GI Radiology > Hernia > Quiz Answers

Hernia Quiz Answers

1.  Imaging of hernias is best achieved by:

A. Upper GI study then small bowel follow through.
B. CT, ultrasound, or herniography, since either technique is equally effective.
C. Depends on clinical scenario, with each imaging modality providing different strengths.
D. CT, ultrasound, then MRI.

C: The choice of imaging technique depends on the clinical scenario. Opacified herniated bowel loops may make diagnosis easy with CT scan, and CT is often useful to evaluate for an alternative disease process that may be mimicking a hernia. Real-time imaging with ultrasound and/or herniography may be preferable if specific maneuvers (i.e. Valsalva) elicit hernia symptoms.

2.  Which of the following is NOT true regarding hiatal hernias:

A. The majority of hiatal hernias (99%) are sliding hiatal hernias. 1% are paraesophageal hernias.
B. Paraesophageal hernias are benign and usually not treated.
C. Upper GI barium series is the preferred study for fully evaluating hernias.
D. Sliding hernias occurs when the gastroesophageal junction, along with a portion of the stomach, prolapses into the mediastinum.

B: Paraesophageal hernias are dangerous, and potentially life threatening, because of the risk of volvulus and incarceration. They are often operated on after diagnosis.

3.  The following images demonstrates what type of hernia?

A. Morgagni hernia.
B. Petit hernia.
C. Grynfeltt hernia.
D. Bochdalek hernia.

D: Bochdalek hernias occur "back to the left" of the diaphragm.

4.  Morgagni hernias are classically located:

A. Medially, in a retrosternal or parasternal location, more frequently on the right.
B. Posteriorly to the left of the diaphragm.
C. Through a defect in the anterior or lateral abdominal wall.
D. At the site of a previous surgery.

A: Morgagni hernias occur medially through developmental defects in diaphragmatic attachments to the sternum and costal cartilages. They are more frequently on the right because the heart prevents protrusion on the left. Remember, Morgagni = Medial.

5.  Which is NOT true about the following type of hernia:

A. It may be an incisional hernia if it is at the site of previous surgery.
B. Small aperture hernias of this type are less dangerous than large aperture hernias of this type.
C. Repair is usually on an elective basis, but may be urgent if bowel strangulation occurs.

B: Small incisional hernias are more dangerous than larger hernias because smaller hernias are more likely to strangulate if incarcerated.

6.  The following image demonstrates what type of hernia? (R=rectus abdominus)

A. Bochdalek hernia.
B. Spigelian hernia.
C. Femoral hernia.
D. Direct inguinal hernia.

B: Spigelian hernias occur through the anterior abdominal wall, lateral to the rectus abdominus.

7.  Umbilical hernias may resolve spontaneously if they are less than 1.5 cm. Thus, surgery is not considered until the defect persists after 4 years of age.


TRUE: Treatment of umbilical hernia is observation. More than 95% of these hernias will close by the age of 5 years. If the hernia is large or if the child is over 4, surgery may be suggested.

8.  Indirect inguinal hernias:

A. Occur as a result of a patent processus vaginalis.
B. Are located medial to the inferior epigastric vessels, through the floor of Hasselbach's triangle.
C. Cannot migrate into the scrotum.

A: The processus vaginalis is closed off in most infants in the first few months of life. Persistence of the processus vaginalis allows bowel to migrate through inguinal canal and into the scrotum or labia majora. Strangulation can occur.

9.  What type of hernia is demonstrated below?

A. Indirect inguinal hernia.
B. Obturator hernia.
C. Direct inguinal hernia.
D. None of the above.

B: Obturator hernias pass through the obturator membrane, coming to lie between the obturator internus and the pectineus muscles.

10.  Which of the following is NOT true regarding Grynfeltt and Petit hernias?

A. Grynfeltt hernias occur through the superior lumbar triangle.
B. Petit hernias occur through the inferior lumbar triangle.
C. Are common in occurrance and are typically seen on the right side.
D. They may consist of bowel, omentum, kidney, spleen, or stomach.

C: Lumbar hernias occur in the superior and inferior lumbar spaces, better known as the Grynfeltt-Lesshaft and Petit Triangles. These hernias are rare in occurrance and are typically seen on the left side.

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