deck_1406100 Flashcards
Where are the three most common sites for hernias?
Inguinal canal, femoral ring and the umbilicus
What a two points of weakness in the inferior part of the abdominal cavity?
The superficial and deep inguinal ring openings
What is the inguinal canal?
The 4cm passage which arises between the superficial and deep inguinal rings.
What passes through the inguinal canal?
The ilioinguinal nerve passes through here in men and women, as well as the spermatic cord or the round ligament of the uterus.
Where do you find the inguinal canal?
In between the muscles of the anterior abdominal wall above the inguinal ligament.
What is the inguinal ligament?
The inferior border of the aponeurosis of the external oblique muscle. It is attached between the ASIS and the pubic tubercle.
Define an abdominal hernia
Protrusion of part of the abdominal viscus through a defect in the abdominal wall.
What is the commonest form of hernia?
Indirect inguinal hernia
Describe an indirect inguinal hernia
Hernia enters via the deep inguinal ring, extending along the inguinal canal. It can appear in the scrotum or the labium majora if it passes fully along the canal.
Describe a direct inguinal hernia
Enters into the inguinal canal directly through its posterior wall through Hesselbach’s triangle. Usually only presents as a bulge in the inguinal region.
Describe a difference between where inguinal and femoral hernias are in relation to the inguinal ligament
Inguinal hernias, the neck of the sac arises above the inguinal ligament. Femoral hernias, the neck of the sac arises below the inguinal ligament
Describe a femoral hernia
The hernia sac protrudes into the femoral canal through the femoral ring. Appears as a bulge int he femoral triangle.
What are the borders of the femoral triangle?
Superior: Inguinal ligamentMedial: Medial border of Adductor longusLateral: Medial border of SartoriusFloor: Pectineus, iliopsoas and adductor longus muscleRoof: Fascia lata
What happens with femoral hernias?
Compresses the contents of the femoral canal as hernia is bounded by the femoral vein and lacunar ligament. Can increase in size if they pass through the saphenous opening into the subcutaneous tissue of the thigh.
What are the characteristics of people who get femoral hernias?
More common in females than males (due to wider hips).Tend to be quite rare.
What is a common complication of femoral hernias?
Strangulation of hernia often occur due to the rigid boundaries of the femoral ring.
What is a diaphragmatic hernia?
Hernia protrude through a developmental defect in the diaphragm into the thoracic cavity.
Describe an epigastric hernia?
Occur in the epigastric region, where there is a herniation between the xiphoid process and the umbilicus through the damaged fibres of the linea alba.
What are the risk factors for epigastric hernias?
Obesity and pregnancy
Describe umbilical hernias
Can be acquired or congenital – congenital hernias are present at birth and resolve with 2-3 years. Due to incomplete closure of anterior abdominal wall after ligation of the umbilical cord at birth. – acquired hernias are due to increased abdominal pressure due to heavy lifting, obesity, persistent coughing or multiple pregnancies (more common in men)
What are the borders of hesselbach’s triangle?
Inferiorly – Medial half of the inguinal ligamentMedially – Lower lateral border of rectus abdominisLaterally – Inferior epigastric artery
What are some complications that can occur with hernias?
Strangulation and incarceration
Describe strangulation of a hernia
Constriction of the blood vessels to the tissue
Describe incarceration of a hernia
Hernia cannot be reduced or pushed back into place without surgical intervention
What is a divarication of recti?
Separation of the rectus abdominis and thinning of the linea alba
Describe incisional hernias
A hernia which occurs along or close to the line of a previous surgery due to imcomplete healing of the previous surgical wound.
Give some characteristics of incisional hernias
Can be complicatedLong surgery and recovery timeOften strangulate and cause pain.
What can cause groin pain in sports people?
Tearing of the inguinal ligaments
What is the different between the mid-point of the inguinal ligament and the mid inguinal point
MP of inguinal ligament – half way between ASIS and pubic tubercle. Find femoral nerve here. Mid-inguinal point – half way between ASIS and pubic symphysis. Where you palpate for the femoral artery.
Where do you find the mid-inguinal point?
Halfway between the ASIS and pubic symphesis
Where do you find the mid-point of the inguinal ligament?
Half way between the ASIS and pubic tubercle
