Hernias Flashcards
indirect inguinal hernia
- hernia through the internal ring of the inguinal canal
- travels down the external ring
which nerve travels on the spermatic cord?
ilioinguinal nerve
what happens if you cut the ilioinguinal nerve?
numbness of inner thigh or lateral scrotum
goes away w/in 6 mo (typically)
what is the conjoint tendon made of?
aponeurosis of the transversus abdominus + internal oblique
what is the floor of the inguinal canal?
inguinal ligament / poupart’s
what are the 3 nerves of the groin?
iliohypogastric
genital branch of the genitofemoral nerve
ilioinguinal nerve
what is the roof of the inguinal canal?
conjoint tendon
where do you find the ilioinguinal nerve?
between the internal/external oblique
What is the surface marking of the deep inguinal ring?
midpoint of the inguinal ligament - between the ASIS / pubic tubercle
What is the surface marking of the deep inguinal ring? midpoint of the inguinal ligament
between the ASIS / pubic tubercle
what is the anterior wall of the inguinal canal?
external oblique aponeurosis
what is the posterior wall of the inguinal canal?
transversalis fascia
what is the length of the inguinal canal?
pubic tubercle to ASIS
what is in the spermatic cord (6)?
1) cremasteric muscle fibers
2) vas deferens
3) testicular artery
4) testicular pampiniform venous plexus
5) genital branch of the genitofemoral nerve
6) +/- hernia sac
what is the hernia sac made of?
peritoneum (direct)
patent processus vaginalis (indirect)
what is ddx of inguinal hernia?
lymphadenopathy psoas abscess ectopic testis hydrocele of the cord saphenous varix lipoma varicocele testicular torsion femoral artery aneurysm abscess
what is the difference b/w herniorrhaphy vs. herniotomy vs. hernioplasty?
Herniotomy: removal of sac only
herniorrhaphy: removal of sac plus repair of posterior wall of inguinal canal
hernioplasty: removal of sac + reinforcement of posterior wall of inguinal canal with mesh
what are the borders of the hesselbach’s triangle?
epigastric vessels (superior-lateral) inguinal ligament (inferior) lateral border of the rectus (medial)
what nerve is in found on top of the spermatic cord?
ilioinguinal nerve
what attaches the testicle to the scrotum?
gubernaculum
what is the most common organ in an inguinal hernia sac in men vs. women?
men = small intestine women = ovary/fallopian tube
from what abdominal muscle layer is the cremaster muscle derived?
internal oblique muscle
from what abdominal layer is the inguinal ligament
external oblique muscle aponeurosis
what lies in the inguinal canal in the female instead of the VAS?
round ligament
where in the inguinal canal does the hernia sac lie in relation to the other structures?
anteromedially
what is a cord lipoma?
preperitoneal fat on the cord structures (pushed in by the hernia sac) not a real lipoma remove surgically (if feasible)
internal ring
transversalis fascia
external ring
external oblique aponeurosis
what percentage of the strength of the floor repair does the external oblique aponeurosis represent
ZERO
what are the boundaries of the femoral canal?
1) cooper’s ligament posteriorly
2) inguinal ligament anteriorly
3) femoral vein laterally
4) lacunar ligament medially
what factors are assoc. w/ femoral hernia?
women, pregnancy, and exertion
what is a femoral hernia?
hernia traveling beneath the inguinal ligament down the femoral canal medial to the femoral vessels (FM radio)
what is the howship-romberg sign?
pain along the medial aspect of the proximal thigh from nerve compression - caused by obturator hernia
what must you do before leaving the OR after an inguinal hernia repair?
pull the testicle back down to the scrotum
how can an incarcerated hernia be reduced in the ER?
1) apply ice
2) sedate
3) use the trendelenburg for inguinal hernias
4) apply steady gentle manual pressure
5) admit & observe for signs of necrotic bowel after reduction
6) perform surgical herniorrhaphy ASAP
what is the floor of hasselbach’s triangle?
external oblique aponeurosis, internal oblique, transversus abdominis muscles
