6) Hernias

Question 1

What is a hernia?

Answer 1

Protrusion of part of the abdominal contents beyond the normal confines of the abdominal wall

Question 2

What 3 parts does a hernia consist of?

Answer 2

Sac
Contents
Covering

Question 3

What is the sac?

Answer 3

Pouch of peritoneum

Question 4

Generally, what are the contents for a hernia?

Answer 4

Any structures found within the abdominal cavity

Commonly, loops of bowel or ommentum

Question 5

What is the covering of a hernia?

Answer 5

Layers of abdominal wall through which the hernia has passed

Question 6

What weaknesses in the abdominal wall may a hernia pass through?

Answer 6

Inguinal canal
Femoral canal
Umbilicus
Previous incisions

Question 7

What is the inguinal canal?

Answer 7

Oblique passage through lower part of abdominal wall, extends from inside peritoneal cavity to scrotum in males

Question 8

What passes through inguinal canal in males?

Answer 8

Ilioinguinal nerve and spermatic cord

Question 9

What passes through inguinal canal in females?

Answer 9

Ilioinguinal nerve and round ligament (from uterus to labum majus)

Question 10

Why is an inguinal hernia more likely in men?

Answer 10

Larger and more prominent

Failure of processus vaginalis to obliterate

Question 11

Where are the testes located before descent?

Answer 11

Posterior abdominal wall, retroperitoneal

Question 12

What is the gubernaculum?

Answer 12

Condensed band of mesenchyme that connects testes to scrotal pouch

Question 13

How do the testes descend?

Answer 13

Gubernaculum shortens

Question 14

What is the processus vaginalis?

Answer 14

Outpouching of peritoneum which is anterior to testes

Question 15

What usually happens to the processus vaginalis?

Answer 15

Obliterates to form tunica vaginalis - small amount of peritoneum covering an aspect of testicle

Question 16

What leads to increased risk of inguinal hernia?

Answer 16

Partial recession of processus vaginalis

Question 17

Why does partial recession of processus vaginalis increase risk of hernia?

Answer 17

Leaves a peritoneal lined pathway from peritoneal cavity to scrotum

Question 18

What forms the floor of the inguinal canal?

Answer 18

Inguinal ligament (a rolled edge of external oblique aponeurosis) and thickened medially by the lacunar ligament

Question 19

What forms the roof of the inguinal canal?

Answer 19

Internal oblique and transversus abdominis

Question 20

What forms the posterior wall of the inguinal canal?

Answer 20

Transversalis fascia, conjoint tendon medially (aponeurosis of IO + TA)

Question 21

What forms the anterior wall of the inguinal canal?

Answer 21

Aponeurosis of external oblique

Question 22

What and where is the entrance to the inguinal canal?

Answer 22

Deep ring, posterior wall

Question 23

What and where is the exit of the inguinal canal?

Answer 23

Superficial ring, anterior wall

Question 24

What is an indirect hernia?

Answer 24

Hernia that is lateral to inferior epigastric vessels

Question 25

What is at the mid-inguinal point?

Answer 25

Femoral artery, between ASIS and pubic symphysis

Question 26

What is at the mid point of the inguinal ligament?

Answer 26

Deep inguinal ring, between ASIS and pubic tubercle

Question 27

Describe the entry point and passage of an indirect hernia:

Answer 27

Enters through deep inguinal ring, traverses canal and exits through superficial ring Can descend into scrotum depending on processus vaginalis obliteration

Question 28

Describe the entry passage of a direct hernia:

Answer 28

Through Hesselbach's triangle

Question 29

What are the borders of Hesselbach's triangle?

Answer 29

Medial - rectus abdominis Lateral - inferior epigastric vessels Floor - Inguinal ligament

Question 30

What is an incarcerated hernia?

Answer 30

Stuck or irreducible hernia

Question 31

What is a strangulated hernia?

Answer 31

Disruption of hernia blood supply, can result in tissue necrosis

Question 32

What is a femoral hernia?

Answer 32

Protrusion of abdominal viscera into femoral canal through femoral ring

Question 33

Why are femoral hernias more common in females?

Answer 33

Wider pelvis and broader femoral ring

Question 34

Why is strangulation likely in femoral hernias?

Answer 34

Femoral ring has rigid boundaries

Question 35

What is an epigastric hernia?

Answer 35

Protrusion through linea alba between xiphoid process and umbilicus Chronic straining forces more fat and peritoneum out

Question 36

What 3 types of umbilical hernia are there?

Answer 36

Congenital Acquire infantile Acquire adult

Question 37

What is a congenital umbilical hernia?

Answer 37

Through umbilical ring, contents herniate into umbilical cord and have peritoneal covering

Question 38

What is an acquire infantile umbilical hernia?

Answer 38

Herniation through weakness in scar of umbilicus

Question 39

What is an acquire adult umbilical hernia?

Answer 39

Increased intra-abdominal pressure cause herniation through linea alba in region of umbilicus Causes: chronic cough, obesity