Inguinal Hernia

Question 1

What is an inguinal hernia?

Answer 1

Protrusion of abd contents enter inguinal canal
Causing visible / easily palpable bulge

Question 2

What are the risk factors for an inguinal hernia? (5 things)

Answer 2

1. Age
2. Male
3. Obesity
4. Raised intra-abd pressure: heavy lifting / chronic cough / chronic constipation
5. Previous abd surgery

Question 3

What are the 2 different types of hernia?

Answer 3

1. Direct
2. Indirect

Question 4

How do you define a DIRECT inguinal hernia? (2 things)

Answer 4

1. Bowel enters inguinal canal DIRECTLY thru posterior wall of inguinal canal –> thru weakness in Hesselbach’s Triangle
2. Causes a Peritoneal bulge

Question 5

What are the borders of Hesselbach’s triangle? (3 things)

Answer 5

1. Rectus abdominis
2. Inf epigastric vessels
3. Inguinal ligament

Question 6

How do you define an INDIRECT inguinal hernia?

Answer 6

Bowel enters inguinal canal via Deep Inguinal Ring

Question 7

Which type of inguinal hernia is more common?

Answer 7

INDIRECT

Question 8

How does an INDIRECT inguinal hernia arise? (2 steps)

Answer 8

Congenital

1. Incomplete closure of Processus Vaginalis (outpouching of peritoneum)
2. –> Embryonic testicular descent of Bowel contents

Question 9

How does a DIRECT hernia arise? (2 things)

Answer 9

1. Abdominal wall laxity
2. Significant rise in intra-abd pressure

Question 10

What test can you do to distinguish between DIRECT and INDIRECT inguinal hernias? (5 steps)

Answer 10

1. Locate Deep Inguinal Ring (midway between Ant Sup Iliac Spine n pubic tubercle)
2. Reduce hernia (by compressing it towards Deep Inguinal Ring)
3. Apply pressure over Deep Inguinal Ring
4. Ask patient to cough / stand
5. If hernia comes back = DIRECT // If it does not = INDIRECT

doesnt come back bc ur compressing da DIR innit

Question 11

What is the gold standard way of distinguishing between DIRECT and INDIRECT inguinal hernias?

Answer 11

Surgery

1. Direct = medial to Inf epigastric vessels (aka in H triangle)
2. Indirect = lateral

Question 12

What are the other differentials that present similarly (lump in groin) to inguinal hernias? (6 things)

Answer 12

1. Femoral hernia
2. Inguinal lymphadenopathy
3. Lipoma
4. Groin abscess
5. Internal iliac aneurysm
6. Hydrocele / varicocele / testicular mass (if mass extends into scrotum)

Question 13

How do you diagnose an inguinal hernia?

When would imaging be required? (3 things)

Answer 13

Clinical diagnosis

Imaging (CT) only needed if
1. Diagnosis uncertain
2 Exclude other pathology
3. Complications of obstruction / strangulation

Question 14

How do you manage a patient with inguinal hernia?

Answer 14

1. Surgery
2. 1/3 patients no symptoms –> conservatively

Question 15

What is the surgical management of a patient with inguinal hernia?

Answer 15

1. Open mesh repair (for primary inguinal hernia)
2. Laparoscopic (for recurrent / bilateral)

Question 16

What are the complications of inguinal hernia that require surgical intervention? (3 things)

Answer 16

1. Irreducible / incarcerated
2. Strangulation
3. Bowel obstruction

Question 17

What happens in strangulation of an inguinal hernia?

Answer 17

Hernia compression has compromised blood supply –> bowel ischaemia

Emergency bc u dont want bowel infarction