Hernias

Question 1

Diaphragmatic hernia

Answer 1

Abd structures near the thorax
Infant: due to defective pleuroperitoneal membrane

Most commonly hiatal hernia, in which stomach herniates upward through the esophageal hiatus of the diaphragm.

Question 2

Diaphragmatic hernia

Sliding vs paraesophageal

Answer 2

Sliding: GE junction displace upward, hourglass stomach

Paraesophageal hernia: GE junction is normal, fundus produces into the thorax

Question 3

Indirect inguinal hernia

Answer 3

Goes into the internal (deep) inguinal ring,
External (superficial) inguinal ring, and
Into scrotum.

Enters internal ring lateral to inferior gastric artery.

Question 4

Indirect inguinal hernia:
Pathophys
prevalence
covered by

Answer 4

Occurs in infants owing to failure of processues vaginalis to close (can form hydrocele)

Covered by all three layers of spermatic fascia

Much more common in males

Question 5

Direct inguinal hernia

Answer 5

Through the inguinal (Hesselbach’s triangle)
Buldges directly through abd wall medial to inferior gastric artery.

Goes through external inguinal ring only.

Question 6

Direct inguinal hernia:
prevalence
covered by

Answer 6

Covered by external spermatic fascia

Usually in older men.

Question 7

Mneumonics for hernia

Answer 7

MD don’t LIe
Medial to IGA= Direct
Lateral to IGA=Indirect

Question 8

Femoral hernia

Answer 8

Protrudes below inguinal ligament through
femoral canal below and lateral to pubic tubercle

More common in women.
Leading cause of bowel incarceration.

Question 9

Hesselbach’s triagle

Answer 9

Inferior gastric vessels
Lateral border of rectus abdominus
Inguinal ligament