GI - Anatomy (Inguinal canal & Hernias)

Question 1

Draw the region of the inguinal canal, including and labeling the following: (1) Aponeurosis of external oblique muscles (2) Abdominal wall: site of protrusion of direct hernia (3) Conjoined tendon (4) Cremasteric muscle and fascia (internal oblique) (5) External spermatic fascia (external oblique) (6) Extraperitoneal tissue (7) Inguinal ligament (8) Internal oblique muscle (9) Internal inguinal ring site of protrusion of indirect hernia (10) Inferior epigastric vessels (11) Internal spermatic fascia (transversalis fascia) (12) Linea alba (13) Medial umbilical ligament (14) Median umbilical ligament (14) Pyramidalis muscle (15) Parietal peritoneum (16) Spermatic cord (17) Rectus abdominis muscle (18) Transversalis fascia (19) Transversus abdominis muscle (20) Superficial inguinal ring.

Answer 1

See p. 343 in First Aid 2014 for visual

Question 2

What are the 3 layers of (spermatic) fascia around the inguinal canal (superficial to deep), and what muscles contribute to each?

Answer 2

(1) External spermatic fascia (external oblique) (2) Cremasteric muscle and fascia (internal oblique) (3) Internal spermatic fascia (transversalis fascia)

Question 3

What is the site of protrusion of the indirect hernia?

Answer 3

Internal inguinal ring: site of protrusion of indirect hernia

Question 4

What is the site of protrusion of the direct hernia?

Answer 4

Abdominal wall: site of protrusion of direct hernia

Question 5

In general, what is a hernia, and where does it usually occur?

Answer 5

A protrusion of peritoneum through an opening, usually a site of weakness

Question 6

What defines diaphragmatic hernia?

Answer 6

Abdominal structures enter the thorax

Question 7

Why may diaphragmatic hernia occur in infants?

Answer 7

May occur in infants as a result of defective development of pleuroperitoneal membrane

Question 8

What is the most common type of diaphragmatic hernia? What defines this hernia?

Answer 8

Most commonly a hiatal hernia, in which stomach herniates upward through the esophageal hiatus of the diaphragm

Question 9

What is the most common hiatal hernia? What defines and visually characterizes this hernia?

Answer 9

Sliding hiatal hernia is most common. Gastroesophageal junction is displaced high; “hourglass stomach”

Question 10

How is the gastroesophageal junction of paraesophagel hernia? What defines this hernia?

Answer 10

Paraesophageal hernia - gastroesophageal junction is normal. Fundus protrudes into the thorax.

Question 11

What is the route take by an indirect inguinal hernia? What else follows this path?

Answer 11

Goes through the internal (deep) inguinal ring, external (superficial) inguinal ring, and into the scrotum; An indirect inguinal hernia follows the path of descent of the testes

Question 12

Describe the entrance point of an indirect inguinal hernia in reference to 2 other structures.

Answer 12

Enters internal inguinal ring lateral to inferior epigastric artery

Question 13

What causes indirect inguinal hernia to occur in infants? What can result from this?

Answer 13

Occurs in infants owing to failure of processus vaginalis to close (can form hydrocele)

Question 14

In what gender is indirect inguinal hernia much more common?

Answer 14

Much more common in males

Question 15

What covers an indirect inguinal hernia?

Answer 15

Covered by all 3 layers of spermatic fascia.

Question 16

Through what does a direct inguinal hernia protrude? Reference at least 2 structures in your description. Through what structure does it travel?

Answer 16

Protrudes through the inguinal (Hasselbach) triangle. Bulges directly through abdominal wall medial to inferior epigastric artery. Goes through the external (superifical) inguinal ring only.

Question 17

What spermatic fascia layer(s) cover(s) direct inguinal hernia?

Answer 17

Covered by external spermatic fascia

Question 18

In what patient population is direct inguinal hernia usually seen?

Answer 18

Usually in older men

Question 19

What is the reference artery used to distinguish the location of direct versus indirect hernias? What are these locations?

Answer 19

Inferior epigastric artery; Medial to inferior epigastric artery = Direct hernia; Lateral to inferior epigastric artery = Indirect hernia; Think: “MDs don’t LIe”

Question 20

Where does a femoral hernia protrude, and route does it take? Be specific in describing its location.

Answer 20

Protrudes below inguinal ligament through femoral canal below (on p. 344 in First Aid 2014) and lateral to pubic tubercle

Question 21

In what gender is femoral hernia more common?

Answer 21

More common in females

Question 22

Of what condition is femoral hernia the leading cause?

Answer 22

Leading cause of bowel incarceration

Question 23

What 3 structures create the Hesselbach triangle?

Answer 23

(1) Inferior epigastric vessels (2) Lateral border of rectus abdominis (3) Inguinal ligament

Question 24

What is another name for Inguinal ligament?

Answer 24

Inguinal (Poupart) ligament

Question 25

Draw the femoral canal, including and labeling the following: (1) Direct inguinal hernia (2) Femoral artery (3) Femoral hernia (4) Femoral vein (5) Inferior epigastric vessels (6) Inguinal (Poupart) ligament (7) Indirect inguinal hernia (8) Rectus abdominis muscle (9) Hesselbach triangle.

Answer 25

See p. 344 in First Aid 2014 for visual at bottom of page