Abdominal hernia

Question 1

hernia

Answer 1

abnormal protraction of a cavity contents through a weakness in the wall of the cavity

Question 2

aetiology

Answer 2

structural weakness
increased pressure

Question 3

structural weakness

Answer 3

• Commonly in the body wall
• Normal anatomical weakness e.g. diaphragm, umbilicus, inguinal/femoral canal
• Abnormal weakness - congenital diaphragmatic hernia, inherited collagen disorders, surgical scars

Question 4

increased pressure

Answer 4

• Repeated bouts of increased intra-abdominal pressure on that part of the body wall
  
  • Smoking
  • Chronic cough
  • Obesity
  • Pregnancy
  • Strenuous activity
  • previous surgery
• Straining during bowel movements or urination

Question 5

reducible

Answer 5

hernia can easily be pushed back into the abdomen

Question 6

incarcerated/irreducible hernia

Answer 6

when a hernia cannot be manipulated back to the abdomen

Question 7

strangulated hernia

Answer 7

• vascular supply to the contents contained within the hernia is compromised, resulting in ischaemic and gangrenous tissue
  
  • Symptoms depend on organ involved

Question 8

internal hernia

Answer 8

cannot be seen or palpated

Question 9

external hernia

Answer 9

can be seen or palpated

Question 10

clinical presentation

Answer 10

• Symptoms/signs present in 66% of cases
• Pain and discomfort, especially on straining
• Bulge that disappears on lying down
• Bowel obstruction may be first presentation
• Heartburn or dysphagia

Question 11

investigations

Answer 11

• Detailed history - SOCRATES
• Thorough examination
• Investigations/imaging
  
  • USS
  • CT
  • Endoscopy
  • Laparoscopy

Question 12

epigastric hernia

Answer 12

Fascial defect in the linea alba between the xiphoid process and the umbilicus

Question 13

clinical presentation of epigastric hernia

Answer 13

• Main presentation is a midline lump
• Asymptomatic (75%) or can present with pain

Question 14

paraumbilical hernia

Answer 14

• Found just above or just below umbilicus
• Risk factors include stretching of the abdominal wall by obesity, multiple pregnancies and ascites

Question 15

clinical presentation of paraumbilical hernia

Answer 15

• Frequently symptomatic presenting with pain
• High incidence of incarceration and strangulation

Question 16

adult umbilical hernia

Answer 16

Usually results from persistent elevation of intraabdominal pressure

Question 17

clinical presentation of adult umbilical hernia

Answer 17

• Frequently symptomatic presenting with pain
• High incidence of incarceration and strangulation

Question 18

inguinal hernia

Answer 18

• more frequent in males
• right sided more common than left

Question 19

clinical presentation of inguinal hernia

Answer 19

• Groin swelling which usually disappears when lying down
• Usually located above and medial to the pubic tubercle
• Palpable cough impulse on examination

Question 20

investigation of inguinal hernia

Answer 20

Dynamic USS can be useful if there is doubt over diagnosis

Question 21

femoral hernia

Answer 21

• Hernia passes through the femoral ring into the femoral canal
• More common in females
• occur just below the inguinal ligament
• femoral hernia has to be repaired as there is a high risk of strangulation

Question 22

incisional hernia

Answer 22

• Iatrogenic
• Hernia occurs when the defect is the result of an incompletely healed surgical would
• Commonest complication of a laparotomy

Question 23

risk factors of incisional hernia

Answer 23

morbid obesity, wound complications, inherited collagen abnormalities, smoking, wound infection, hematoma

Question 24

parastomal hernia

Answer 24

• Common
• Develops with increased abdominal pressure around any stoma; ileostomy, colostomy, ileal conduit
• difficult to treat

Question 25

Spigelian hernia

Answer 25

Occur at the lateral edge of the rectus sheath, below and lateral to the umbilicus

Question 26

lumbar hernia

Answer 26

Occur on the posterolateral abdominal wall

Question 27

hiatus hernia

Answer 27

- Occurs at the point at which the oesophagus meets the stomach - Can be sliding or non-sliding - Non-sliding are dangerous as they can cause rotation and obstruction of the stomach - Can present with dysphagia and GORD-like symptoms

Question 28

divarication of recti

Answer 28

- Not a true hernia - Occurs due to a rupture in the rectus abdomnis

Question 29

obturatory hernia

Answer 29

- Uncommon - Usual first presentation is obstruction - CT is diagnostic tool for choice - surgical repair is necessary

Question 30

management of hernia

Answer 30

- hernia belt or surgery - if asymptomatic best to leave alone - only perform surgery if there is high risk of strangulation

Question 31

complications of irreducible

Answer 31

hernia cannot be manipulated back into abdominal cavity

Question 32

complication of obstruction hernia

Answer 32

- the loop of the bowel can become non functioning with no compromise to its blood supply - Gives you more time to plan as opposed to strangulated hernia

Question 33

complications of strangulation hernia

Answer 33

- blood supply to the bowel is compromise leading to gangrene, perforation and peritonitis - NEEDS emergency surgical treatment