hernia Flashcards
Describe the difference between the mid-inguinal point and the midpoint of the inguinal ligament
mid-inguinal point halfway between the pubic symphysis and the ASIS. the femoral pulse can be palpated here.
The midpoint of the inguinal ligament is halfway between the pubic tubercle and the anterior superior illiac spine (the two attachments of the inguinal ligament) the opening of the inguinal canal is located just above this point.
What are the boundaries (general) of the inguinal canal?
four boundaries anterior, posterior, roof and floor
Anterior border of the inguinal canal
aponeurosis of external oblique, reinforced by the internal oblique muscle laterally.
What is the posterior border of the inguinal canal?
transversals fascia
What is the floor of the inguinal canal formed by?
inguinal ligament, thickened medially by the lacunar ligament.
What is the roof of the inguinal canal formed by?
transversals fascia, internal oblique, and transversus abdominis
What are the contents of the inguinal canal?
spermatic cord (males) round ligament (female) illioinguinal nerve (sensory innervation) genitials
gential branch of the genitofemoral nerve- cremasteric reflex.
What are the types of inguinal hernia?
direct and indirect
What is a direct hernia?
where the peritoneal sac enters the inguinal canal through the posterior wall of the inguinal canal.
what is a indirect hernia?
Where the peritoneal sac enters the inguinal canal though the deep inguinal ring.
What is the most common type of inguinal hernia?
indirect caused by failure of the processes vaginalis to regress. Therefore these are mostly congenital
What is the cause of a direct hernia?
mostly aquired due to weakening the abdominal wall.
Where does a direct hernia enter the abdominal wall in relation to the epigastric artery?
medial to the epigastric artery.
Where is a femoral hernia located?
inferior and lateral to the pubic tubercle on the upper medial thigh.
What are the borders of the femoral canal?
lateral border the femoral vein
medial lacunar ligament
anterior inguinal ligament
posterior coopers ligament
Spigellian hernia location
below and lateral to the umbilicus
it is lateral to the rectus sheath
Femoral or inguinal what is the risk of strangulation?
inguinal lower risk of strangulation?
What method can use to repair the paraumbilical hernia?
Mayo’s repair- tension suture
What are the risk factors for an incisional hernia?
infection, obesity smoking
immunosupression.
What are the indications for hernial repair?
complicated hernia
uncomplicated with moderate symptoms: inguinal pain on excretion, limiting daily living activities, manual reduction not possible
what are the indications for open hernia repair?
complicated hernia
previous preperitoneal surgeries (hysterectomy, c section)
presence of ascites
recurrent hernia
What are the indications for laparoscopic hernia repair?
bilateral hernai recurrent hernia (if originally had open)
What is the surgical management of a hernia?
reinforcement of the posterior wall of the inguinal canal with a synthetic mesh or primary tissue approximation.
What is preferred?
mesh because there is decreased reoccurrence rates and post op pain. it is contraindicated in the case of inguinal infection or contamination.
What is a complicated hernia?
incarcerated (not reducible)
strangulated hernia (tight construction of the blood vessels) emergency need to be in surgery within 4-6 hours symptoms of pain and erythema in the lower abdomen and scrotum. possible leads to intestinal perforation and peritonitis.
What are the possible complications of mesh repair?
infection reoccurrence groin pain damage to surrounding structures urinary retention bladder injury
