Hernias

Question 1

What is a hernia?

Answer 1

Protrusion of an organ or part of an organ through connective tissue or wall of a cavity in which it is normally enclosed

Can be congenital or acquired through weakening/disruption of abdominal wall fascia, or failed healing of surgical incision.

Question 2

What does ‘reducible’ mean in the context of hernias?

Answer 2

Herniated contents can be manually placed back into anatomic position spontaneously or with gentle pressure.

Question 3

What is an incarcerated hernia?

Answer 3

Hernia cannot be reduced back to anatomic position, increasing risk for bowel obstruction.

Question 4

Define a strangulated hernia.

Answer 4

Blood supply to incarcerated hernia is compromised, leading to ischemia and necrosis of tissue.

Question 5

What are the common symptoms of a strangulated hernia?

Answer 5

Steadily increasing pain, nausea, vomiting.

Question 6

What physical exam finding is associated with hernias?

Answer 6

Hernia may only appear with increased intra-abdominal pressure; evaluate in standing and recumbent positions.

Question 7

What percentage of hernias occur in the groin?

Answer 7

75%.

Question 8

What is the most common type of hernia?

Answer 8

Inguinal hernia.

Question 9

What is the lifetime risk for men and women to develop inguinal hernias?

Answer 9

Men: 27%, Women: 3%.

Question 10

List the types of groin hernias.

Answer 10

• Indirect inguinal hernia
• Direct inguinal hernia
• Femoral hernia.

Question 11

What are the types of abdominal hernias?

Answer 11

• Umbilical hernia
• Epigastric hernia
• Spigelian hernia
• Incisional hernia.

Question 12

What anatomical layers are involved in abdominal hernias?

Answer 12

• Skin
• Subcutaneous tissue
• Superficial fascia
• External oblique
• Internal oblique
• Transversus abdominus
• Transversalis fascia
• Preperitoneal adipose tissue
• Peritoneum.

Question 13

What is a Spigelian hernia?

Answer 13

Rare hernia occurring along arcuate line due to weakness from lack of posterior rectus sheath below line.

Question 14

What risk factors are associated with incisional hernias?

Answer 14

• Diabetes
• Immunosuppressant use
• Smoking
• Obesity
• Malnutrition
• Connective tissue disorders.

Question 15

What are the contents of the inguinal canal in males?

Answer 15

• Spermatic cord
• Vas deferens.

Question 16

What forms the deep (internal) inguinal ring?

Answer 16

Hiatus in transversalis fascia.

Question 17

What are the boundaries of Hesselbach’s triangle?

Answer 17

• Superolaterally: Inferior epigastric vessels
• Medially: Lateral edge of rectus sheath
• Inferior: Inguinal ligament.

Question 18

True or False: Inguinal hernias are 5 times more common than femoral hernias.

Answer 18

True.

Question 19

What is the indication for surgical repair of umbilical hernias?

Answer 19

Symptomatic, incarceration, failure to close spontaneously after 5 years.

Question 20

Fill in the blank: Hernias can develop at the site of a previous _______.

Answer 20

[abdominal incision].

Question 21

What is the risk of incarceration in Spigelian hernias?

Answer 21

Up to 20%.

Question 22

What is the anterior layer of the rectus sheath composed of?

Answer 22

• External oblique
• Internal oblique
• Transversus abdominus fascia.

Question 23

What is the role of the arcuate line in hernia anatomy?

Answer 23

Demarcates transition between posterior wall of rectus sheath covering superior ¾ of rectus abdominus and transversalis fascia covering inferior ¼.

Question 24

What does the femoral triangle contain?

Answer 24

Femoral artery, vein, and nerve

The femoral triangle is an important anatomical landmark in the groin region.

Question 25

What does the femoral sheath contain?

Answer 25

Femoral artery, vein, canal (with deep inguinal nodes), but NO nerve ## Footnote The femoral sheath is crucial for understanding femoral hernias.

Question 26

Which nerves are involved in the innervation of the groin?

Answer 26

* Iliohypogastric n. * Ilioinguinal n. * Genitofemoral n. (Genital and Femoral branches) * Lateral Femoral Cutaneous n. ## Footnote These nerves originate from the lumbar plexus.

Question 27

What guides the descent of the testes into the scrotum?

Answer 27

Gubernaculum ## Footnote The gubernaculum is a fibrous cord that helps in the descent of the testes.

Question 28

What is the processus vaginalis?

Answer 28

An evagination that protrudes through the inguinal canal and is involved in the descent of the testes ## Footnote Failure of closure of the processus vaginalis can lead to hernias.

Question 29

What happens if the processus vaginalis persists?

Answer 29

Predisposed to indirect inguinal hernia and hydrocele ## Footnote Hydrocele is the accumulation of fluid in the tunica vaginalis.

Question 30

What characterizes an indirect inguinal hernia?

Answer 30

Herniated contents enter through deep inguinal ring, lateral to inferior epigastric vessels ## Footnote It is the most common type of inguinal hernia.

Question 31

When do indirect inguinal hernias typically form?

Answer 31

In the first year of life, but may not become symptomatic until adulthood ## Footnote This hernia type is common in both genders.

Question 32

What is the path of a direct inguinal hernia?

Answer 32

Enters through parietal peritoneum, medial to inferior epigastric vessels, and lateral to rectus abdominus ## Footnote Direct inguinal hernias are less common and usually occur in older men.

Question 33

What is a femoral hernia?

Answer 33

Passes beneath inguinal ligament through femoral canal into the upper thigh ## Footnote Femoral hernias are more common in females due to pelvic anatomy.

Question 34

What is the risk associated with femoral hernias?

Answer 34

Increased risk of incarceration/strangulation due to rigid boundaries of femoral ring ## Footnote The femoral ring is bordered by the femoral vein and lacunar ligament.

Question 35

What imaging techniques are used to diagnose hernias?

Answer 35

* US * CT * MRI ## Footnote MRI is the most sensitive and specific for hernia diagnosis.

Question 36

What is the current standard for hernia repair?

Answer 36

Synthetic tension-free mesh ## Footnote This method has shown to decrease recurrence rates.

Question 37

What is the recurrence rate after hernia repair?

Answer 37

Ranges from 0.5% to 15% ## Footnote Recurrence rates can vary based on the type of hernia and repair method.

Question 38

What is a clinical sign of a hernia?

Answer 38

Nonreducible bulging mass, tender to palpation ## Footnote This sign is often accompanied by pain and may indicate incarceration.

Question 39

True or False: Femoral hernias are less common than inguinal hernias.

Answer 39

True ## Footnote However, they are more common in females.

Question 40

Fill in the blank: The __________ is used to provide external compression over a hernia defect.

Answer 40

truss ## Footnote Non-surgical repair methods may be temporary solutions.