Hernias

Question 1

Define hernia

Answer 1

protrusion of part of the abdo contents beyond the normal confines of the abdo wall

Question 2

What 3 parts make up a hernia?

Answer 2

The sac = pouch of peritoneum

Contents of the sac = any structure with abdo cavity

Covering of he sac = layers of the abdo wall through which the hernia has passed

Question 3

What are the areas of potential weakness in the abdominal wall?

Answer 3

Inguinal canal

Femoral canal

Umbilicus

Previous incisions

Question 4

What is the inguinal canal?

Answer 4

Short passage extending inferior and medially through the inferior part of the abdo wall

Superior and parallel to inguinal ligament

Site of potential weakness

Males = testes descend

Females = round ligament goes from Uterus-labium majus

Question 5

What is the processus vaginalis?

Answer 5

Out-pocketing of peritoneum flanking the inguinal canal in the embryonic stage

When it obliterates = tunical vaginalis

If remaining = can result in indirect hernia

Question 6

What is the gubernaculum?

Answer 6

Condensed band of mesenchyme that links inferior portion of gonad to labioscrotal swelling

Aids descent of the gonads

Question 7

What happens if the processes vaginalis doesn’t close?

Answer 7

Inguinal hernia

Scrotal hernia

Question 8

Outline the borders of the inguinal canal

Answer 8

Anterior = aponeurosis of external oblique

Inferior = inguinal ligament (thickening of external oblique aponeurosis)

Superior = arched fibres of internal oblique

Posterior = conjoint tendon (internal oblique + transverse abdo muscles) + transversalis fascia

Question 9

What is the entrance to the inguinal canal?

Answer 9

Deep ring through tranversalis fascia (posterior wall)

Question 10

What is the exit of the inguinal canal?

Answer 10

Superficial ring through aponeurosis of external oblique (anterior wall)

Question 11

Describe an indirect hernia

Answer 11

Fail to obliterate processes vaginalis = descend into scrotum

Passes through deep inguinal ring

Occurring lateral to inferior epigastric vessels

Most common

Question 12

Describe a direct inguinal hernia

Answer 12

Through hesselbach’s triangle and superficial inguinal ring

Occurring medial to inferior epigastric vessels

Question 13

Why are men at higher risk of inguinal hernia than females?

Answer 13

Due to testes descent

R descending slower/after the left

Question 14

Name the borders of the hesselbach’s triangle

Answer 14

Base = inguinal ligament

Lateral = inferior epigastric vessels

Medial = lateral border of rectus abdo muscles

Question 15

What is hesselbach’s triangle

Answer 15

Area of weakness on the inferior interior aspects of the anterior abdo wall near the groin

Contains depression = medial inguinal fossa = direct inguinal hernias protrude through the abdo wall

Question 16

Outline a femoral hernia

Answer 16

More common in females = shape of pelvis = wider femoral canal

Through femoral canal

Entrance = femoral ring
Medial = lacuna ligament 
Lateral = femoral vein

Incarcerated = cant force back in

Strangulate = blood supply is compromised, tissue death

Question 17

Discuss an umbilical hernia

Answer 17

Congenital = omphalocele

Acquired infantile = through weakness in scar of umbilicus

Acquired adult = through the linea alba (midline fusion of recus shealth)

Question 18

What is an epigastric hernia?

Answer 18

Between xiphoid process and umbilicus

Starts small but can grow

Chronic staining forces more at thought, eventually pulling peritoneum through