Hernias

Question 1

_ is a peritoneal-lined sac that protrudes through the abdominal wall

Answer 1

Hernia is a peritoneal-lined sac that protrudes through the abdominal wall

Question 2

A _ hernia protrudes through the inguinal triangle and may enter the medial part of the inguinal canal

Answer 2

A direct inguinal hernia protrudes through the inguinal triangle and may enter the medial part of the inguinal canal

Question 3

A _ hernia protrudes through the deep (internal) inguinal ring and enters the inguinal canal

Answer 3

An indirect inguinal hernia protrudes through the deep (internal) inguinal ring and enters the inguinal canal

Question 4

Complete direct and indirect inguinal hernias exit the _

Answer 4

Complete direct and indirect inguinal hernias exit the superficial ring and enter the scrotum or labium majus

Question 5

A _ hernia protrudes into the femoral triangle (specifically the femoral canal)

Answer 5

A femoral hernia protrudes into the femoral triangle (specifically the femoral canal)

Question 6

A _ hernia is when bowel passes through a defect in the diaphragm and enters the thoracic cavity

Answer 6

A diaphragmatic hernia is when bowel passes through a defect in the diaphragm and enters the thoracic cavity

Question 7

A _ is a hernia at the umbilicus

Answer 7

An umbilical hernia is a hernia at the umbilicus
* Common in newborns and toddlers
* Usually resolve on their own

Question 8

A _ is a hernia at the site of a past surgical incision

Answer 8

An incisional hernia is a hernia at the site of a past surgical incision

Question 9

Reducible vs. irreducible

Answer 9

Reducible: the herniated bowel can be returned to the abdominal cavity by manipulation

Irreducible: the hernia is so occluded that it cannot be returned by manipulation

Question 10

Incarcerated hernia

Answer 10

Incarcerated hernias are hernias in which the viscus is stuck in a sac and cannot be reduced

Question 11

Obstructed hernia

Answer 11

Obstructed hernias are hernias in which the hernia does not allow the passage of feces

Question 12

A _ hernia is an incarcerated hernia that blocks blood flow

Answer 12

A strangulated hernia is an incarcerated hernia that blocks blood flow

Question 13

Sliding hernia

Answer 13

Sliding hernias are hernias of a retroperitoneal organ into the hernia sac
* Inguinal hernia: part of the colon
* Esophageal hiatal hernia: esophagus pulls part of the stomach through the diaphragm

Question 14

The superior boarder of the femoral triangle is the _

Answer 14

The superior boarder of the femoral triangle is the inguinal ligament otherwise known as the Poupart’s ligament

Question 15

The medial boarder of the femoral triangle is the _

Answer 15

The medial boarder of the femoral triangle is the adductor longus muscle

Question 16

The lateral boarder of the femoral triangle is the _

Answer 16

The lateral boarder of the femoral triangle is the sartorius muscle

Question 17

What are the four components of the femoral triangle?

Answer 17

Femoral triangle contains:
1. Femoral nerve
2. Femoral artery
3. Femoral vein
4. Femoral canal (lymphatic vessels)

Question 18

The femoral sheath surrounds _ , _, and _

Answer 18

The femoral sheath surrounds femoral artery , femoral vein, and femoral canal
* The femoral nerve lies outside

Question 19

The femoral canal houses the lymphatic vessels/nodes, otherwise known as the _

Answer 19

The femoral canal houses the lymphatic vessels/nodes, otherwise known as the node of Cloquet

Question 20

A femoral hernia is a protrusion of abdominal viscera through the _ and into the _

Answer 20

A femoral hernia is a protrusion of abdominal viscera through the femoral ring and into the femoral canal
* The femoral ring is the opening at the top of the femoral canal
* The hernia sac can usually be palpated within the femoral triangle

Question 21

The _ ligament is very tight and can sometimes cause strangulation of the loop of bowel and result in necrosis

Answer 21

The lacunar ligament is very tight and can sometimes cause strangulation of the loop of bowel and result in necrosis

Question 22

The _ is an oblique passageway through the inferior abdominal wall, which allows structures to pass from inside the abdominal cavity to the outside perineal region (location of the external genitalia)

