343 - 344 - GI anatomy Flashcards
Where does an indirect hernia emerge from the abdomen?
internal inguinal ring
Through which abdominal wall layers does the spermatic cord travel?
- parietal peritoneum
- extraperitoneal tissue
- transversalis fascia
- transversus abdominis muscle
- internal oblique muscle
- aponeurosis of external oblique muscle
- inguinal ligament
Which structures form the borders of the inguinal triangle? What is another name for this triangle?
medial - rectus abdominus (lateral border)
superolateral - inferior epigastric vessels
inferior - inguinal ligament
Hasselbach triangle
Where does a direct hernia emerge from the abdomen?
protrudes through the abdominal wall in the inguinal triangle
What are the layers of the spermatic cord?
- internal spermatic fascia (transversalis fascia)
- cremasteric muscle and fascia (internal oblique)
- external spermatic fascia (external oblique)
What fibrous structure runs midline from the xiphoid process to the pubic symphisis?
linea alba
Which structure is more medial at the level of the spermatic cord: medial umbilical ligament or median umbilical ligament?
median umbilical ligament
What are 4 main types of hernia in the GI system?
- diaphragmatic
- indirect inguinal
- direct inguinal
- femoral
What is the definition of a hernia?
a protrusion of peritoneum through an opening, usually a site of weakness
What is a diaphragmatic hernia?
abdominal structures enter thorax
Who gets diaphragmatic hernias and why?
infants as a result of defective development of pleuroperitoneal membrane
What is the most common type of diaphragmatic hernia? What happens?
hiatal hernia - stomach herniates upward through esophageal hiatus of the the diaphragm
What is the most common type of hiatal hernia? What happens?
sliding hiatal hernia: GE junction is displaced ↑ through diaphragm → “hourglass stomach”
What is the less common type of hiatal hernia? What happens?
paraesophageal hernia: fundus protrudes into the thorax; GE junction is normal
What is a physical exam finding in a paraesophageal hernia? (pathoma)
bowel sounds in lower lung field (it also causes lung hypoplasia)
Describe an indirect inguinal hernia
Goes through the internal (deep) inguinal ring, external (superficial) inguinal ring, and into the scrotum
Does an indirect inguinal hernia enter the internal inguinal ring medially or laterally to the inferior epigastric artery?
laterally
MD’s don’t LIe: Medial = Direct; Lateral = Indirect
Who gets indirect inguinal hernias?
- infants: due to failure of processus vaginalis to close (can form hydrocele)
- more common in males
What layers of the spermatic fascia cover an indirect hernia vs. a direct hernia?
indirect: all 3 (external, cremasteric, internal spermatic fascia)
direct: external spermatic fascia only
Describe what happens in a direct inguinal hernia
gut bulges directly through abdominal wall through the inguinal triangle
Does a direct inguinal hernia enter the internal inguinal ring medially or laterally to the inferior epigastric artery?
medially
MD’s don’t LIe: Medial = Direct; Lateral = Indirect
Which inguinal ring(s) does an external inguinal hernia pass through?
external ring only
Who gets direct inguinal hernias?
older men usually
Describe what happens in a femoral hernia
protrudes below the inguinal ligament through the femoral canal below and lateral to the pubic tubercle
Who gets femoral hernias?
more common in females
What kind of hernia is the leading cause of bowel incarceration?
femoral hernia
