3. Hernias Flashcards
What are the chief sites of hernia?
Inguinal, femoral, and umbilical.
What are the potential areas of weakness for hernias?
Inguinal canal, femoral ring, and umbilicus.
What is the inguinal canal?
An oblique passage that extends in a downward and medial direction.
Where does the inguinal canal begin?
At the deep inguinal ring.
Where does the inguinal canal end?
The superficial inguinal ring, 4cm away from the deep inguinal ring.
What passes through the inguinal canal in men and women?
Spermatic cord in men, and the round ligament of the uterus in women. The ilioinguinal nerve passes through part of the canal in both sexes.
What makes up the floor of the inguinal canal?
The inguinal ligament and medially, the lacunar ligament.
What makes up the roof of the inguinal canal?
The internal oblique, transversus abdominus and transveralis fascia.
What makes up the posterior wall of the inguinal canal?
The transversalis fascia and medially, the conjoint tendon.
What makes up the anterior wall of the inguinal canal?
The aponeurosis of the external oblique.
What is a direct inguinal hernia?
It protrudes into the inguinal canal through a weakened area in the tranversalis fascia near the medial inguinal fossa within Hesselbach’s triangle.
What are the borders of the Hesselbach’s triangle?
Inferiorly - medial half of the inguinal ligament. Medially - lower lateral border of rectus abdominis. Laterally - inferior epigastric artery.
What is an indirect inguinal hernia?
It protrudes through the deep inguinal ring, within the diverging arms of the transveralis fascial sling.
What are most indirect inguinal hernias a result of?
Failure of embryonic closure of the deep inguinal ring after the testicle has passed through it.
Where do epigastric hernias occur?
In the epigastric region, in the midline between the xiphoid process and the umbilicus, through linea alba.
What are the risk factors of epigastric hernias?
Obesity and pregnancy.
Where do umbilical hernias occur?
Through the umbilical ring.
What causes umbilical hernias?
Raised intra-abdominal pressure with weakness and incomplete closure of the anterior abdominal wall after ligation of the umbilical cord at birth.
What is the common patient of acquired umbilical hernias?
Women and obese people.
What is a femoral hernia?
A protrusion of abdominal viscera into the femoral canal, occurring through the femoral ring.
How does a femoral hernia appear?
As a mass, often tender, in the femoral triangle.
How are femoral hernias bounded?
By the femoral vein laterally and the lacunar ligament medially.
What is the effect of a hernia in the femoral triangle?
It compresses the contents and distends the wall of the canal.
Why are femoral hernias originally small?
They are contained within the canal.
How can femoral hernias grow larger?
By passing inferiorly through the saphenous opening into the subcutaneous tissue of the thigh.
In which gender are femoral hernias more common?
Females.
Why are femoral hernias more common in females?
They have a wider pelvis.
Why may strangulation of femoral hernias occur?
Because of the sharp, rigid boundaries of the femoral ring.
What is strangulation of hernias?
The constriction of blood vessels, preventing the flow of blood to tissue.
What is incarceration of hernias?
The hernia can’t be reduced, or pushed back into place, without very much external effort.
