Hernia MCQs

LAPAROSCOPY This is a useful technique for the diagnosis of intra-abdominal and hepatic metastases. It has the advantage of enabling tissue samples or peritoneal cytology to be obtained and is the only modality reliably able to detect peritoneal tumour seedlings. This is particularly important for tumours arising from the intra-abdominal portion of the oesophagus, cardia and where there is a potential communication between a full-thickness tumour and the peritoneal cavity, for instance where there is a hiatus hernia. Laparoscopy Laparoscopic staging is useful in adenocarcinomas, especially those of the OGJ, but not for squamous cell cancer. Laparoscopy should be reserved for patients in whom confirmation of metastatic disease that is not otherwise obtainable is essential in deciding on treatment. Reference : Bailey & Love's short practice of surgery, chapter: 66, Edition: 28th, Pg: 1139

Volvulus of the stomach Rotation of the stomach usually occurs around the axis and between its two fixed points, i.e. the cardia and the pylorus . In theory, rotation can occur in the horizontal (organoaxial) or vertical (mesenteroaxial) direction but, commonly, it is the former which occurs. This condition is usually associated with a large diaphragmatic defect around the oesophagus ( paraesophageal herniation ). Reference: Bailey & Love's short practice of surgery, chapter: 67, Edition: 28th, Pg: 1180

Answer- C. Pneumonectomy Causes of opaque hemithorax Technical : - Rotation, Scoliosis. Pleural : - Pleural effusion, Pleural thickening, Mesothelioma. Surgical : - Pneumonectomy, Thoracoplasty. Congenital : - Pulmonary agenesis. Mediastinal : - Gross cardiomegaly, tumors. Pulmonary : - Collapse, Consolidation, fibrosis, Foreign body. Diaphragmatic hernia

Seroma A seroma is the collection of fluid containing fat, serum, and lymph that develops at surgical wound or dead space from surgery. Seromas are common in surgical procedures, which create dead space or interruption of lymphatic drainage. Examples of this include breast or axillary surgery and hernia surgery. The use of prosthetic mesh in hernia surgery may contribute to poor flap adherence and trigger inflammation which can increase the risk of seroma formation. Reference : Sabiston textbook of Surgery, chapter: 12, Edition: 21st, Pg: 239

Dynamic, in which peristalsis is working against a mechanical obstruction. It may occur in an acute or a chronic form. Adynamic, in which there is no mechanical obstruction; peristalsis is absent or inadequate (e.g. paralytic ileus or pseudo-obstruction). Reference : Bailey & Love's short practice of surgery, chapter: 78, Edition: 28th, Pg: 1375

Indications for early surgical intervention Obstructed external hernia Clinical features suspicious of intestinal strangulation Obstruction in a 'virgin' abdomen Reference : Bailey & Love's short practice of surgery, chapter: 78, Edition: 28th, Pg: 1386

In the embryo, the umbilical ring is a relatively large defect in the ventral abdominal wall transmitting several structures that connect the fetus to the placenta.An umbilical hernia is common and caused by incomplete closure of the umbilical ring; incarceration is very rare. Most umbilical hernias resolve by 4 years of age. Supraumbilical hernias occur through defects in the linea alba just above the umbilical ring and do not close but are still repaired at around 4 years of age. Epigastric hernias are defects higher still that allow a small amount of preperitoneal fat to prolapse. They are repaired if symptomatic. Reference: Bailey and love's short practice of surgery, 27 th edition, Page - 127

The rule that absolute constipation is present in intestinal obstruction does not apply in: Richter’s hernia; Gallstone ileus; Mesenteric vascular occlusion; Functional obstruction associated with pelvic abscess; All cases of partial obstruction (in which diarrhoea may occur). Reference : Bailey & Love's short practice of surgery, chapter: 78, Edition: 28th, Pg: 1380