Hernias

Question 1

Most common type of hernia after age 50

Answer 1

Direct

Question 2

External hernia

Answer 2

Sac protrudes completely through abdominal wall

Question 3

Intraparietal hernia

Answer 3

Sac is contained within the abdominal wall

Question 4

Internal hernia

Answer 4

Sac is within the visceral cavity (ex. diaphragmatic hernia)

Question 5

Protruding viscus can be returned to abdomen

Answer 5

Reducible hernia

Question 6

Strangulated hernia

Answer 6

Vascularity of the viscus is compromised. Surgical emergency!

Question 7

Anterior wall of inguinal canal

Answer 7

External oblique aponeurosis

Question 8

Posterior wall of inguinal canal

Answer 8

Transverse abdominal muscle aponeurosis

Question 9

Innervates cremaster muscle, skin of the side of the scrotum and labia

Answer 9

Genital nerve (L1-L2)

Question 10

Site of direct inguinal hernia

Answer 10

Hesselbach’s triangle

Question 11

Why are females more predisposed to femoral hernias than men?

Answer 11

Increased diameter of true pelvis…proportionally widens the femoral canal

Question 12

DDX for inguinal hernia

Answer 12

Abdominal wall mass
Desmoids
Neoplasm
Adenopathy
Rectus sheath hematoma

Question 13

Bassini’s repair

Answer 13

Suturing of conjoint tendon to the incurved part of the inguinal ligament

Question 14

Benefits of laparoscopic repair

Answer 14

Decreased post-op pain

Decreased wound infection

Question 15

How do you handle a hernia in a patient with ascites?

Answer 15

Repair the hernia AFTER the ascites is controlled

Question 16

Complications of hernia surgery

Answer 16

Ischemic orchitis with testicular atrophy

Residual neuralgia

Question 17

Recurrence is more common with which type of hernia?

Answer 17

Direct

Question 18

Hernia more common in smokers

Answer 18

Direct: due to weakened connective tissue

Question 19

Where is pain referred in a direct inguinal hernia?

Answer 19

Testis

Question 20

Congenital indirect hernia is associated with a patent what?

Answer 20

Processus vaginalis

Question 21

Which side is a hernia more common on in the first decade of life? Why?

Answer 21

Right: because of the late descent of right testis

Question 22

Symptoms of obstructed femoral hernia?

Answer 22

vomiting, constipation

Question 23

DDX femoral hernia

Answer 23

Inguinal hernia
Saphenous varix
Enlarged femoral lymph node
Lipoma
Femoral artery aneurysm
Psoas abscess

Question 24

Associated factors with umbilical hernias?

Answer 24

Ascites
Pregnancy
Obesity

Question 25

Cause of pediatric umbilical hernia

Answer 25

Failure of timely closure of umbilical ring...central defect in linea alba

Question 26

Type I esophageal hiatal hernia

Answer 26

Sliding type: cardia of stomach upwardly dislocates in the posterior mediastinum *Most common type

Question 27

Type II hiatal hernia

Answer 27

Upward dislocation of the gastric fundus alongside a normally positioned cardia *No disruption of GE junction

Question 28

Type III hiatal hernia

Answer 28

Upward dislocation of both the cardia and the gastric fundus

Question 29

Sliding hiatal hernia predisposes patient to what?

Answer 29

Barretts esophagus

Question 30

Which type of hiatal hernia warrants prompt surgical correction?

Answer 30

Type II (paraesophageal)--high frequency of complications (obstruction, strangulation, hemorrhage)

Question 31

Richter's hernia

Answer 31

Only part of the intestinal wall circumfrence is in the hernia. May strangulate without obstruction.

Question 32

Littre's hernia

Answer 32

Hernial sac containes Meckel's diverticulum

Question 33

Garengoff's hernia

Answer 33

Hernial sac has the appendix

Question 34

Pantaloon hernia

Answer 34

combo of direct and indirect inguinal hernia

Question 35

Cooper's hernia

Answer 35

Hernia that involves the femoral canal and tracts to the labia majora in females and to the scrotum in males

Question 36

Hernias associated with obesity

Answer 36

Direct inguinal Paraumbilical Hiatal hernia

Question 37

Incisional hernia

Answer 37

Result as surgical complication: associated with obesity, diabetes, and infection