343 - 344 - GI anatomy

Question 1

Where does an indirect hernia emerge from the abdomen?

Answer 1

internal inguinal ring

Question 2

Through which abdominal wall layers does the spermatic cord travel?

Answer 2

1. parietal peritoneum
2. extraperitoneal tissue
3. transversalis fascia
4. transversus abdominis muscle
5. internal oblique muscle
6. aponeurosis of external oblique muscle
7. inguinal ligament

Question 3

Which structures form the borders of the inguinal triangle? What is another name for this triangle?

Answer 3

medial - rectus abdominus (lateral border)
superolateral - inferior epigastric vessels
inferior - inguinal ligament
Hasselbach triangle

Question 4

Where does a direct hernia emerge from the abdomen?

Answer 4

protrudes through the abdominal wall in the inguinal triangle

Question 5

What are the layers of the spermatic cord?

Answer 5

1. internal spermatic fascia (transversalis fascia)
2. cremasteric muscle and fascia (internal oblique)
3. external spermatic fascia (external oblique)

Question 6

What fibrous structure runs midline from the xiphoid process to the pubic symphisis?

Answer 6

linea alba

Question 7

Which structure is more medial at the level of the spermatic cord: medial umbilical ligament or median umbilical ligament?

Answer 7

median umbilical ligament

Question 8

What are 4 main types of hernia in the GI system?

Answer 8

1. diaphragmatic
2. indirect inguinal
3. direct inguinal
4. femoral

Question 9

What is the definition of a hernia?

Answer 9

a protrusion of peritoneum through an opening, usually a site of weakness

Question 10

What is a diaphragmatic hernia?

Answer 10

abdominal structures enter thorax

Question 11

Who gets diaphragmatic hernias and why?

Answer 11

infants as a result of defective development of pleuroperitoneal membrane

Question 12

What is the most common type of diaphragmatic hernia? What happens?

Answer 12

hiatal hernia - stomach herniates upward through esophageal hiatus of the the diaphragm

Question 13

What is the most common type of hiatal hernia? What happens?

Answer 13

sliding hiatal hernia: GE junction is displaced ↑ through diaphragm → “hourglass stomach”

Question 14

What is the less common type of hiatal hernia? What happens?

Answer 14

paraesophageal hernia: fundus protrudes into the thorax; GE junction is normal

Question 15

What is a physical exam finding in a paraesophageal hernia? (pathoma)

Answer 15

bowel sounds in lower lung field (it also causes lung hypoplasia)

Question 16

Describe an indirect inguinal hernia

Answer 16

Goes through the internal (deep) inguinal ring, external (superficial) inguinal ring, and into the scrotum

Question 17

Does an indirect inguinal hernia enter the internal inguinal ring medially or laterally to the inferior epigastric artery?

Answer 17

laterally

MD’s don’t LIe: Medial = Direct; Lateral = Indirect

Question 18

Who gets indirect inguinal hernias?

Answer 18

1. infants: due to failure of processus vaginalis to close (can form hydrocele)
2. more common in males

Question 19

What layers of the spermatic fascia cover an indirect hernia vs. a direct hernia?

Answer 19

indirect: all 3 (external, cremasteric, internal spermatic fascia)
direct: external spermatic fascia only

Question 20

Describe what happens in a direct inguinal hernia

Answer 20

gut bulges directly through abdominal wall through the inguinal triangle

Question 21

Does a direct inguinal hernia enter the internal inguinal ring medially or laterally to the inferior epigastric artery?

Answer 21

medially

MD’s don’t LIe: Medial = Direct; Lateral = Indirect

Question 22

Which inguinal ring(s) does an external inguinal hernia pass through?

Answer 22

external ring only

Question 23

Who gets direct inguinal hernias?

Answer 23

older men usually

Question 24

Describe what happens in a femoral hernia

Answer 24

protrudes below the inguinal ligament through the femoral canal below and lateral to the pubic tubercle

Question 25

Who gets femoral hernias?

Answer 25

more common in females

Question 26

What kind of hernia is the leading cause of bowel incarceration?

Answer 26

femoral hernia