Hernias

Question 1

What is an inguinal hernia

Answer 1

Protrusion of abdominal contents through the inguinal canal

Question 2

What arteries run through the spermatic cord

Answer 2

1. Testicular artery
2. Cremasteric artery
3. Artery of Vas

Question 3

What veins run though the spermatic cord

Answer 3

1. Pampiniform plexus of testicular veins
2. Cremasteric vein
3. Vas vein

Question 4

What does the ilii-inguinal nerve supply

Answer 4

Skin sensation to anterior 1/3 of external genitalia

Question 5

What does the genitofemoral nerve supply

Answer 5

Cremasteric muscle

Question 6

What does the sympathetic nerve supply

Answer 6

Vas and testicular pain

Question 7

Role of vas deferens

Answer 7

Duct that transports sperm from the epididymis to the ejaculatory ducts

Question 8

What is the tunica vaginalis

Answer 8

Serous membrane that covers the testes

Question 9

Is a direct or indirect inguinal hernia more common

Answer 9

Indirect

Question 10

What people do inguinal hernias effect

Answer 10

Men over 40

Question 11

Risk factors for an inguinal hernia

Answer 11

1. Male
2. Chronic cough
3. Constipation
4. Urinary obstruction
5. Heavy lifting
6. Ascites
7. Past abdominal surgery

Question 12

What is the inguinal canal

Answer 12

A short passage that extends through inferior abdominal wall

Question 13

Extent of inguinal canal

Answer 13

From deep inguinal ring to superficial ring

Question 14

Role of the inguinal canal

Answer 14

Allows structures to pass from abdominal wall to the external genitalia

Question 15

Where is the inguinal canal weakest

Answer 15

Aldo wall

Question 16

Length of inguinal canal

Answer 16

5cm

Question 17

Where does the direct hernia occur

Answer 17

1. Where peritoneal sac enters the inguinal canal through posterior wall of the inguinal canal (medial to the inferior epigastric vessels)

Question 18

Why are direct hernias not very common

Answer 18

Rarely strangulate

Question 19

Where are indirect hernias located

Answer 19

Where peritoneal sac enters inguinal canal through deep inguinal ring

Lateral to inferior epigastric artery

Question 20

Clinical presentation of an inguinal hernia

Answer 20

1. Bulges when you cough or strain
2. Rarely painful
3. Painful = strangulation

Question 21

Differential diagnosis of an inguinal hernia

Answer 21

1. Femoral hernia
2. Epididymitis
3. Testicular torsion
4. Groin abscess
5. Aneurysm
6. Hydrocele
7. Undescended testes

Question 22

How is a inguinal hernia treated

Answer 22

1. Use of truss to contain and prevent further progression
2. Prosthetic mesh/open repair/ laparoscopy
3. Pre-op: diet and stop smoking
4. May reoccur

Question 23

What is a femoral hernia

Answer 23

Bowel comes through the femoral canal blow the inguinal ligament

Question 24

In what gender are femoral hernias common

Answer 24

FEMALES

Question 25

Pathophysiology of femoral hernias

Answer 25

1. Bowel meters femoral canal presenting as a mass

Question 26

Where is the femoral hernia mass felt

Answer 26

1. upper medial thigh | 2. Above inguinal ligament where it points down the leg

Question 27

Where do inguinal hernias point to

Answer 27

Groin

Question 28

Characteristic of femoral hernias

Answer 28

Irreducible and easily strangulated

Question 29

Why is the femoral hernia easy to strangulate

Answer 29

Due to rigidity of the canal's borders

Question 30

Where is the neck of the femoral hernia felt

Answer 30

1. Inferior and lateral to pubic tubercle (inguinal hernias are superior and medial to this point)

Question 31

Differential diagnosis of femoral hernias

Answer 31

1. Inguinal hernia 2. Lipoma 3. Femoral aneurysm 4. Psoas abscess 5. Saphena varix

Question 32

What is the saphena varies

Answer 32

Dilation of saphenous vein at junction of femoral vein in groin

Question 33

How are femoral hernias treated

Answer 33

1. Surgical repairs 2. Heriotomy (ligation and excision of sac) 3. Herniorrhaphy (repair of hernial defect)

Question 34

What is ligation

Answer 34

Stopping bleeding once sac is removed

Question 35

What is an incisional hernia

Answer 35

1. Occurs when tissue protrudes through surgical scar that is weak

Question 36

Where can incisional hernias occur

Answer 36

Anywhere there is an incision and follows breakdown of muscle closure after surgery

Question 37

What factor makes repairing an incisional hernia more difficult

Answer 37

Obesity

Question 38

Risk factors for incisional hernias

Answer 38

1. Emergency surgery 2. Wound infection post-op 3. Persistent coughing and heavy lifting 4. Poor nutrition

Question 39

Who do hiatus hernias tend to effect

Answer 39

Over 50 aged women

Question 40

What is a sliding hiatus hernia

Answer 40

1. Where gastro-oesophageal junction part of the stomach slides up to the chest via the hiatus so that it lies above the diaphragm

Question 41

Why does acid reflux happen in hiatus hernias

Answer 41

As lower oesophageal sphincter becomes less competent in many cases

Question 42

What is a rolling or para-oesophageal hiatus

Answer 42

Where the gastro-oesophageal junction remains in the abdomen but part of the funds of the stomach prolapses through the hiatus alongside the oesophagus

Question 43

When is reflux uncommon in para-oesophageal hiatus

Answer 43

When the gastro-oesophageal junction remains intact

Question 44

Clinical feature of hiatus hernias

Answer 44

GORD (50% of patients)

Question 45

How is hiatus hernias diagonsed

Answer 45

1. Barium swallow and Upper GI endoscopy

Question 46

Why is an upper GI endoscopy beneficial in hiatus hernias

Answer 46

Visualises the mucosa (can't exclude hiatus hernia)

Question 47

How are hiatus hernias treated

Answer 47

1. Lose weight 2. Treat reflux symptoms 3. Surgically treat to prevent strangulation