Hernias Flashcards
Approx. 75% of abdominal wall hernias occur where?
groin
Lifetime risk of inguinal hernias in men vs women?
men 27% women 3%
Most common subtype of groin hernia in men and women?
indirect inguinal hernia
Most common hernia in women?
indirect inguinal hernia
70% of femoral hernia repairs reported in women, however inguinal hernias are;
5x more common
The incidence of inguinal hernias has a bimodal age distribution;
before 1st year of age >40
The deep internal inguinal ring is a defect in what?
tranversalis fascia
The superficial external inguinal ring is a defect in what?
external oblique aponeurosis
This is the point at which the spermatic cord crosses the external oblique aponeuoosis;
superficial external inguinal ring
What are the boundaries of the inguinal canal?
A–> EO aponeurosis P–> tranversalis fascia, TO S–> IO I–> Inguinal (Poupart’s) ligament
Contents of the spermatic cord?
vas deferens testicular A ductus deferens A cremasteric A pampiniform plexus genital branch of genitofemoral N PSNS/SNS nerves lymphatics
What is the lacunar ligament?
triangular fanning of inguinal ligament as it joins pubic tubercle
What is Cooper’s (pectineal) ligament?
lateral portion of lacunar ligament that’s fused to periosteum of pubic tubercle
What two muscles make up the conjoint tendon?
IO + TA aponeurosis (they insert on pubic tubercle)
What’s an indirect hernia?
protrusion lateral to inferior epigastric vessels through deep inguinal ring
What’s a direct inguinal hernia?
protrude medial to inferior epigastric vessels within Hasselbach’s triangle
What are borders of Hasselbachs triangle?
inguinal ligament inferiorly
lateral edges of rectus sheath medially
inferior epigastric vessels superolaterally
Femoral hernias protrude thru the femoral ring, what are the borders?
iliopubic tract and inguinal ligament anteriorly
Cooper’s ligament posteriorly
lacunar ligament medially
femoral vein laterally
This classifies hernias based on location, size and type:
Nyhus classification
Inferior epigastric artery supplies what m?
rectus abdominus
Inferior epigastrics are derived from?
external iliac artery
Inferior epigastric vessels anastomose with what?
superior epigastric vessels which come off the internal mammary A
What 4 nerves are of interest during hernia repairs?
ilioinguinal N
iliohypogastric N
lateral femoral cutaneous N
genitofemoral N
What’s the course of the ilioinguinal nerve?
comes out medial to ASIS
enters inguinal canal
exits thru superifical inguinal ring