7. Hernias Flashcards
What is a hernia?
Protrusion of part of the abdominal contents beyond the normal confines of the abdominal wall, beyond the confines of its containing cavity.
What 3 parts does a hernia consist of?
The sac.
Contents of the sac.
Coverings of the sac.
What forms the sac of the hernia?
Pouch of peritoneum.
What forms the contents of a hernia?
Any structure found within the abdominal cavity, commonly loops of bowel and omentum.
What forms the coverings of the sac in a hernia?
The layers of the abdominal wall through which the hernia has passed.
Weaknesses in what 4 areas can lead to an abdominal hernia?
Inguinal canal.
Femoral canal.
Umbilicus.
Previous incisions (from surgery).
What is the inguinal canal?
Is an oblique passage through the lower part of the abdominal wall.
What abnormality in foetal development can lead to inguinal hernias in a male?
Incomplete (partial) obliteration of the processes vaginalis.
What abnormality in foetal development can lead to scrotal hernias in a male?
No obliteration of the processes vaginalis.
What forms the floor of the inguinal canal?
Inguinal ligament and the lacunar ligament reinforces it medially.
What forms the roof of the inguinal canal?
The internal oblique and transverse abdominus.
What forms the posterior wall of the inguinal canal?
The transversalis fascia (contains the deep ring), and is reinforces by the conjoint tendon medially.
What forms the anterior wall of the inguinal ligament?
The aponeurosis of the external oblique (contains the superficial ring).
What type of inguinal hernia is more common and occurs in more males than females?
Indirect hernias.
What type of hernia is mainly right sides?
Indirect hernias.
What is an indirect inguinal hernia?
Hernia taking an indirect path through the inguinal canal. Passes through the deep ring, into the canal and then out of the superficial. Can only occur if there was failure to obliterate the processus vaginalis during development.
Where does an indirect inguinal hernia occur?
Lateral to the inferior epigastric vessels. Depending on where the processus vaginalis was obliterated, can potentially descend into the scrotum.
What is a direct inguinal hernia?
Hernia bulging through Hesselbach’s triangle.
Where does a direct inguinal hernia occur?
Medial to the inferior epigastric vessels, generally in the vicinity of the superficial inguinal ring.
What is a femoral hernia?
Hernia into the femoral canal, entering via the femoral ring.
Is a femoral hernia more common in males or females? Why?
Females (but still less common than inguinal hernias in females).
Due to different pelvic anatomy - femoral ring is wider.
Why can femoral hernias become strangulated?
Easily get incarcerated (stuck), arterial pressure pushes blood in, venous pressure is too low, leads to inflammation, blood supply becomes compromised, bowel dies, leading to necrosis and sepsis.
What are the boarders of the femoral ring?
Medially - lacunar ligament.
Laterally - femoral vein.
What is an acquired adult umbilical hernia (para-umbilical hernia)?
Adult umbilical hernia, through the linea alba (midline fusion of the rectus sheath) in the region of the umbilicus.
