Weakest wall in inguinal canal

Answer 9

Transversalis fascia

Question 10

Where does the inguinal canal end

Answer 10

Pubic tubercle

Question 11

Most common type of inguinal hernia

Answer 11

Indirect

Question 12

fact file of direct inguinal hernias

Answer 12

Bowel enters inguinal canal through weakness in posterior wall (Hesselbach’s triangle)

Easily reduce and rarely strangulate

Question 13

Fact file of indirect inguinal hernias

Answer 13

Bowel passing through the deep ring of inguinal canal due to an incomplete closure of processus vaginalis

Question 14

Which inguinal hernias are more likely to strangulate

Answer 14

Indirect

Question 15

Which inguinal hernia has more likely to exit superficial ring and pass into scrotum

Answer 15

Indirect

Question 16

How to distinguish between indirect vs direct

Answer 16

Press over deep ring (just above midpoint of inguinal ligament)

Ask patient to cough

If hernia reappears it is direct

Question 17

How do we know if its direct vs indirect hernia during surgery

Answer 17

Indirect hernias are lateral to inferior epigastric vessels

Direct hernias are medial to inferior epigastric vessels

Question 18

femoral canal contents and purpose

Answer 18

Fatty tissue and lymph nodes

Lies medial to the femoral vein and allows it space for it to expand

Question 19

What are femoral hernias

Answer 19

Abdominal viscera or momentum pass through femoral ring into the potential space of the femoral canal

Question 20

Risk factors for femoral hernias

Answer 20

Female (wider pelvis)
Pregnancy
Raised intra-abdominal pressure
Age

Question 21

Problem with femoral hernias

Answer 21

High risk of strangulation so require urgent surgical intervention

Question 22

Femoral vs inguinal hernias

Answer 22

Inguinal- superiomedial to pubic tubercle

Femoral- Inferolateral

Question 23

Why do femoral hernias pose a high strangulation risk

Answer 23

Due to narrow neck of the femoral canal

Question 24

Epidemiology of direct vs indirect inguinal hernias

Answer 24

Direct- older men

Indirect- Younger men

Question 25

Cause of ubilical hernia

Answer 25

Defect in transversalis fascia or umbilical ring

Question 26

Factfile of umbilical hernia

Answer 26

More common in children Low strangulation risk Occur in adults due to pregnancy or gross ascites

Question 27

Cause of paraumbilical hernia

Answer 27

Weakness in linea alba More common in 25-50yo women Usually caused by obesity or gross ascites High risk of strangulation

Question 28

What is an epigastric hernia caused by

Answer 28

Herniation of fat which overlies the bowel through the linea alba above the umbilicus

Question 29

Who do epigastric hernias most occur in and what are the symptoms

Answer 29

Young males Discomfort on exercise or eating Relieved by reclining

Question 30

What are small epigastric hernias prone to

Answer 30

Incarceration and strangulation

Question 31

What do small epigastric hernias contain

Answer 31

Extraperitoneal fat

Question 32

What do large epigastric hernias contain

Answer 32

omentum

Question 33

What is divarication of recti

Answer 33

Separation of rectus abdomens due to linea alba laxity

Question 34

Risk factors of divarication fo recti

Answer 34

Truncal obesity Pregnancy Repeated midline operations and chronically raised intra abdominal pressure

Question 35

How to diagnose divarication of recti

Answer 35

ultrasound

Question 36

When do you not have to intervene in incisional hernias

Answer 36

If patient is asymptomatic