Abdominal Wall And Hernias

Question 1

What is a hernia?

Answer 1

A protrusion of part of the abdominal contents beyond the normal confines of the abdominal wall.

Question 2

What does a hernia consist of?

Answer 2

The sac
The contents of the sac
Coverings of the sac

Question 3

What is the sac?

Answer 3

A pinch of peritoneum

Question 4

What may form the contents of a hernia?

Answer 4

Loops of bowel or omentum

Any structure seen within the abdominal cavity

Question 5

How do we decide on the position of a hernia?

Answer 5

The point at which the sac leaves the abdomen

Question 6

What is the coverings of a hernia?

Answer 6

The layers of abdominal wall the hernia passes through

Question 7

Where are common sites of hernaition (i.e. Weak points in the abdominal wall?

Answer 7

Inguanal canal
Femoral canal
Umbilicus
Any previous incision site

Question 8

What’s the inguanal canal?

Answer 8

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

Question 9

Where do you find the inguanal canal?

Answer 9

Slightly medial to mid point of the inguanal ligament

Question 10

Where do testis normally descend?

Answer 10

7-8months gestation

Question 11

What’s the processes vaginalis and what should happen to it?

Answer 11

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)

Question 12

What’s the gubernaculum?

Answer 12

Condensed band of mesenchyme that links the inferior border of the testis to the labioscrotal swelling

Question 13

What congenital defect puts an individual at risk of inguanal hernaition indirectly?

Answer 13

Failure to obliterate processes vaginalis

Question 14

What are the boundaries of the inguanal canal?

Answer 14

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

Question 15

What’s the difference between a direct and an indirect inguanal hernia?

Answer 15

Indirect passes through the canal by the deep ring and means the processes vaginalis failed to obliterate

Question 16

What Re the apidemiological features of inguanal hernias?

Answer 16

50% indirect 7:1 male to female and more right sided (testis sits lower)
25% direct

Question 17

What proportion of abdominal hernias are inguanal?

Answer 17

75%

Question 18

What percentage of admonish hernias are umbilical and incisional?

Answer 18

10% each

Question 19

What is the least common abdominal hernia type?

Answer 19

Femoral 3/5% of abdominal hernias

Question 20

The inferior epigastric vessels are useful markers for what when considering abdominal hernias?

Answer 20

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)

Question 21

What is Jesselbachs triangle?

Answer 21

The weakness in the abdominal walla where direct inguanal hernaition takes place

Question 22

List the three borders of the Hesselbachs triangle.

Answer 22

Medial- rectus abdominus
Superior (looks lateral in diagram)- inferior epigastric vessels
Inferior - lacunar ligament

Question 23

List the course of an abdominal indirect inguanal hernia that terminates in the scrotum.

Answer 23

Deep inguanal ring
Inguanal canal
Superificial inguanal ring
Scrotum - needs patent processes vaginalis for this last step

Question 24

The scrotum is medial to the inferior epigastric vessels so why is an inguanal hernia here indirect?

Answer 24

Leaves abdomen at the deep inguanal ring

Question 25

Do direct inguanal hernias pass through the inguanal canal?

Answer 25

No they leave through the hesselbachs triangle weakness and exit at the superficial ring.

Question 26

Which gender are femora hernias more common In?

Answer 26

Females

Question 27

Why is a femoral hernia more likely to occur in females?

Answer 27

Wider pelvis for birthing

Question 28

What’s and incarcerated hernia?

Answer 28

Nonreducible

Question 29

What’s the concern with a non reducible femoral hernia?

Answer 29

It may strangulate (the blood supply to the tissue may be disrupted leading to sepsis)

Question 30

Do you get more inguanal or femoral hernias in women?

Answer 30

Inguanal
(1 in 8 inguanal hernias are females and inguinal hernias account for 75% of abdominal hernias- femoral are only 3-5% so even though they are more common in women there are still more cases of female inguinal overall)

Question 31

How does strangulation of a hernia lead to sepsis?

Answer 31

Veins occluded by strangulation so area becomes venous engorged as arterial pressure sufficient enough to still perfuse.
Pressure increases with venous engorgement until arteries occlude.
Tissue becomes necrotic and ruptures.
Peritonitis and sepsis

Question 32

Where is the femoral canal?

Answer 32

In the femoral triangle medial to the femoral vein

Question 33

What opening may a femoral hernia leave the femoral canal through?

Answer 33

The saphenous opening

Question 34

Name a congenital umbilical hernia.

Answer 34

Ompahlocoele

Question 35

Gastrochisis and ompahaloceoele differ in which key ways?

Answer 35

Omphalocoele is a persistence of the developmental physiological herniation so the viscera remain covered in peritoneum.
Gastrochisis leads to bowel loops externally with no peritoneal coverings (more dangerous, amniotic fluid is toxic to the bowel wall)

Question 36

Why should an acquired umbilical hernia really be called a paraumbilical hernia?

Answer 36

Abdominal contents leaves through linea albuginea (the midline rectus sheath fusion line)

Question 37

Which gender more commonly suffers an acquired umbilical hernia?

Answer 37

Women

Question 38

What herniation occurs between the xiphoid process and the umbilicus through the line alba?

Answer 38

Epigastric hernia

Question 39

What contents herniates first in an epigastric hernia?

Answer 39

Extra-peritoneal fat

Continued straining will pull Peritoneum through with it.

Question 40

What range of symptoms can occur for hernias?

Answer 40

Ache a bit, to vomiting to sepsis