Abdominal Wall And Hernias Flashcards
What is a hernia?
A protrusion of part of the abdominal contents beyond the normal confines of the abdominal wall.
What does a hernia consist of?
The sac
The contents of the sac
Coverings of the sac
What is the sac?
A pinch of peritoneum
What may form the contents of a hernia?
Loops of bowel or omentum
Any structure seen within the abdominal cavity
How do we decide on the position of a hernia?
The point at which the sac leaves the abdomen
What is the coverings of a hernia?
The layers of abdominal wall the hernia passes through
Where are common sites of hernaition (i.e. Weak points in the abdominal wall?
Inguanal canal
Femoral canal
Umbilicus
Any previous incision site
What’s the inguanal canal?
Oblique passage through the lower part of the abdominal wall- present for testicular descent from the abdomin and the round ligament of the uterus runs through this tothe labium majus
Where do you find the inguanal canal?
Slightly medial to mid point of the inguanal ligament
Where do testis normally descend?
7-8months gestation
What’s the processes vaginalis and what should happen to it?
It’s a punch of peritoneum tha should obliterate following testicular descent (leaving no peritoneal connection between the abdomen and the testis through the inguanal canal)
What’s the gubernaculum?
Condensed band of mesenchyme that links the inferior border of the testis to the labioscrotal swelling
What congenital defect puts an individual at risk of inguanal hernaition indirectly?
Failure to obliterate processes vaginalis
What are the boundaries of the inguanal canal?
Anterior wall- aponeurosis of external oblique (exit point at superficial ring)
Roof- internal oblique and transverse abdominus
Floor - inguanal ligament and lacunae ligament
Posterior- transversalis fascia (deep ring is the entrance point) and medically the conjoint tendon of internal oblique and transverse abdominus
These are the coverings of the inguanal canal hernia
What’s the difference between a direct and an indirect inguanal hernia?
Indirect passes through the canal by the deep ring and means the processes vaginalis failed to obliterate
What Re the apidemiological features of inguanal hernias?
50% indirect 7:1 male to female and more right sided (testis sits lower)
25% direct
What proportion of abdominal hernias are inguanal?
75%
What percentage of admonish hernias are umbilical and incisional?
10% each
What is the least common abdominal hernia type?
Femoral 3/5% of abdominal hernias
The inferior epigastric vessels are useful markers for what when considering abdominal hernias?
If an inguanal hernia is lateral to the inferior epigastric vessels it’s indirect as it’s exiting through the deep ring. If the inguanal hernia is medial to the inferior epigastric vessels in direct as its not running through the inguanal canal (it can’t be if it’s not entering the deep ring which is lateral)
What is Jesselbachs triangle?
The weakness in the abdominal walla where direct inguanal hernaition takes place
List the three borders of the Hesselbachs triangle.
Medial- rectus abdominus
Superior (looks lateral in diagram)- inferior epigastric vessels
Inferior - lacunar ligament
List the course of an abdominal indirect inguanal hernia that terminates in the scrotum.
Deep inguanal ring
Inguanal canal
Superificial inguanal ring
Scrotum - needs patent processes vaginalis for this last step
The scrotum is medial to the inferior epigastric vessels so why is an inguanal hernia here indirect?
Leaves abdomen at the deep inguanal ring
