Hernias

Question 1

What are the borders of Hasselbach’s triangle?

Answer 1

Medial = Lateral border of rectus abdominis muscle.
Lateral = Inferior epigastric vessels.
Inferior = Inguinal ligament

Question 2

Describe features of a direct inguinal hernia

Answer 2

• Herniates medial to inferior epigastric vessels so in Hassebach’s triangle.
• Usually acquired in older age

Question 3

Describe features of indirect inguinal hernias

Answer 3

Often congenital due to incomplete closure of processus vaginalis. Bowel herniates lateral to epigastric vessels.

Question 4

What is an incisional hernia?

Answer 4

Protrusion of the omentum or organ through a surgical incision

Question 5

What is the mid-inguinal point?

Answer 5

Halfway between ASIS and pubic symphysis where the femoral pulse can be felt

Question 6

Where is the mid point of the inguinal ligamnet?

Answer 6

Half way between pubic tubercle and ASIS

Question 7

What runs through the inguinal canal?

Answer 7

Spermatic cord
Round ligament
Ilioinguinal nerve
Genital branch of genitofemoral nerve

Question 8

What are the risk factors for femoral hernias?

Answer 8

Being female, pregnant, raised intra-abdominal pressure (chronic constipation) and increasing age

Question 9

Explain the presentation of femoral hernias

Answer 9

• Small lump in groin found infero-lateral to pubic tubercle
• Likely to be unreducible

Question 10

Explain the investigations and treatment of femoral hernias

Answer 10

• Investigate via ultrasound or CT abdo-pelvis.
• High risk of strangulation so need managed surgically

Question 11

What does an obstructed hernia mean?

Answer 11

The bowel luman has become obstructed leading to clinical features of bowel obstruction

Question 12

What does a strangulated hernia mean?

Answer 12

Compression of the hernia has compromised blood supply causing bowel to become ischaemic

Question 13

Name some other examples of abdominal hernias

Answer 13

• Epigastric hernia (upper midline fibres of linea alba)
• Paraumbilical hernia (usually contained pre-peritoneal fat)
• Spigelian hernia (occurs at semi-lunar line)
• Obturator hernia (Mass in medial thigh and can have features of small bowel obstruction)

Question 14

What are the risk factors for abdominal wall hernias?

Answer 14

• Obesity, ascities, increasing age, surgical wounds

Question 15

Describe features of a congenital inguinal hernia

Answer 15

• Ocurrs from a patent processus vaginalis.
• If presenting within in first few months of life then hernia should be repaired urgently. If over 1 years old then it can be performed electively.

Question 16

Describe features of an infantile umbilical hernia

Answer 16

Symmetrical bulge under the umbilicus.Usually resolve within 3 years so no treatment required

Question 17

What is an incarcerated hernia?

Answer 17

When it can no longer be reducable

Question 18

What are the symptoms of a strangulated hernia?

Answer 18

Pain, fever, increased size of hernia, erythema of overlying skin, peritonitic features, bowel obstruction, bowel ischaemia

Question 19

What are the investigations for strangulated hernias?

Answer 19

• Imaging (limited help, more to exclude differentials)
• FBC and ABG can show leukocytosis and raised lactate

Question 20

What is the management of a strangulated hernia?

Answer 20

A-E assessment
Surgical repair

Question 21

What is a Richter Hernia?

Answer 21

Rare hernia where antimesenteric border of bowel herniates through fascial defect.
A richter hernia an present with strangulation without symptoms of obstruction