Hernias Flashcards
Define an abdominal hernia
A protrusion of part of the abdominal contents beyond the normal confines of the abdominal wall
What are the 3 parts of a hernia
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).
What are the 4 common places for abdonimal hernias to occur?
- inguinal canal - femoral canal - umbilicus - previous excisions
List the layers of the abdominal wall from out to in (8)
- Skin - Subcutaneous tissue/ fat - Superficial fascia - Deep fascia - External oblique - Internal oblique - Transversus abdominus - Transversalis fascia
What forms the roof of the inguinal canal?
The internal oblique mainly, plus transversus abdonminus and transversalis facia in some books
What forms the anterior wall of the inguinal canal
Aponeurosis of external oblique, superficial and deep fascia. Internal oblique (according to some)
What forms the floor of the inguinal canal?
inguinal ligament and lacunar ligament (medially)
What forms the posterior wall of the inguinal canal?
The transversalis fascia
What passes through the inguinal canal in males?
The vas deferense Illiolingual and gentiofemoral nerve Processus vaginalis Blood vessels and lymphatics
What passes through the inguinal canal in females?
The round ligament Illiolingual and gentiofemoral nerve Blood vessels and lymphatics
How is the processus vaginalis created and what happens to it?
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
What implications does a patent processus vaginalis have for inguinal hernias?
It means inguinal hernias may herniate all the way down into the scrotum, also may create a hydrocele.
What is a deep/ indirect inguinal hernia?
A hernia that passes through the deep inguinal ring of the inguinal canal. It may herniate down and through the superficial ring also
What % of hernias are direct inguinal hernias and what % are indirect?
50% are direct, they also affect M more than F and right more than left. 25% are indirect
What is a direct inguinal hernia?
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.
What males up hesselbach’s triangle?
Medial- lateral aspect of rectus abdonmius Lateral- Inferior epigastric blood vessels Posterior- Inguinal ligament
How can you distinguish between a direct and indirect inguinal hernia?
Direct will originate medial to the inferior epigastric vessels
Which sex gets femoral hernias more and why
Females, because they have proportionally wider hips and so wider femoral canals, so contents are move into it more easily
Why are femoral hernias more severe than inguinal?
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.
What are the two main causes of umbellical hernias
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.
What is a hernia above the umbellicus region called and how does it occur?
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.
