hernias

Question 1

hernia?

Answer 1

• Abnormal protrusion of a viscus outwith its normal body cavity

Question 2

what is the most common?

Answer 2

inguinal

Question 3

predisposing factors?

Answer 3

heavy lifting, coughing, constipation, prostates, pregnancy, obesity

Question 4

how can you classify hernias?

Answer 4

reducible and non reducible

Question 5

natural hernias ?

Answer 5

Inguinal, femoral, umbilicus, oesophageal hiatus, obturator

Question 6

weakness?

Answer 6

Incisional, parastomal, epigastric, paraumbilical

Question 7

epigastric hernia arises from congenital weakness in the

Answer 7

linea alba

Question 8

what does epigastric usually contain?

Answer 8

extraperitoneal fat

Question 9

how is epigastric treated?

Answer 9

suture or mesh

Question 10

what would you do with a paediatric inguinal hernia?

Answer 10

operate immediatey

Question 11

Femoral hernia - male or female?

Answer 11

female

Question 12

anatomical position of femoral?

Answer 12

below and lateral to the pubic tubercle

Question 13

how do femoral hernias present ?

Answer 13

50% PRESENT AS SURGICAL EMERGENCY AND 50% then require small bowel resection

Question 14

inguinal hernia - male or female?

Answer 14

male

Question 15

how do you differentiate between inguinal and femoral?

Answer 15

find pubic tubercle
if above and medial –> inguinal
if below and lateral –>femoral

Question 16

what need to tell patient after surgery for hernia?

Answer 16

no driving for about a week, no heavy lifting for about a months

Question 17

complications?

Answer 17

haematoma, urinary retention, wound infection, chronic neurogenic pain, hernia recurrence, testicular pain and atrophy

Question 18

in inguinal - how can you differentiate direct and indirect?

Answer 18

Indirect
♣ Lateral to inf. Epigastric vessels and with the cord
♣ May reach scrotum (inguino-scrotal)
♣ Congenital hernias are indirect
♣ Controlled by digital pressure over internal ring
o Direct
♣ Posterior bulge through transversalis fascia
♣ Medial to inf. Epigastric vessels
♣ Often bilateral
♣ Poor controlled by digital pressure
♣ OLDER MEN

Question 19

Indirect hernia - medial or lateral to epigastric vessels?

Answer 19

lateral

Question 20

direct - medial or lateral to epigastric vessels

Answer 20

medial