Hernias

Question 1

Define an abdominal hernia

Answer 1

A protrusion of part of the abdominal contents beyond the normal confines of the abdominal wall

Question 2

What are the 3 parts of a hernia

Answer 2

The sac (peritoneum), the contents of the sac (bowel, omentum, fat ect) and the coverings of the sac (anything its passed through, internal oblique ect).

Question 3

What are the 4 common places for abdonimal hernias to occur?

Answer 3

• inguinal canal - femoral canal - umbilicus - previous excisions

Question 4

List the layers of the abdominal wall from out to in (8)

Answer 4

• Skin - Subcutaneous tissue/ fat - Superficial fascia - Deep fascia - External oblique - Internal oblique - Transversus abdominus - Transversalis fascia

Question 5

What forms the roof of the inguinal canal?

Answer 5

The internal oblique mainly, plus transversus abdonminus and transversalis facia in some books

Question 6

What forms the anterior wall of the inguinal canal

Answer 6

Aponeurosis of external oblique, superficial and deep fascia. Internal oblique (according to some)

Question 7

What forms the floor of the inguinal canal?

Answer 7

inguinal ligament and lacunar ligament (medially)

Question 8

What forms the posterior wall of the inguinal canal?

Answer 8

The transversalis fascia

Question 9

What passes through the inguinal canal in males?

Answer 9

The vas deferense Illiolingual and gentiofemoral nerve Processus vaginalis Blood vessels and lymphatics

Question 10

What passes through the inguinal canal in females?

Answer 10

The round ligament Illiolingual and gentiofemoral nerve Blood vessels and lymphatics

Question 11

How is the processus vaginalis created and what happens to it?

Answer 11

It is created by the descent of the testis pinching off a pouch of peritoneum as it descends. Normally the cord should obliterate and only a small portion should remain around the testicle as the tunica vaginalis

Question 12

What implications does a patent processus vaginalis have for inguinal hernias?

Answer 12

It means inguinal hernias may herniate all the way down into the scrotum, also may create a hydrocele.

Question 13

What is a deep/ indirect inguinal hernia?

Answer 13

A hernia that passes through the deep inguinal ring of the inguinal canal. It may herniate down and through the superficial ring also

Question 14

What % of hernias are direct inguinal hernias and what % are indirect?

Answer 14

50% are direct, they also affect M more than F and right more than left. 25% are indirect

Question 15

What is a direct inguinal hernia?

Answer 15

Protrusion of abdominal contents through the hesselbachs triangle and into the inguinal canal- this is a point of weakness in the abdominal wall. From here they can often pass through the superficial inguinal ring.

Question 16

What males up hesselbach’s triangle?

Answer 16

Medial- lateral aspect of rectus abdonmius Lateral- Inferior epigastric blood vessels Posterior- Inguinal ligament

Question 17

How can you distinguish between a direct and indirect inguinal hernia?

Answer 17

Direct will originate medial to the inferior epigastric vessels

Question 18

Which sex gets femoral hernias more and why

Answer 18

Females, because they have proportionally wider hips and so wider femoral canals, so contents are move into it more easily

Question 19

Why are femoral hernias more severe than inguinal?

Answer 19

Because they can easily become stuck (incarcerated, so you cant push it back) and obstructred and if the blood supply becomes cut off it is said to be strangulated- emergency.

Question 20

What are the two main causes of umbellical hernias

Answer 20

In infants- omphalocele (failure of reveral of physiolocal herniation of intestines- usually reverses on its own). In adults- hernation through the tunica albergenia in the region of the umbellicus.

Question 21

What is a hernia above the umbellicus region called and how does it occur?

Answer 21

An epigastric hernia. It usually starts with small hernia of extra peritoneal fat poking through the linea alba. Chronic straining forces will cause more fat and eventually peritoneum to poke through.