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Medicine Gastrointestinal > Herniation > Flashcards

Herniation Flashcards

1
Q

Herniation definition

A

Any structure passing through another but ending up in the wrong place

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2
Q

Two factors required for development of a hernia

A

Structural weakness, increased pressure

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3
Q

Normal anatomical weakness for hernias to develop

A

Diaphragm - diaphragmatic hernia
Umbilicus - umbilical hernia
Inguinal canal - inguinal hernia
Femoral canal - femoral hernia

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4
Q

Abnormal anatomical weakness for hernias to develop

A

Congenital diaphragmatic hernia, surgical scars - incising hernia

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5
Q

Causes of increased pressure that can lead to hernia

A

Chronic cough, pregnancy, strenuous activity, straining bowel movements or urination

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6
Q

Where is the linea alba?

A

Xiphoid process to pubic symphysis

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7
Q

Where does the umbilicus lie in relation to the linea alba?

A

Partway along it

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8
Q

Where is the inguinal region?

A

Around the area of the hip crease

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9
Q

What is the linea semilunaris

A

Semilunar line separating the anterior abdominal wall from the lateral abdominal wall. It is the line lateral to where your abs would be

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10
Q

What does the inguinal ligament mark?

A

An anterior boundary between the abdomen and thigh

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11
Q

Where does the inguinal ligament run?

A

Anterior superior iliac spine inferomedially to the pubic tubercle

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12
Q

Where is the sublingual space? What does it do?

A

Below the inguinal ligament and allows communication from the abdominal structures with the thigh

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13
Q

Where is the inguinal canal? What does it do?

A

Just above the inguinal ligament and allows communication from the abdominal structures with the perineum

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14
Q

What is the inguinal canal?

A

Oblique passage between the abdomen and perineum

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15
Q

Which direction does the inguinal canal run?

A

Inferomedially

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16
Q

Where is the entrance to the inguinal canal?

A

Deep inguinal ring in contact with abdominal structures

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17
Q

Where is the exit from the inguinal canal?

A

Superficial inguinal ring in contact with body wall structures or perineum

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18
Q

Contents of the inguinal canal

A

Spermatic cord or round ligament of the uterus, blood and lymphatic vessels, ilioinguinal nerve

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19
Q

Where do testes develop?

A

Posterior abdominal wall

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20
Q

When do the testes descend?

A

7th week

21
Q

Gubernaculum

A

Fibrous cord which during development shortens and contracts

22
Q

What does the gubernaculum attach?

A

Inferior pole of the testes to the skin of the body wall

23
Q

What does the gubernaculum become in adults?

A

Spermatic cord in males and round ligament of uterus in females

24
Q

What is the vaginal process?

A

Area of peritoneum that gets deeper at about the 12th week

25
Q

Tunica vaginalis

A

Pocket of peritoneal fluid created by two layers of the vaginal process

26
Q

What happens when the two borders of the vaginal process do not form?

A

It can create a pathway for herniation to occur

27
Q

What makes up the boundaries of the inguinal canal of the:

  • Anterior wall
  • Posterior wall
  • Roof
  • Floor
A

Anterior - external oblique aponeurosis, internal oblique muscle (laterally)
Posterior - transversus fascia (laterally), conjoint tendon (medially)
Roof - transversalis fascia (laterally), arches of internal oblique and transversus abdominus aponeurosis, external oblique aponeurosis
Floor - gutter of infolded inguinal ligament

28
Q

Hesselbach’s triangle (inguinal triangle)

A

Inferior epigastric artery, inguinal ligament, lateral border of rectus abdominus

29
Q

Site of direct inguinal herniation

A

Hesselbach’s triangle

30
Q

Direct inguinal hernia:

- Path taken

A

Directly through the abdominal wall structures to gain access to inguinal canal, medial through the inferior epigastric artery, through Hesselbach’s triangle to superficial ring parallel to the spermatic cord

31
Q

Indirect inguinal hernia:

- Path taken

A

Uses inguinal canal and deep inguinal ring. Uses a pathway already created by the body to get access to the inguinal canal. Passes lateral to inferior epigastric artery, through the superficial ring and within the spermatic cord or layers of abdominal wall

32
Q

Where is the sub-inguinal space?

A

Posterior and inferior to the inguinal ligament

33
Q

What does the sub-inguinal space contain?

A

Hip flexors, femoral artery and vein, lymphatics, nerves

34
Q

Where can femoral herniation arise?

A

Femoral canal

35
Q

Classification of hernias (3)

A

Reducible, incarcerated or irreducible hernia, strangulated hernia

36
Q

Reducible hernia

A

Hernia can be easily pushed back into the abdomen

37
Q

Incarcerated/irreducible hernia

A

When a hernia cannot be manipulated back to the abdomen

38
Q

Strangulated hernia

A

Vascular supply to the contents contained within the hernia is compromised, resulting in ischaemic and gangrenous tissue

39
Q

Treatment for hernias

A

Conservative management or surgical management

40
Q

Epigastric hernia:

  • Definition
  • Presentation
A
  • Fascial defect in the linea alba between the xiphoid process and umbilicus
  • Midline lump, 75% asymptomatic but can present with pain
41
Q

Paraumbilical hernia:

  • Aetiological factors
  • Presentation
  • Management
A
  • Stretching of abdominal wall by obesity, multiple pregnancies or ascites
  • Frequently asymptomatic or present with pain
  • Nearly always surgical - do not resolve spontaneously and high incidence of incarceration and strangulation
42
Q

3 coverings of the spermatic cord

A

Internal spermatic fascia, cremasteric fascia, external spermatic fascia

43
Q

6 contents of the spermatic cord

A

Vas deferens, arteries (testicular artery, artery to Vas deferens, cremasteric artery), pampiniform plexus, lymphatics, nerves, remains of the processus vaginalis

44
Q

Are direct inguinal hernias or indirect inguinal hernias more common?

A

Indirect

45
Q

Diagnosis of inguinal hernia

A

Groin swelling which usually disappears lying down, usually located above and medial to the pubic tubercle, palpable cough impulse on examination, dynamic ultrasound can be helpful

46
Q

Management of inguinal hernia

A

Non-surgical or surgical

47
Q

Management of femoral hernia

A

Surgical

48
Q

Predisposing factors to incisional hernia

A

Wound complications, inherited collagen abnormalities, advanced age, smoking, morbid obesity, malignancy, surgical technique

Medicine Gastrointestinal (24 decks)

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