Abdomen and hernia (+all GI surgery core) Flashcards
Where is mid-inguinal point? Significance?
Halfway between ASIS and pubic symphysis
Landmark of femoral artery, DIR for occlusion test
Where is the midpoint of inguinal ligament?
Halfway between ASIS and pubic tubercle
Where is Hasselbach’s triangle? Significance?
(inferior) inguinal ligament + (medial) rectus abdominus + (lateral) inferior epigastric vessels.
Significance site of direct inguinal hernias(indirect lateral to the triangle)
RF weakness of abd wall due to trauma esp abd surgery & elderly (degenerative weakness)
Boundaries of femoral canal?
inguinal (ant), lacunar (med), pectineal (post) ligaments, fem vein (lateral)
Boundaries of the femoral triangle?
(superior) inguinal ligament, (lateral) sartorius, (medial) adductor longus
Boundaries of the inguinal canal?
Entrance DIR (1 cm above the midpoint of the inguinal ligament); exit - SIR
Anterior EOM aponeurosis, Posterior Transversalis fascia laterally, conjoint tendon medially. Roof IOM + transversus abdominis muscles Floor inguinal ligament
Contents of inguinal canal?
3 vessels
1. Artery to vas deferens
2. Testicular artery/v
3. Cremasteric artery/v
3 nerves
1. Ilioinguinal*
2. sympathetic fiber from T10
3. Genital branch of genitofemoral
3 others
1. Vas deferens (round ligament in F)
2. Pampiniform plexus
3. Lymphatics
Why do you insist on palpating the testis during hernia exam?
Indirect hernia is associated with undescended testis
Chronic compression on spermatic cord by hernia sac may cause testicular atrophy.
Confirm the diagnosis by ruling out DDX: CA testis, communicating hydrocele
What is the risk of hernia on the other side if the patient has previous hx of hernia?
30%
What is Pantaloon hernia?
simultaneous protrusion of direct & indirect on same side
Rank the order of risks of strangulation of different hernias.
Spigelian > femoral > indirect > direct (incisional depending on size)
