Inguinal Hernia

Question 1

What is an inguinal hernia

Answer 1

• Protrusion of abdo contents through inguinal canal

- Indirect or direct

Question 2

How common is it

Answer 2

• most common type hernia

Question 3

Who does it affect

Answer 3

• M>F (8:1)

Question 4

How common are indirect and direct hernias

Answer 4

• Indirect inguinal = 80%

- Direct = 20%

Question 5

What is an indirect inguinal hernia

Answer 5

• Pass through internal inguinal ring (if large also through external ring)
• Can strangulate)

Question 6

What is a direct inguinal hernia

Answer 6

• Push directly forward through posterior wall of inguinal canal –> into defect in abdo wall –> Hesselbach’s triangle
• Easily reducible, rarely strangulation

Question 7

What are boundaries of the inguinal canal

Answer 7

• Floor: inguinal ligament + lacunar ligament medially
• Roof: Fibres of transversalis, internal oblique
• Ant: external oblique aponeurosis + internal oblique for lateral 1/3
• Post: laterally = transversalis fascia, medially = conjoint tendon

Question 8

What are some of the risk factors in infants and adults

Answer 8

• In infants –> prematurity, male

- In adults –> male, obesity, constipation, chronic cough, heavy lifting, urinary obstruction, ascites

Question 9

What are the symptoms of inguinal hernia

Answer 9

• Swelling appear w/ lifting + accompanied w sudden pain (indirect more prone to cause pain)
• ‘Dragging’ sensation –> indirect
• Impulse (^ in swelling) on coughing
• May be reducible

Question 10

What are the signs of an inguinal hernia

Answer 10

• MASS ABOVER + MEDIAL TO PUBIC TUBERCLE

Question 11

How do you distinguish between an indirect and direct hernia

Answer 11

• Reduce hernia + occlude deep/int ring w. fingers, ask pt to cough or stand
• Hernia restrained = indirect
• Hernia appars = direct

Question 12

What investigations would you perform

Answer 12

• USS

- Dx largely clinical

Question 13

How do you treat

Answer 13

• Surgery - hernitomy, mesh techniques (reinforce post wall)
• Advise diet + stop smoking pre-op
• Warn about recurrence