Hernia & Abdominal Wall

1 - What is the most common site for indirect inguinal hernia:

a- Anterolateral.
Anterolateral to the vas & vessels
b- Posterolateral.
c- Anteromedial.
d- Posteromedial.
e- Any where.

Distinction between indirect and direct inguinal hernias, and a femoral hernia.
An indirect inguinal hernia travels down the canal on the outer (lateral and
anterior) side of the spermatic cord.
A direct hernia comes out directly forwards through the posterior wall of the inguinal
canal.
While the neck of an indirect hernia is lateral to the inferior epigastric vessels, the
direct hernia usually emerges medial to this except in the saddle-bag or pantaloon
type, which has both a lateral and a medial component.
An inguinal hernia can be differentiated from a femoral hernia by ascertaining the
relation of the neck of the sac to the medial end of the inguinal ligament and the
pubic tubercle, i.e. in the case of an inguinal hernia the neck is above and medial,
while that of a femoral hernia is below and lateral (Fig. 55.14).
Digital control of the internal ring will help in distinguishing between an indirect
inguinal hernia and a direct inguinal hernia, but final proof is only possible by
displaying the anatomy at operation.
2- Indirect inguinal hernia, all are true except :
a) You can get above it.
13. In the inguinal region, the integrity of the abdominal wall requires which of the following
structures to be intact:
a. Transversalis fascia.
b. Lacunar ligament.
c. Inguinal ligament.
d. Iliopectineal ligament.
e. Femoral sheath.

The deep inguinal ring is a U-shaped opening in the transversalis fascia 1.25 cm
above the midpoint of the inguinal ligament (Pouparts ligament). The transversalis
fascia is the fascial envelope of the abdomen, and the competency of the deep
inguinal ring depends upon the integrity of this fascia.

3- The inguinal canal is:

a) shorter in infants than adults
b) just above the medial 2/3 of skin crease
c) roofed by inguinal ligament
infolded surface of inguinal ligament inferiorly make the floor
d) all of the above
e) none of the above
4- Regarding strangulated inguinal hernia these statements are correct except:
a) more common in males than female
b) always present with tenderness
c) always present with absent impulse with cough
d) always present with obstructed gut
e) always present with tense swelling

Sex

Approximately 90% of all inguinal hernia repairs are performed on males.11

Reduction of hernias in females may be complicated by inclusion of the ovary in the hernia.
Femoral hernias (although rare) occur almost exclusively in women because of the
differences in the pelvic anatomy.
The female-to-male ratio of obturator hernias is 6:1.12

5- Femoral hernia is usually:

a) commenest hernia in females
b) lateral to public tubercle
c) medial to pubic tubercle
d) never mistaken with lymphadenitis when strangulated
e) none of the above

the relation of the neck of the sac to the medial end of the inguinal ligament and the
pubic tubercle, i.e. in the case of an inguinal hernia the neck is above and medial,
while that of a femoral hernia is below and lateral .

6- In indirect inguinal hernia all of the following are true, except :

- You can get above the swelling
(if descends to scrotum)
- Swelling descends to the scrotum