Hernias Flashcards
What are the contents of the inguinal canal in a female?
Round ligament of the uterus + ilioinguinal nerve
What are the contents of the inguinal canal in a mail?
Spermatic cord + ilioinguinal nerve
What are the contents of the spermatic cord?
3 arteries: vas, testicular, cremasteric
3 fascial layers: extenral spermatic, cremasteric, internal spermatic
3 nerves: traversing ilioinguinal, sympathetics, genitofemoral
3 other things: pampiniform plexus of veins, vas deferens, lymphatics
The inguinal canal is located between what 2 structures?
Deep inguinal ring to superficial inguinal ring
The opening of the inguinal canal is located laterally to what structure?
Inferior epigastric artery
What are the contents of the femoral triangle?
NAVL femoral nerve femoral artery femoral vein lymphatics deep inguinal LN
What is the superior border, medial border and lateral border of the femoral triangle?
Superior border inguinal ligament
Medial border adductor longus
Lateral border sartourius
What is the relevance of the mid inguinal point?
Where are you can palpate the femoral pulse
What is the relevance of the midpoint of the inguinal ligament?
Location of deep inguinal ring
What is the definition of a hernia?
Abnormal protrusion of a body part through a wall that should normally contain it
What is the definition of a irreducible hernia?
Can’t be shoved back in
What is the definition of a incarcerated hernia?
Stuck in its sack
What is the definition of a strangulated hernia?
Blood supply cut off
Our inguinal hernia is more common on the right or left side?
Right
remember open appendectomy is a risk factor
Can inguinal hernia is cause obstruction of small or large bowel?
SBO
How can inguinal and femoral hernia is be differentiated on examination?
Femoral hernia below inguinal ligament and pubic tubercle
Inguinal hernia above pubic tubercle
What is an indirect inguinal hernia?
Goes IN the canal, through deep ring int inguinal canal, out superficial ring into scrotum
What is a direct inguinal hernia?
Through defect in abdominal wall, directly out superficial ring
Does direct or indirect inguinal hernia have a higher risk of obstruction / strangulation
Indirect
Does a direct or indirect hernia pop out on coughing?
Direct pops out on coughing
If the hernia is in the scrotum, it must be a direct or indirect inguinal hernia?
Indirect
Name 3 risk factors for inguinal hernia
Pregnancy Weightlifting Chronic cough Ascites Constipation Past abdominal wall surgery Male Smoker
Direct and indirect inguinal hernia is have the same management - true or false
True
How are inguinal hernia is diagnosed in the non-acute setting?
Clinical diagnosis
How are inguinal hernia is investigated in the emergency setting?
CT
All inguinal hernias are operated on - true or false
False
Risk of chronic pain so only operate if hernia causes pain
If not; conservative Mx
What is the standard type of inguinal hernia repair?
Lichtenstein open mesh repair
Where are femoral hernias located in relation to the pubic tubercle?
Below + lateral to the pubic tubercle
Does inguinal or femoral hernia is have a higher risk of incarceration/ strangulation?
Femoral
since femoral canal isn’t as stretchy as inguinal canal
Femoral hernias are always operated on - true or false?
True
How are femoral hernias investigated in the acute setting?
CT
How are femoral hernia is diagnosed in the non-acute setting?
Clinical diagnosis
In a inguinal hernia, can you palpate ‘get above’ the lump?
No
In a femoral hernia, can you palpate ‘get above’ the lump?
No
In inguinal lymphadenopathy in the scrotum, can you palpate ‘get above’ the lump?
No
In a varicocele/ hydrocele, can you palpate ‘get above’ the lump?
Yes
In a testicular tumour, can you palpate ‘get above’ the lump?
Yes
In a epididymal cyst, can you palpate ‘get above’ the lump?
Yes
Triad fever + back pain + limp =
Psoas abscess
Which specialty does drainage of a psoas abscess?
Interventional radiology
Define a sinus
Blind ended tract from an epithelial surface
one opening
A groin sinus only occurs in what group of people?
PWIDs
Give 3 causes of a groin swelling in a IVDU
Abscess (groin/psoas) Aneurysm Infected DVT Pseudoaneurysm Lymphadenitis
If you suspect a groin aneurysm, what test is done for diagnosis?
CT angiogram