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Content provided by Jon Lund
Clinical Associate Professor, School of Graduate Entry Medicine & Health, University of Nottingham 		 
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Hernia sub-site:
Introduction Learning Objectives Definition Anatomy Symptoms, Signs and Complications Examination Operation Quiz
Test how much you've learnt by doing the quiz below. Each question refers to one of the pages in this site. When you've fininshed click the submit button to take you to the answers and feedback. There are links to the original text with the answers so that you can revise an area you may have not done so well in.

A hernia is defined as (chose one):

  • A protrusion of bowel from the abdomen
  • A lump in the groin
  • Protrusion of a viscus beyond its normal confines
  • A swelling in the scrotum

In the following 3 question choose which startements are correct (more than one statement per question may be correct) Which of the following concerning inguinal hernia are true?:

  • It is more common in females
  • Inguinal hernia is more common than femoral hernia in females
  • Inguinal hernia is more common on the left
  • Direct hernias are lateral to the inferior epigastric vessels
  • Inguinal hernia has its peak incidence in males less than one year of age


When examining the groin:

 
  • The patient can be examined lying down throughout the examination
  • A femoral hernia lies above the inguinal ligament
  • An indirect inguinal hernia can be controlled by pressure over the deep inguinal ring
  • An uncomplicated hernia will produce an expansile impulse when the patient coughs
  • The contents of the scrotum should always be examined in a male

 

Concerning complications of inguinal hernia:

  • The most usual symptom of inguinal hernia is a severe pain in the groin and vomiting
  • Obstructed inguinal hernia may present with colicky abdominal pain and vomiting
  • Patients with obstructed and stangulated hernias need to be taken to the operating theatre immediately
  • An incarcerated hernia is irreducible but painless
  • A strangulated hernia is irreducible but painful and tender


Clinical Senarios - From the following pick the best answer from the drop down box.


A 75 year old man presents with a dragging sensation in the right groin. He is a keen gardener and otherwise well. On examination there is a lump in the groin which is above the inguinal ligament, reduces on lying down but is not controlled by pressure over the deep inguinal ring. The most likely diagnosis is:


A 75 year old man had a dragging sensation in the right groin for a month. He is a keen gardener but otherwise well. On examination there is a non-tender lump in the groin which is above the inguinal ligament and cannot be reduced. The most likely diagnosis is:


A 75 year old man presents with a dragging sensation in the right groin. He is a keen gardener and otherwise well. On examination there is a lump in the groin which is above the inguinal ligament, reduces on lying down and is controlled by pressure over the deep inguinal ring. The most likely diagnosis is:


A 75 year old man noticed a lump in the right groin 2 weeks ago. Yesterday the lump became very painful. He is a keen gardener and otherwise well. On examination he looks unwell and in pain. There is a tender lump in the groin which is above the inguinal ligament and cannot be reduced. The skin over the lump is red. The most likely diagnosis is:


A 75 year old man noticed a lump in the right groin 2 weeks ago. Yesterday he began to have central abdominal pain coming in waves. Today he has vomited foul smelling brown liquid. He is a keen gardener and otherwise well. On examination he looks dehydrated. There is a non-tender lump in the groin which is above the inguinal ligament and cannot be reduced. The skin over the lump is normal. The most likely diagnosis is:


Anatomy

Point with the cursor to identify:
  1. Aponeurosis of external oblique muscle
  2. Inguinal ligament
  3. Superficial inguinal ring
  4. Pubic tubercle
  5. Anterior superior iliac spine

 

external oblique aponeurosis inguinal ligament anterior superior iliac spine pubic tubercle superficial ring

Point with the cursor to identify:

  1. Spermatic cord
  2. Deep inguinal ring
  3. Inferior epigastric artery
  4. Conjoint tendon

spermatic cord deep ring inferior epigastrics conjoint tendon

Answers