Abdominal Wall Hernias Flashcards
Majority of all abdominal wall hernias are found in the ____
groin
majority of groin hernias are located in the
inguinal canal
What are the layer of the abdominal wall (anterior to posterior)
Skin Camper (Superficial fatty), Scarpa (Deep Membranous), Gallaudet (External oblique fascia) Internal Oblique fascia Transversus abdominis Transversalis fascia Properitoneal space and fat Parietal peritoneum
What are the layers of the scrotum?
SkIn Dartos Colles External spermatic fascia Cremasteric fascia Does not reach the scrotum Internal spermatic fascia Properitoneal space and fat Tunica vaginalis
The superficial fatty layer is the ____ muscle of the scrotum
Superficial fatty (camper) : dartos
The colles fascia is equivalent to the _____ in the abdominal wall
Scarpas
Deep Membranous (scarpa) : Colles
Gallaudet fascia is also the ____ in the scrotum
external spermatic fascia
The tunica vaginalis is equivalent of ___ in the abdomen
parietal peritoneum
This layer of the abdominal wall does not reach the scrotum
transversus abdominis
This is equivalent of the transversalis fascia in the in the internal spermatic fascia
transversalis fascia
What is the length of the inguinal canal?
4-6 cm in length
What are the walls of the inguinal canal?
Anterior: External oblique aponeurosis
Posterior: Medial - Conjoint, Lateral - transversalis fascia and TA muscle
Lateral: Internal oblique
Medial: Conjoint tendon
Superior: arching fibers of IO and TA muscles
Inferior: Inguinal and lacunal ligamnet
This lies immediately above and medial to the pubic tubercle; triangular opening
superficial inguinal ring
located between the pubic tubercle and the anterior superior iliac spine
deep inguinal ring
Contents of the femoral sheath
- Femoral artery
- Femoral vein
- Lymphatics
The inguinal ligament is also called
Poupart’s ligament
the conjoint tendon is composed of _____
Internal Oblique
Transversus Abdominis
[true/false]
the spermatic cord passes through the inguinal canal
true
What are the contents of the spermatic cord?
3 fasciae: external, cremasteric, internal spermatic fascia
3 arteries: testicular, cremasteric, vas deferens
3 veins: pampiniform, cremasteric, deferential
3 nerve: autonomic, genital branch of genitofemoral nerve, ilioinguinal nerve
Vas deferens
Lymphatics
the lacunar ligament under the inguinal ligament is called
Giembernat’s
the nerve inside the triangle of doom
Genital branch of genitofemoral nerve
the arteries and veinsinside the triangle of doom
iliac artery and vein
gonadal vessels
the medial border of the triangle of doom is
ductus deferens
What are the borders of the triangle of pain
Inferolateral: iliopubic
Lateral: peritoneum
Superomedial: gonadal vessels
What are the arteries and veins containing the triangle of pain
deep circumflex iliac artery and vein
What are the nerve inside the triangle of pain
Femoral nerve
Femoral branch of the genitofemoral nerve
anterior cutaneous nerve
lateral femoral cutaneous nerve
the circle of death is composed of these arteries
- External iliac arteries (from common iliac)
- Internal iliac arteries (from common iliac)
- obturator artery
- Aberrant artery
- Inferior epigastric
[sphincter/shutter action]
Tranversalis fascia
sphincter action
[sphincter/shutter action]
Transversus abdominis and internal oblique muscles
shutter action
This forms a sling that closes the internal ring under the muscular edge of the internal oblique muscle by contraction fo the transversus abdominis muscle. This acts as a sphincter.
transversalis fascia
____ hernia that does not traverse the internal ring; traverses through abdominal wall
direct inguinal hernia
____ hernia that passes through the internal inguinal ring and down the inguinal canal
indirect inguinal hernia
___ hernia
medial or inferior to the inferior epigastric vessels
direct inguinal hernia
MAD LICE
____ hernia is lateral or superior to the inferior epigastric vessels
indirect inguinal hernia
MAD LICE
[NYHUS classification]
indirect, normal sized internal ring
Type I
[NYHUS classification]
indirect, does not extend into scrotum, internal ring enlarged
Type II
[NYHUS classification]
Direct hernia
Type III-A
[NYHUS classification]
Indirect hernia, large that it enroaches the posterior inguinal wall
Type III-B
[NYHUS classification]
indirect hernia, indirect sliding, scrotal, pantaloon hernias
Type III-B
[NYHUS classification]
femoral hernia
Type III-C
[NYHUS classification]
Recurrent direct hernia
Type IV-A
[NYHUS classification]
Recurrent indirect hernia
Type IV-B
[NYHUS classification]
Recurrent femoral hernia
Type IV-C
[NYHUS classification]
Recurrent hernia, combination
Type IV-D
[Physical Examination]
in the Zieman Technique, the index finger is placed at the ____
deep inguinal ring
[Physical Examination]
in the Zieman Technique, the middle finger is placed at the ____
superficial inguinal ring
[Physical Examination]
in the Zieman Technique, the ring finger is placed at the ____
saphenous opening
[Physical Examination]
in the Zieman Technique, the impulse is felt at the index finger, the hernia is ___
indirect
index finger: deep inguinal
[Physical Examination]
in the Zieman Technique, the impulse is felt at the middle finger, the hernia is ___
direct
middle finger: superficial ring
direct: middle: superficial
[Physical Examination]
in the Zieman Technique, the impulse is felt at the ring finger, the hernia is ___
femoral
ring finger: saphenous opening
[management]
symptomatic hernia
elective surgery
[management]
strangulated hernia
urgent surgery
[management]
In a symptomatic, primary unilateral hernia. The type of surgery is?
Lichtenstein or endoscopic
[management]
In a symptomatic, primary bilateral hernia. The type of surgery is?
Endoscopic or lichtenstein
What are the structures lateral to the femoral hernia
Femoral: NAV (lateral to medial)
the surgical technique in treating femoral hernia
Mcvay
Bassini procedure includes closure of these layers
3 layers
TF, TA, IO
Shouldice repair includes repair of how many layers?
4 layers
[what nerve is damaged]
severe burning pain radiating down the lateral side of the ipsilateral thigh
lateral femoral cutaneous nerve
this nerve innervates the inguinal and gluteal region
Iliohypogastric
This nerve innervates the anterior surface of the scrotum, labia majora, root of penis, mons pubis, small portion of the upper anteromedial thigh
Ilioinguinal nerve
This innervates the spermatic cord/round ligament
genitofemoral nerve
this nerve innervates the anterior thigh and anteromedial aspect of the leg
femoral nerve
[Name that hernia]
superior lumbar triangle hernia
Grynfeltt’s hernia
[Name that hernia]
inferior lumbar triangle
Petit’s hernia
[Name that hernia]
only antimesenteric part of the bowel
richter
[Name that hernia]
meckel diverticulum
littre hernia
[Name that hernia]
direct + indirect hernia
pantaloon
[Name that hernia]
2 loops in same ring
W shaped
Madyl
[Name that hernia]
appendix
amyand
[Name that hernia]
anterior diaphragm
morgagni
[Name that hernia]
posterior diaphragm
bochdalek
[Name that hernia]
lateral to rectus muscle
spigelian
[Name that hernia]
due to defective midline fusion of lateral abdominal wall;
located in the midline between the xiphoid process and the umbilicus
epigastric hernias
[diagnose]
clinically evident separation of the rectus abdominis muscle pillars resulting to a characteristic bulgin og the abdominal wall in the epigastrium
rectus abdominis diastasis
