Hernia (abdominal wall and groin)

Rationale

A hernia is an abnormal protrusion of part of a viscus through its containing wall. Hernias are very common, particularly inguinal hernias, and herniorrhaphy is a common surgical intervention.

Causal Conditions

(list not exhaustive)

1. Congenital hernia
   1. Infantile inguinal hernia
   2. Umbilical
2. Acquired hernia
   1. Inguinal hernia
      1. Indirect
      2. Direct
   2. Femoral hernia
   3. Umbilical hernia
   4. Ventral hernia

Key Objectives

Given a patient with suspected hernia, particular attention should be paid to the physical examination in order to confirm the diagnosis of hernia and, when possible, identify its type.

Enabling Objectives

Given a patient with a hernia, the candidate will

1. list and interpret critical clinical findings, including those based on
   1. differentiation of hernias through physical examination,
   2. differentiation of hernias from other masses, and
   3. identification of hernias requiring emergent surgical repair (e.g., an incarcerated [nonreducible] hernia, which carries a high risk of strangulation);
2. list critical investigations and interpret their findings in case of a hernia complicated by strangulation, ischemia, or bowel obstruction;
3. construct an effective management plan, including
   1. offering active observation (“watchful waiting”) if appropriate,
   2. counselling regarding appropriate nonsurgical therapies to be used while awaiting definitive treatment,
   3. educating the patient on the risks of untreated hernias and providing strategies to minimize postoperative recurrence (particularly for ventral hernia),
   4. ordering appropriate imaging studies, and
   5. determining if the patient requires a surgical consultation.