hernia Flashcards
where can the femoral vessels be found and what order do they exist in ?
1/3 way between the ASIS and the pubic symphysis
nerve - artery - vein - lymphatics
what are the borders of the femoral triangle ?
superior : inguinal ligament
medial: adductor longus
lateral sartorius
what are the contents of the femoral sheath ?
femoral bein
artery
femoral ring ( carries the lymphatics)
no nerve is carried here
what is the anatomy of the spermatic cord ?
travels through the inguinal canal , first enters through the superficial inguinal ring and exits through the deep inguinal ring
the spermatic cord is a bundle of things
what are the three fascial layers of the spermatic cord ?
external spermatic fascia ( external oblique)
cremasteric fascia (internal oblique )
internal spermatic fascia (transversalis fascia )
what does the inguinal canal carry in males vs females ?
males: spermatic cord
female : round ligament
what is the floor of the inguinal canal ?
inguinal ligament
what are the types of inguinal hernias ?
indirect
direct
femoral
what is the anatomy of indirect inguinal hernias ?
they go through the inguinal canal , not through a hole
they are lateral to the epigastric vessels
follows the path of the descent of the testes
origin of the indirect inguinal hernia ?
deep inguinal ring
as a congenital defect how does an indirect inguinal hernia form ?
bowel protrudes through patent processus vaginalis
what is the remaining remanent of the processus vaginalis ?
tunica vaginalis testis
what type of patient has a higher risk of developing indirect inguinal hernia ?
more common in males
more common on the right side
commonly extends into the scrotum
associated with heavy lifting
straining
newborns on mechanical ventilation
what is the path of indirect inguinal hernias in women ?
follows the round ligament towards labia majora
what is the origin of direct inguinal hernias ?
medial to the epigastric vessels
what to direct inguinal hernias protrude through ?
through hesselbachs triangle
buldge through the abdominal wall
what are the borders of hesselbach triangle?
inguinal ligament
inferior epigastric
rectus abdominis
floor : transversalis fascia
what is the cause of direct inguinal hernias ?
cause by weakness in the transversalis fascia
happens in older men
what is the location of femoral hernias in relation to the femoral vessel ?
medial to the femoral vessel
what is the problem with femoral hernias ?
highest risk of incarceration because the femoral ring is a small opening
incarceration = irreducibility
what is the problem with incarceration ?
may become strangulated - urgent surgery is often indicated
what is the treatment of hernias ?
mesh hernia surgery
what are the types of ventral hernias ?
umbilical hernia
incisional hernia
these happen in the anterior abdominal wall
what is a hiatal hernia ?
herniation of the stomach into the thorax
leads to GERD
what is the major risk factor for hiatal hernias ?
obesity
what is the most common type of hiatal hernia ?
type 1: sliding hiatal hernia
where there is displacement of the gastro-oesophageal junction above the diaphragm
giving an hourglass appearance
what is the paraoesophageal hiatal hernia ?
part of the stomach herniates fo2 next to the oesophagus
what is the defect associated with para esophagela hernias ?
defect in the phrenooesopphageal membrane
what is the classic finding associated with paraesophageal hiatal hernia ?
bowel sounds in the lung fields
what is the problem associated with congenital diaphragmatic hernia ?
developmental defect of diaphragm
hole in the diaphragm
what is the prognosis of CDH ?
pulomonary hypoplasia happens - often fatal
what are the contenst of the inguinal canal ?
vas deferens
illioinguinal nerve
internal spermatic vessels
what is a spigelian hernia ?
happens through a defect between the rectus abdominus and the semi lunar line in the spigelian aponeurosis