Answer 22

The inguinal canal is an oblique passageway through the inferior abdominal wall, which allows structures to pass from inside the abdominal cavity to the outside perineal region (location of the external genitalia)

Question 23

The inguinal canal has two openings, _ and _

Answer 23

The inguinal canal has two openings, deep inguinal ring and superficial inguinal ring

Question 24

The deep inguinal ring is located _

Answer 24

The deep inguinal ring is located on the inside of the abdominal wall

Question 25

The superficial inguinal ring is located _

Answer 25

The superficial inguinal ring is located **in the medial aspect of the aponeurosis of the external oblique**

Question 26

What are the main structures transversing the inguinal canal?

Answer 26

Inguinal canal contents: * **Spermatic cord** (in males) * **Round ligament of the uterus** (in females) * **Ilioinguinal nerve** and the **genital branch of the genitofemoral nerve**

Question 27

The spermatic cord contains the _

Answer 27

The spermatic cord contains the **neurovasculature of the testicle** * During embryonic development, the testicle and spermatic cord traverse through the inguinal canal to reach the scrotum

Question 28

_ hernias are located within the spermatic cord

Answer 28

**indirect inguinal hernias** are located within the spermatic cord

Question 29

Indirect inguinal hernias occur when abdominal contents pass through the _ ring and exit the _ ring

Answer 29

Indirect inguinal hernias occur when abdominal contents pass through the **deep ring** and exit the **superficial ring**

Question 30

Indirect inguinal hernias can also be called _

Answer 30

Indirect inguinal hernias can also be called *congenital inguinal hernias*

Question 31

Indirect inguinal hernias protrude through the abdominal wall (medial/ lateral) to the inferior epigastric vessels

Answer 31

Indirect inguinal hernias protrude through the abdominal wall **lateral** to the inferior epigastric vessels

Question 32

The medial boundary of the hesselbach triangle is the _

Answer 32

The medial boundary of the hesselbach triangle is the **rectus abdominis muscle**

Question 33

The lateral boundary of the hesselbach triangle is the _

Answer 33

The lateral boundary of the hesselbach triangle is the **inferior epigastric vessel**

Question 34

The inferior boundary of the hesselbach triangle is the _

Answer 34

The inferior boundary of the hesselbach triangle is the **inguinal ligament**

Question 35

The hesselbach triangle represents an area of abdominal wall that lacks muscular support; hence this area is prone to _ hernias

Answer 35

The hesselbach triangle represents an area of abdominal wall that lacks muscular support; hence this area is prone to **direct inguinal hernias**

Question 36

Direct inguinal hernias protrude through hesselbach's triangle (medial/ lateral) to the inferior epigastric vessels

Answer 36

Direct inguinal hernias protrude through hesselbach's triangle **medial** to the inferior epigastric vessels * Often occur in middle aged adults (weak abdominal wall)

Question 37

Direct inguinal hernias result in contents _ the spermatic cord

Answer 37

Direct inguinal hernias result in contents **outside** the spermatic cord

Question 38

Direct vs indirect inguinal hernias in relation to the inferior epigastric vessels

Answer 38

Direct vs indirect inguinal hernias in relation to the inferior epigastric vessels: * Direct inguinal hernia: **medial** to vessel * Indirect inguinal hernia: **lateral** to vessel

Question 39

Indirect inguinal hernias are a result of a congenital defect of the _ when it fails to close

Answer 39

Indirect inguinal hernias are a result of a congenital defect of the **processus vaginalis** when it fails to close * Or failed fusion of the deep inguinal ring and the spermatic cord

Question 40

The _ nerve, passes through the inguinal ligament, and lies on top of the spermatic cord. It must be isolated separately from the cord during hernia surgeries

Answer 40

The **ilioinguinal nerve** arises from L1, passes through the inguinal ligament, and lies on top of the spermatic cord. It must be isolated separately from the cord during hernia surgeries

Question 41

Pain or popping upon internal rotation and flexion/extension of the tibia/fibula indicates _ injury

Answer 41

McMurray test: Lateral meniscus: internal rotation Medial meniscus: external rotation