Hernias

Front 1

List the layers surrounding the testicle from outermost to innermost.

Back 1

OUTER
- Skin
- Dartos muscle
- Colles' fascia
- External spermatic fascia
- Cremaster muscle
- Internal spermatic fascia
- Peritoneum + fat
- Tunica vaginalis
INNER

Front 2

What are the major constituents of the spermatic cord?

Back 2

- Ductus (vas) deferens
- Testicular artery
- Artery of vas deferens
- Cremasteric artery
- Pampiniform plexus
- Lymphatics
- Genitofemoral nerve (genital branch)

Front 3

What structures are contained within the femoral sheath?

Back 3

Femoral artery + vein
NOT femoral nerve

Front 4

What are the boundaries of the femoral triangle?

Back 4

- Inguinal ligament (sup.)
- Adductor longus (med.)
- Sartorius (lat.)
- Pectineus/iliopsoas (floor)

Front 5

What are the major risk factors for abdominal hernia?

Back 5

- Undescended testis
- Family history
- Increased age
- Increased intra-abdominal pressure (e.g. ascites, pregnancy)
- Abdominal wall weakness
- Other genitourinary abnormalities

Front 6

Describe these terms:
1. Reducible hernia
2. Incarcerated hernia
3. Strangulated hernia

Back 6

1. Reducible hernia - can be reduced by manual manipulation
2. Incarcerated hernia - irreducible, but intestine not compromised
3. Strangulated hernia - irreducible, intestine ischaemic (risk of necrosis)

Front 7

Compare and contrast DIRECT and INDIRECT inguinal hernias.

Back 7

DIRECT
- Bulge at superficial inguinal ring
- Less frequency in males
- Rarely incarcerate
- Always acquired (never congenital)

INDIRECT
- Bulge at deep inguinal ring
- Travels down spermatic cord
- Proceeds to scrotal hernia
- High incidence in males
- Often incarcerates / strangulates
- Acquired or congenital

Front 8

What is a Spigelian hernia?

Back 8

Spigelian hernia occurs at the site of the arcuate line, lateral to the rectus abdominis.

Front 9

What are the umbilical and epigastric hernias?

Back 9

Umbilical - occur in the umbilicus, often congenital.

Epigastric - occur in the linea alba, usually contain fat, not intestine.

Front 10

Incisional hernias occur in ____ % of post-laparotomy patients.

Back 10

10-20 %

Front 11

What simple examinations and investigations can be in a patient presenting with a lump?

Back 11

1. Palpation of the lump through the inguinal ring(s).
2. Cough manoever to elicit the lump.
3. Auscultation for bowel sounds in the lump
4. AXR to visualise bowel

Front 12

What are some common treatment options for hernias?

Back 12

- Surgical repair using mesh.

Front 13

List six DDx's of groin lump.

Back 13

1. Inguinal hernia
2. Femoral hernia
3. Hydrocoele
4. Psoas abscess
5. Cryptorchidism
6. Saphenous varix
7. Enlarged lymph node
8. Aneurysm of femoral artery

Front 14

List six causes of intestinal obstruction.

Back 14

1. Adhesions
2. Intussusception
3. Diverticulitis
4. Stricture
5. Volvulus
6. Faecal impaction