Anatomy of Hernias

Question 1

Boundaries of the inguinal triangle

Answer 1

Inferiorly - Inguinal ligament Medially - Lateral border of rectus femorus Laterally - Inferior epigastric vessels

Question 2

Which is congenital - direct or indirect inguinal hernia?

Answer 2

Indirect inguinal hernia

Question 3

Lumbar plexus in the groin is made of fibers from __ to ___.

Answer 3

L1-L4

Question 4

Inguinal ligament are formed by what muscles?

Answer 4

Aponeurosis of external oblique attach to the pubic crest, forming the inguinal ligament.

Question 5

Deep inguinal ring made out of

Answer 5

The transversalis fascia mainly makes up the deep inguinal ring (though internal oblique also contributes)

Question 6

Femoral artery and vein come out of the

Answer 6

deep inguinal ring

Question 7

Superficial inguinal ring is made from the

Answer 7

aponeurosis of the external oblique

Question 8

Inguinal ligament is an extension of ___ that attaches to the ___ and the ___.

Answer 8

Aponeurosis of the ext oblique. Attaches to the anterior superior iliac spine and the pubic crest.

Question 9

Gonads start in the posterior abdomen and then the ____ contracts, pulling down the gonads down into the scrotum.

Answer 9

gubernaculum Layers of abdominal wall are brought down with it.

Question 10

Processus vaginalis is an extension of

Answer 10

peritoneum that is brought down with the fascia of the abdominal wall in the descent of the gonads into the scrotum. Should close off later.

Question 11

Indirect inguinal hernias occur lateral to the epigastric vessels; They pass through the ___ into the ___. They are the result of a deformation in what structure? These are congenital.

Answer 11

Indirect inguinal hernias pass through the deep inguinal ring and into the inguinal canal; often descends through the superficial ring into the scrotum or labium. PATENT PROCESSUS VAGINALIS - peritoneal fluid and anything mobile in the abdomen can enter

Question 12

The gubernaculum remnant for the female is the

Answer 12

round ligament of the uterus

Question 13

how can you recognize an indirect inguinal hernia on an MRI?

Answer 13

Ext oblique are clearly pulled back

Testes are pulled to the side

Question 14

Direct inguinal hernias occur medial to the epigastric vessels. Where can the intestines herniate into? Why does this occur?

Answer 14

Through Hasselbach’s/inguinal triangle. Can pass through the superficial inguinal ring, but not the deep like indirect does. Occurs because of weakness in the abdominal wall

Question 15

Iliohypogastric nerve of lumbar plexus in hernia repair

Answer 15

Arises from L1.

Innervates the internal oblique & transverse muscles.

>Anterior branch supplies hypogastric (pubic) region skin

>Lateral branch supplies lateral buttock/thigh skin

Question 16

Ilioinguinal nerve of lumbar plexus in hernia repair

Answer 16

Efferent to the internal oblique and transversus abdominis.

Provide sensory to…

> skin of upper & medial thigh

> root of penis and upper scrotum in men

> mons pubis & labum majus in women.

Question 17

What are the 3 nerves from L1 that can be affected in hernia repair (superior to inferior)?

Answer 17

Iliohypogastric

Ilioinguinal

Genitofemoral

Question 18

Genitofermoral nerve’s two branches

Answer 18

Genital branch: efferent that draws up testes in the Cremaster reflex when skin on medial upper thigh is stroked

Femoral branch provides sensation to the skin of upper & medial thigh, anterior scrotum, penis/mon pubis, scrotum/labium majus

Question 19

Femoral hernia

Answer 19

Hernia through the femoral ring and femoral canal (medial to the femoral vessels and femoral sheath) into the medial aspect of the thigh. Occurs in women with wide pelvises. Loss of natural fat pad creates a canal for the bowel to herniate through.

Question 20

If an examiner puts their pinky into the superficial ring and asks the patient to cough: ___ inguinal hernia will be felt on the tip ___ inguinal hernia will be felt on the side

Answer 20

INDIRECT inguinal hernia at the tip DIRECT inguinal hernia on the side

Question 21

___ hernia is the most common groin hernia in females.

Answer 21

Indirect inguinal hernia

Question 22

What causes a direct inguinal hernia? A defective ___.

Answer 22

Aponeurosis of the transversus abdominus, because it forms a significant portion of the posterior wall of the inguinal canal and the lower part of the inguinal triangle.