44 - Hernias

Question 1

What is the content of the inguinal canal? (6)

Answer 1

spermatic cord
testicular artery
ductus deference 
pampiniform plexus
genital branch of genitofemoral nerve
tunica vaginalis

Question 2

Which nerves go through the inguinal canal? (3)

Answer 2

genital branch of genitofemoral nerve
sympathetic nerve
ilioinguinal nerve

Question 3

The genital branch of genitofemoral nerve is part of the ___ ___ itself

Answer 3

spermatic cord

Question 4

Ilioinguinal nerve does not enter through the ___ ring, but exist through the ___

Answer 4

deep

superficial

Question 5

What are the 3 levels of hernia?

Answer 5

reducible
irreducible/incarcerated
strangulated

Question 6

External hernia= classic, the sac moves with the ___ space

Answer 6

peritoneal

Question 7

What kind of groin hernia do you know?

Answer 7

inguinal

femoral

Question 8

Inguinal hernia may be indirect (___) or direct (___)

Answer 8

deep ring

Hesselbach triangle

Question 9

Groin hernias make up to __% of all hernias

Answer 9

80

Question 10

Groin hernia are __ times more common in ___. __ are direct.

Answer 10

25
men
2/3

Question 11

Femoral hernias are __ times more common in ___.

Answer 11

10

women

Question 12

Umbilical hernias are ___ times more common in women

Answer 12

2

Question 13

Strangulated hernia may lead to bowel ___ and ___

Answer 13

ischemia

obstruction

Question 14

Inguinal hernia require ___ only if symptomatic

Answer 14

surgery

Question 15

Femoral hernia always require ___ due to high frequency of ___ (20%)

Answer 15

surgery

strangulation

Question 16

If there is no reason to suspect ___, we can try and perform a ____ maneuver to restore the intestine

Answer 16

strangulation

manual

Question 17

The typical imaging test for inguinal hernia is ___

Answer 17

US

Question 18

The typical imaging test for ventral hernias is ___

Answer 18

CT

Question 19

Name 5 DDs for a groin mass

Answer 19

hernia (inguinal/femoral)
lymphadenopathy (reactive/infective/tumor)
cryptorchidism 
abscess
lymphoma

Question 20

Testicular tumors metastasize to the ___ lymph nodes rather than the ___ lymph nodes

Answer 20

retroperitoneal

groin

Question 21

Scrotum tumors (skin) metastasize to the ___ lymph nodes (superficial inguinal nodes)

Answer 21

gorin

Question 22

Indirect hernias are the ___ common type.

Answer 22

most

Question 23

In direct hernia, the intestine’s loop enter through the ___ __ to the ___ ___. It is a premade anatomic path.

Answer 23

deep
ring
inguinal
canal

Question 24

Complete hernia is when the loop exists through the ___ inguinal canal, into the ___ cord

Answer 24

superficial

spermatic

Question 25

Indirect inguinal hernia etiology is the patent ___ ___ that did not go through obliteration properly

Answer 25

process | vaginalis

Question 26

Indirect hernia is more common on the ___ side, due to the fact that on this side the testicle migrate last.

Answer 26

right

Question 27

Indirect hernia are more likely to cause ___.

Answer 27

strangulation

Question 28

What does hernia includes (inside->out) (7)?

Answer 28

``` intestine loop peritoneum internal spermatic fascia cremasteric muscle and fascia external spermatic fascia superficial layer skin ```

Question 29

The indirect hernia passes ___ to the inferior epigastric vessels

Answer 29

latterly

Question 30

Direct inguinal hernia occurs due to ___ in the abdominal wall. Specifically of the ___ fascia.

Answer 30

weakness | transversals

Question 31

The indirect hernia does not enter through the ___ ring, but can occasionally exist through the ___ ring

Answer 31

deep | superficial

Question 32

Direct hernia is usually found in the ___ triangle area, medially to the ___ ___ vessels

Answer 32

Hesselbach | inferior epigastric

Question 33

What are the borders of the Hesselbach triangle? inferior- ___ superior lateral- ___ medially- ___

Answer 33

inguinal ligament inferior epigastric vessels semilunar line of the rectus abdominis

Question 34

Femoral hernia are more common in ___, and makes up to __% of all hernias. It is more common on the ___ side.

Answer 34

women 3 right

Question 35

Femoral hernia goes through the ___ ring, found ____ to the femoral vein, ___ to the ___ ligament

Answer 35

femoral medially superior cooper

Question 36

``` What is the femoral ring anatomy? superior- ___ ligament medially- ___ ligament inferior- ___ ligament latterly- ___ vein ```

Answer 36

inguinal lacunar cooper femoral

Question 37

Femoral hernia has the biggest chance (__%) to become ___, therefore we must perform ___, even if its ___

Answer 37

20 strangulated surgery asymptomatic

Question 38

What are the most common organs to get strangulated in femoral hernia? (2)

Answer 38

intestine | ovary

Question 39

When performing physical examination and palpating a mass ___ the inguinal ligament, ___ hernia should be highly suspected

Answer 39

under | femoral

Question 40

What is pantaloons hernia?

Answer 40

a big hernia, penetrating through the inguinal ring (indirect) and the Hesselbach triangle (direct)

Question 41

Triangle of doom: (3)

Answer 41

inguinal ligament medial umbilical ligament testicular vessels

Question 42

Triangle of pain: (2)

Answer 42

genitofemoral nerve | lateral femoral cutaneous nerve

Question 43

Acute incarceration/strangulation requires __ __ without trying to ___ the hernia, to avoid ___

Answer 43

emergency surgery maneuver perforation

Question 44

Emergency surgery is made with an ____ approach

Answer 44

open

Question 45

If the intestine is strangulated and requires surgical removal, we will not place ___, fearing from infection

Answer 45

net

Question 46

Before performing emergency surgery, we should administrate: (3)

Answer 46

fluids ABx NGT

Question 47

What are the 5 most common complications post hernia surgery:

Answer 47

``` SSI nerve injury- chronic pain syndrome ischemic orchitis/ testicular atrophy vas deferens/viscera injury recurrence ```