Hernias B&B Flashcards
What are the borders of the femoral triangle?
superior = inguinal ligament
Medium = adductor longus
Lateral = sartorius
within (lat-med) = NAVeL, or “venous to the penis” (but femoral nerve is outside of femoral sheath!)
what is carried in the inguinal canal?
testes descend through the inguinal canal to the scrotum, also includes spermatic cord (ductus deferens + arteries + veins + nerves)
inguinal canal runs parallel to the inguinal ligament (on top, diagonal to pelvis)
What are the three fascial layers of the spermatic cord?
spermatic cord travels in inguinal canal and includes ductus deference, arteries, veins, nerves
Three fascial layers = external spermatic fascia, cremasteric fascia, internal spermatic fascia
what is the entrance, exit, and floor of the inguinal canal? What is the inguinal canal carry in males versus females?
entrance = deep inguinal ring
Exit = superficial inguinal ring
floor = inguinal ligament
Carrie spermatic cord in males and round ligament in females
How do indirect inguinal hernias occur?
due to congenital defect in which processus vaginalis is patent (should close after testes descend) and bowel protrudes through
protrude “indirectly” via inguinal canal (may extend into scrotum), not through hole in abdominal wall… therefore covered by all layers of spermatic fascia (direct hernias have only outer layer)
originate lateral to epigastric vessels because the enter at deep/internal inguinal ring
what is the embryological role of the processus vaginalis, and what does it become in adults?
outpouching of peritoneum behind which testes descend - remains open in newborn period but should close/obliterate in infancy after testes descend (seal around spermatic cord)
replaced by fibrous tissue, becomes tunica vaginalis testis (serous covering of testes)
patent processus vaginalis —> indirect inguinal hernia
in which pediatric patients might you see an indirect inguinal hernia?
due to congenital defect in which processus vaginalis is patent and bowel protrudes through (may extend into scrotum)
usually adult males after heavy lifting/straining, but can occur in newborns on mechanical ventilation (increases intra-abdominal pressure)
from where do direct inguinal hernias originate?
bowel bulges directly through abdominal wall via Hesselbach’s triangle, caused by weakness of transversalis fascia
originate medial to epigastric vessels (contrast w/ indirect, which originate lateral) and are covered by external spermatic fascia only
travel through external inguinal ring only (not deep/internal as indirect hernias do)
what are the borders of Hesselbach’s Triangle, and what is its clinical significance?
superior = inferior epigastric vessels
Inferior = inguinal ligament
Medium = lateral border of rectus abdominis
Floor = transversalis fascia
when fascia becomes weak, hole can occur through which direct inguinal hernias can emerge
contrast the following for indirect vs direct inguinal hernias:
a. cause
b. origin
c. location
indirect inguinal hernias: caused by patent processus vaginalis, originate in deep/internal inguinal ring and may extend to scrotum, located laterally to epigastric vessels
direct inguinal hernias: caused by weakness of transversalis fascia, originate in Hesselbach’s Triangle and travel through superficial/external inguinal ring, will NOT extend to scrotum, located medially to epigastric vessels
where do femoral hernias occur?
through femoral ring, medial to femoral vessels - bowel protrudes below inguinal ligament
high risk of incarceration because femoral ring is a small opening
more common in W > M
describe a sliding hiatal hernia (Type I hiatal hernia)
displacement of gastro-esophageal junction above diaphragm - causes “hourglass” appearance on imaging
what is the developmental consequence of congenital diaphragmatic hernia (CDH)?
defective formation of the pleuroperitoneal membrane —> hole in diaphragm through which abdominal organs herniate into chest
in utero herniation causes pulmonary hypoplasia (often fatal)
