Abdo Wall And Hernia

Question 1

What is a hernia ?

Answer 1

Protrusion of tissue or organ beyond its containing cavity

Question 2

What are the 3 components of a hernia ?

Answer 2

The sac
The contents of sac
The covering of sac

Question 3

What is the inguinal canal?

Answer 3

Oblique passage through lower part of abdominal wall for structures to pass between abdomen and testis in males and for round ligament from uterus to labium majus

Question 4

At which age do the testis descend ?

Answer 4

7-8months

Question 5

What is the gubernaculum ?

Answer 5

Fibrous cord of tissue (mesenchyme ) attaching the inferior portion of testes to future scrotum (labioscrotal swelling ), guiding their descent

Question 6

What derives from the gubernaculum in adult male anatomy ?

Answer 6

Scrotal ligament

Question 7

What is the processus vaginalis and what derives from it ?

Answer 7

Pouch of peritoneum evaginating through inguinal canal during descent of testis down to scrotum which then degenerate leaving only the tunica vaginalis , a double fold of parietal peritoneum covering the testes

Question 8

What are the borders of the inguinal canal ?

Answer 8

Floor : inguinal ligament + lacunae ligament medially

Roof : Internal Oblique + transverse abdominis (muscular arches + aponeurosis )

Posterior wall : Transversalis fascia + conjoint tendon medially

Anterior wall : External oblique aponeurosis

Question 9

What important landmark differentiate direct to indirect inguinal hernia ?

Answer 9

Indirect hernia bulge out of abdominal cavity LATERALLY to the inferior epigastric vessels

Direct bulge out MEDIALLY to the inferior epigastric vessels

Question 10

What is the course of an indirect hernia , why can it happen ?

Answer 10

Deep inguinal ring >through canal > superficial ring >can go down to scrotum or labia majora

Happens when processus vaginalis doesn’t close

Question 11

Where do direct inguinal hernia bulge out ?

Answer 11

Medially to inferior epigastric vessels through the weakened abdominal wall at the Hesselbach’s triangle

Question 12

What are the borders of the Hesselbach’s triangle ?

Answer 12

Inferior: Inguinal ligament
Medial : Rectus abdominis muscle
Superior : Inferior epigastric vessels

Question 13

Where does the content of the hernia pass in a femoral hernia ?

Answer 13

The femoral canal through the femoral ring

Question 14

What is special about the femoral hernia and what can be the consequence ?

Answer 14

Easily get stuck : incarcerated , can’t push it back

Can lead to strangulation: compromised venous return cause increase of pressure ultimately compromising arterial supply

Question 15

What are the 3 types of umbilical hernia ?

Answer 15

Congenital : omphalocele
Acquired infantile : Contents herniated through weakness of umbilicus scar
Acquired adult : content goes through linea Alba near the Umbilicus

Question 16

What is the difference between an omphalocele and an acquired infantile umbilical hernia ?

Answer 16

Omphalocele : failure of physiological hernia to regress , content covered by peritoneum and in umbilical cord

Acquired : covered by skin ,normal development

Question 17

Where does an epigastric hernia occur ?

Answer 17

Through linea Alba , between Xiphoid process and umbilicus

Question 18

What can be the symptoms of a hernia ?

Answer 18

Pain
Vomiting (due to obstruction of bowel )
Sepsis (if strangulation and necrosis )