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Surgery.(General 1).Hernia > 5. Direct inguinal hernia > Flashcards

5. Direct inguinal hernia Flashcards

1
Q

INCIDENCE of Direct inguinal hernia

A
  • Common in old males.

* 50 % bilateral

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2
Q

ETIOLOGY of Direct inguinal hernia

A

a. Weakness of lower abdominal wall muscles with chronic increased intra abdominal pressure.
b. Paralysis of conjoint tendon

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3
Q

Pathogenesis of Paralysis of conjoint tendon in ETIOLOGY of Direct inguinal hernia

A

Injury of the ilioinguinal nerve during appendectomy (only after muscle cutting).

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4
Q

PATHOLOGY & TYPES of Direct inguinal hernia

A

1 - Lateral Type “Commonest” :

2- Medial Type “Rare”

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5
Q

commonest type of Direct inguinal hernia

A

Lateral Type

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6
Q

Pathogenesis of Lateral Type of Direct inguinal hernia

A
  • Bulges through the lateral part of Hasselbach’s triangle (made of fascia transversalis only).
  • Thus has a very wide neck and is less liable to complications.
  • Never descends to the scrotum.
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7
Q

Alternative name for Medial Type of Direct inguinal hernia

A

funicular form of Ogilvie

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8
Q

Pathogenesis of Medial Type of Direct inguinal hernia

A

Passes through a defect in the conjoint tendon in front of fascia transversalis in the medial half of the triangle.

  • The edge of the defect is sharp & the neck is narrow )> liable to complicate.
  • It may descend to the scrotum
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9
Q

Type of Direct inguinal hernia Passes through a defect in the conjoint tendon in front of fascia transversalis in the medial half of the triangle.

A

Medial Type of Direct inguinal hernia

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10
Q

Type of Direct inguinal hernia bulges through the lateral part of Hasselbach’s triangle (made of fascia transversalis only)

A

Lateral Type of Direct inguinal hernia

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11
Q

Type of Direct inguinal hernia has a very wide neck and is less liable to complications

A

Lateral Type of Direct inguinal hernia

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12
Q

Type of Direct inguinal hernia in which The edge of the defect is sharp & the neck is narrow and liable to complications

A

Medial Type of Direct inguinal hernia

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13
Q

Type of Direct inguinal hernia Never descends to the scrotum

A

Lateral Type of Direct inguinal hernia

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14
Q

Type of Direct inguinal hernia may descend to the scrotum

A

Medial Type of Direct inguinal hernia

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15
Q

the reason why Lateral Type of Direct inguinal hernia is less liable to complications

A
  • Bulges through the lateral part of Hasselbach’s triangle (made of fascia transversalis only).
  • Thus has a very wide neck and is less liable to complications.
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16
Q

the reason why Medial Type of Direct inguinal hernia is more liable to complications

A

Passes through a defect in the conjoint tendon in front of fascia transversalis in the medial half of the triangle.

  • The edge of the defect is sharp & the neck is narrow )> liable to complicate.
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17
Q

Difference between Oblique inguinal hernia and Direct inguinal hernia by

A

Age
Side

Shape
Descent
Descent to scrotum
Reducibility
Complications

Internal ring test
External ring test

Relation of neck of sac to inferior epigastric artery
(at operation)

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18
Q

Age in Oblique inguinal hernia

A

Any Age

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19
Q

Age in Direct inguinal hernia

A

Usually old age

20
Q

Side in Oblique inguinal hernia

A

Uni or bilateral

21
Q

Side in Direct inguinal hernia

A

Usually bilateral

22
Q

Shape in Oblique inguinal hernia

A

Oblong

23
Q

Shape in Direct inguinal hernia

A

Hemisherical

24
Q

Descent in Oblique inguinal hernia

A

Downwards, forwards and medially

25
Q

Descent in Direct inguinal hernia

A

Forward

26
Q

Descent to scrotum in Oblique inguinal hernia

A

May occur

27
Q

Descent to scrotum in Direct inguinal hernia

A

Very rare

28
Q

Reducibility in Oblique inguinal hernia

A

Upwards, backwards, and laterally

29
Q

Reducibility in Direct inguinal hernia

A

Backwards

30
Q

Complications in Oblique inguinal hernia

A

More common

31
Q

Complications in Direct inguinal hernia

A

Less common

32
Q

Internal ring test in Oblique inguinal hernia

A

Hernia does not protrude

33
Q

Internal ring test in Direct inguinal hernia

A

Hernia protrudes

34
Q

External ring test in Oblique inguinal hernia

A

Impulse at the tip of the finger

35
Q

External ring test in Direct inguinal hernia

A

Impulse at the side

of finger

36
Q

Relation of neck of sac to inferior epigastric artery

(at operation) in Oblique inguinal hernia

A

Lateral to the artery

37
Q

Relation of neck of sac to inferior epigastric artery

(at operation) in Direct inguinal hernia

A

Medial to the artery

38
Q

Internal ring test

A
  • Steps

* Results

39
Q

steps of Internal ring test

A
  1. Let the patient lies down.
  2. Reduce the hernia.
  3. Occlude the internal ring by the thumb of opposite hand (internal ring is 1/2 inch above the mid point of inguinal ligament ).
  4. Then ask the patient TO STAND UP and cough
40
Q

Results of Internal ring test

A
  • If hernia descends )> direct hernia.

* If hernia descends after release of thumb )> indirect hernia.

41
Q

External ring test (not done)

A
  • Steps
  • Results
  • The reason why it’s not done now
42
Q

Steps of External ring test

A

Let the patient lies down & reduce the hernia.

Introduce the little finger into the inguinal through external ring and ask the patient to cough.

43
Q

Results of External ring test

A

If impulse is felt at the tip )> indirect hernia

If impulse is felt at the side )> direct hernia

44
Q

The reason why External ring test is not done now

A

a. Not a very sensitive test.
b. Painful.
c. Can stretch the external ring )> inguinal hernia can reach the scrotum

45
Q

Zeiman’s 3 fingers test

A

The patient lies down then the hernia is reduced,

3 fingers are put as follows :

  • One on the internal ring (for indirect hernia)
  • One on the external ring (for direct hernia)
  • And the third over the saphenous opening (for femoral hernia).
  • The patient is asked to cough and you will see which finger receives the impulse first.

Surgery.(General 1).Hernia (13 decks)

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