Hernias Flashcards
What are the chief sites of hernia?
- Inguinal
- Femoral
- Umbilical
What is the potential area of weakness causing an inguinal hernia?
Inguinal canal
What is the potential area of weakness causing a femoral hernia?
Femoral ring
What is the potential area of weakness causing an umbilical hernia?
The umbilicus
What is the inguinal canal?
An oblique passageway
In what direction does the inguinal canal extend?
Downward and medial
Where does the inguinal canal begin?
At the deep (internal) inguinal ring
How long is the inguinal canal?
Approx 4cm
Where does the inguinal canal end?
Superficial (external) inguinal ring
Where does inguinal canal lie relative to other structures?
- In between the muscles of the anterior abdominal wall
- Runs parallel and superior to medial half of inguinal ligament
What border does the inguinal ligament constitute?
The inferior border of the aponeurosis of the external oblique muscle
Where does the inguinal ligament attach?
The ASIS and the pubic tubercle
What passes through the inguinal canal?
- The ilioinguinal nerve (through part)
- In males, the spermatic cord
- In females, the round ligament of the uterus
Label this diagram
- Anterior superior iliac spine
- External oblique aponeurosis
- Deep membranous layer of subcutaneous tissue
- Itercrural fibres
- Superficial inguinal ring
- Ilioinguinal nerve
- Spermatic cord
Label this diagram
- Aponeurosis of external oblique
- Location of deep inguinal ring
- Femoral vein
- Outline of sublingual space
- Intercrural fibres
- Outline of myopectineal orifice
- Medial crus
- Superficial inguinal ring (with reflected inguinal ligament in posterior wall)
- Pubic tubercle
- Lateral crus
- Lacunar ligament
- Pectineal ligament
- Pectineus
- Femoral canal
- Iliopubic eminence
- Acetabulum
- Femoral sheath
- Psoas major
- Anterior inferior iliac spine
- Femoral artery
- Femoral nerve
- Iliacus
- Inguinal ligament
- Lateral cutaneous nerve of thigh
- Anterior superior iliac spine
What is an inguinal hernia?
A protrusion of the abdominal cavity contents through the inguinal canal
How common are inguinal hernias?
Give lifetime risks
Very common
- Lifetime risk 27% for men
- Lifetime risk 3% for women
What is a direct inguinal hernia?
Protrusion into the inguinal canal through a weakened area in the transversalis fasica near the medial inguinal fossa, within an anatomical region known as the inguinal/Hesselbach’s triangle
What are the borders of the Hesselbach’s triangle?
- Inferiorly- Medial half of the inguinal ligament
- Medially- Lower lateral border of rectus abdominis
- Laterally- Inferior epigastric artery
What is an indirect inguinal hernia?
Protrudes through the deep inguinal ring, within the diverging arms of the transversalis fascial sling
What are most indirect inguinal hernias a result of?
The failure of the embryonic closure of the deep inguinal ring after the testicle has passed through it
Label this diagram illustrating the common sites of hernia
- A - Epigastric hernia
- B - Incisional hernia
- C - Umbilical hernia
- D - Indirect inguinal hernia
- E - Direct inguinal hernia
- F - Femoral hernia
Where do epigastric hernias occur?
In the epigastric region, in the midline between the xiphoid process and the umbilicus, through the linea alba
What are the primary risk factors for epigastric hernias?
- Obesity
- Pregnancy
Where do umbilical hernias occur?
Through the umbilical ring
What size are umbilical hernias?
Usually small
What do umbilical hernias result from?
Increased intra-abdominal pressure in the presence of weakness and incomplete closure of the anterior abdominal wall after ligation of the umbilical cord at birth
Who do acquired umbilical hernias occur in?
Adults, most commonly women and obese people
What is a femoral hernia?
A protrusion of abdominal viscera into the femoral canal
Where does a femoral hernia occur?
Through the femoral ring
What is a femoral hernia bound by?
- Femoral vein laterally
- Lacunar ligament medially
What is the effect of a femoral hernia?
- Compresses the contents of the femoral canal
- Distends the wall of the canal
What is the contents of the femoral canal?
- Loose connective tissue
- Fat
- Lymphatics
What size are femoral hernias?
Initially, they are small, but can enlarge
Why are femoral hernias initially small?
Because they are contained within the canal
How can femoral hernias enlarge?
By passing inferiorly through the saphenous opening into the subcutaneous tissue of the thigh
Who are femoral hernias more common in?
Women
Why are femoral hernias more common in women?
They have wider pelves
Label this diagram
- A - Femoral hernia
- B - Inguinal ligament
- C - Adductus longus
- D - Sartorius
- E - Transversalis fascia
- F - Fascia lata
- G - Inguinal ligament
- H - Femoral artery and vein
- I - Saphenous opening
- J - Great saphenous vein
- K - Femoral hernia
- L - Femoral sheath
- M - Pubic tubercle
- N - Pubic symphysis
- O - Lacunar ligament
- P - Femoral ring
- Q - Aberrant obturator artery
- R - Intestine
- S - Inferior epigastric artery
- T - External iliac artery and vein (cut)
- U - Femoral nerve
- V - Iliopsoas muscle and fascia
What are the potential complications of hernias?
- Strangulation
- Incarceration
What is strangulation?
The constriction of blood vessels, preventing blood flow to the tissue
Why can strangulation occur with femoral hernias?
Because of the sharp, rigid boundaries of the femoral ring
What is incarceration of a hernia?
When the hernia cannot be reduced, or pushed back into place, at least not without very much external effort
