Abdominal wall and hernias Flashcards
What connects the greater and lesser sacs of the peritoneal cavity?
Foramen of Winslow
What kind of things will cause visceral pain?
- Visceral stretching
- Visceral inflammation
- Visceral ischemia
What symtpoms can accompany visceral pain?
- Nausea
- Vomiting
- Sweating
Compared to somatic pain, visceral pain is what?
Poorly defined and oftern midline
What path do sensory fibres of viscera follow?
Follow the reverse path laid out by the nerves
Do sympathetic nerves of the viscera synapse in the sympathetic chain?
Describe their path
No
They first pass through the sympathetic chain and coalesce to form splanchnic nerve and then synapse in ganglia outside the chain which are actually located back infront of the spinal cord
Why is visceral pain often felt in the midline?
Visceral sensory afferents are bilateral, both feeding back to the same place so the brain finds it difficult to determine which side the pain is on
What is a hernia?
A protrusion of part of the abdominal contents beyond the normal confines of the abdominal wall
What name is given to hernias that are stuck and what complications can arise from these?
Incacerated hernias
Cannot be moved and could cause ischemia or eventual necrosis
What are the signs and symptoms of hernias that are not stuck?
- fullness or swelling
- gets larger when intra-abdominal pressure increases
- aches
What are the signs and symptoms of hernias that are stuck?
- Pain
- Cannot be moved
- Nausea and Vomiting
- Systemic problems if ischemic
What causes a hernia?
Any area of weakness in the containing cavity (congenital, post surgery, normal points of weakness)
Accompanied by anything that increases intra abdominal pressure
- obesity
- weightlifting
- chronic constipation/ cough
What 3 parts make up a hernia?
- The sac
- Pouch of peritoneum
- Contents of sac
- any structure in abdominal cavity, usually loops of bowel
- Coverings of sac
- layers of abdominal wall
What is the inguinal canal?
An oblique passage through the lower part of the abdominal wall
Men: structures pass through from abdomen → testes
Women: round ligament passes from uterus → labia majora
What is the processus vaginalis and how can it lead to hernia?
A pouch of peritoneum that descends to the scrotum before the testes → once testes there the connection obliterates (remaining part is tunica vaginalis)
If the processus vaginalis doesn’t close the scotum and peritoneal cavity are connected giving a space for herniation
What are the boundaries of the Inguinal canal?
Floor= Inguinal Ligament (From ASIS→ Pubic Tubercle) & Lacunar ligament (medially)
Roof= internal oblique/ transverse abdominus
Posterior wall= Transversalis fascia
Anterior wall= aponeurosis of external oblique
Which part of the inguinal canal is the deep inguinal ring part of?
A gap in the transversalis fascia (posterior wall)
Where is the superficial ring found in the inguinal canal?
An exit in the anterior wall (aponeurosis of external oblique)
Describe the path of an indirect inguinal hernia as it leaves the containing cavity
Deep inguinal ring → Inguinal canal → superficial ring→ (into scrotum)
What proportion of abdominal hernias are direct vs indirect?
Direct = 25%
Indirect= 75%
Others (umbilical, incisional, femoral)
In relation to the epigastric vessels, how does an indirect inguinal hernia differ from a direct inguinal hernia?
Indirect = lateral to epigastric vessels
Direct = medial to epigastric vessels
What area of weakness do direct inguinal hernias pass through?
Hesselbach’s Triangle
What are the boundaries of Hesselbach’s triangle?
Medial – lateral border of the rectus abdominis muscle.
Lateral – inferior epigastric vessels.
Inferior – inguinal ligament.
What is the path of a direct inguinal hernia?
Through the Hesselbach’s triangle and through the superficial inguinal ring
