Groin Hernias

Question 1

contents of male inguinal canal?

Answer 1

3 arteries (vas artery, cremasteric artery, testicular artery)
3 nerves (genitofemoral nerve, ilioinguinal, sympathetic fibres)
3 fascial layers (external, internal, cremasteric)
3 other things (pampiniform plexus, vas deferens, lymphatics)

Question 2

contents of female inguinal canal?

Answer 2

ilioinguinal and round ligament

Question 3

boundaries of inguinal canal?

Answer 3

MALT
roof = 2 muscles (internal oblique and transversus abdominus)
anterior wall = 2 aponeurosis (internal and external oblique aponeurosis)
floor = 2 ligaments (inguinal and lacunar ligament)
posterior wall = 2 Ts (transversalis fascia, conjoin tendon)

Question 4

contents of femoral triangle?

Answer 4

femoral nerve
femoral artery
femoral vein
deep inguinal lymph nodes

Question 5

borders of femoral canal?

Answer 5

anterior = inguinal ligament
posterior = pectineus muscle
lateral = femoral vein
medial = lacunar ligament

Question 6

what is a hernia?

Answer 6

abnormal protrusion of a body part through the wall which is meant to contain it

Question 7

heria terms?

Answer 7

irreducible
incarcerated
strangulated
obstructed
herniorrhaphy
herniotomy

Question 8

direct vs indirect hernia?

Answer 8

indirect = in the canal
direct = pushes out through the wall

Question 9

which is more likely to strangulate and obstruct, direct or indirect?

Answer 9

indirect

Question 10

are hernias more common on left or right side?

Answer 10

right

Question 11

types of hernia management?

Answer 11

conservative or operative
operative = open mesh repair or lap repair
herniotomy done in children

Question 12

types of repair?

Answer 12

shouldice and bassini (not really done anymore)
lichenstein
new mesh types are generally used these days

Question 13

which type of hernia always needs fixed?

Answer 13

femoral

Question 14

how do femoral hernias present?

Answer 14

below and lateral to pubic tubercle

Question 15

what is richters hernia?

Answer 15

protrusion and/or strangulation of part of the intestine’s antimesenteric border through a rigid small defect in the abdominal wall

Question 16

what types of scrotal lumps can you get above?

Answer 16

hydrocele
epididymal cyst
variocele
epididymo-orchitis
testicular tumour

Question 17

what testicular lumps can you not get above?

Answer 17

inguinal hernia
femoral hernia
enlarged inguinal lymph nodes
saphena varix

Question 18

situations to be aware of?

Answer 18

IVDU groin swellings
psoas abscess (triad of fever, back pain and limp)