Inguinal Canal and Hernias Flashcards
What is the congential thing that can lead to an inguinal hernia?
During development, canal is flanked by an outpocket of the peritoneum - the processus vaginalis
This normally degenerates
Failure to do so can result in a hernia
Where is relation to the inguinal ligament is the inguinal canal?
Superior to the ligament
Which type of hernia is due to a congential abnormality?
Indirect
What is the mid-inguinal point?
Halfway between the pubic symphysis and the ASIS
Where the femoral artery crosses into the lower limb
Where is the midpoint of the inguinal ligament?
As it says
Inguinal ligament runs between the pubic tubercle to the ASIS so halfway between these two
Opening of the inguinal canal is just above it
Boundaries of the inguinal canal?
Anterior wall - aponeurosis of the external oblique, reinforced by the internal oblique muscle laterally
Posterior wall - transversalis fascia
Roof - transversalis fascia, internal oblique and transversus abdominis
Floor - inguinal ligament, thickened medially by the lacunar ligament
What is the inguinal ligament?
A rolled up portion of the external oblique aponeurosis
During increased intra-abdominal pressure, how are abdominal viscera prevented from herniation?
Muscles of the anterior and posterior abdominal wall contract and clamp down on the canal
Where is the deep (internal) ring of the inguinal canal found?
Above the midpoint of the inguinal ligament, lateral to epigastric vessels
What is the deep inguinal ring created by?
Invagination of the transversalis fascia
Forms a covering of the contents of the inguinal canal
Where is the superficial ring of the inguinal canal found?
Just superior to the pubic tubercle
What passes through the inguinal canal?
Men - Spermatic cord which supplies and drains the testes
Women - Round ligament of the uterus
Which rings does an indirect hernia pass through?
Enters via the deep inguinal ring and can then go as far as the superficial ring
What rings does a direct inguinal hernia involve?
Not the deep ring
Protrudes through the posterior wall of inguinal canal
Why does a direct hernia occur?
Weakening of the abdominal musculature
Which is the most common type of inguinal hernia?
Indirect hernia
How to distinguish between a direct and indirect hernia?
Place hand over superficial inguinal ring
Ask patient to cough
If it still pushes through, it is a direct hernia
Where is an epigastric hernia?
Hernia of the epigastric region through the linea alba
Occurs in midline between xiphoid process and umbilicus
Risk factors for an epigastric hernia?
Obesity
Pregnancy
Why is an umbilical hernia common in neonates?
May have weakness/incomplete closure of their abdominal wall after litigation of the umbilical cord at birth
Risk factors for umbilical hernias in adults?
Women
Obesity
What is a femoral hernia?
Protrusion of abdominal viscera into the femoral canal through the femoral ring
Where does a femoral hernia appear?
In the femoral triangle
What are femoral hernias bounded by?
Femoral vein laterally
Lacunar ligament medially
Who are femoral hernias more common in?
Females
Complications of hernias and their definition?
Strangulation - constriction of blood vessels
Incarceration - hernia can’t be reduced or pushed back into place easily
Why can a femoral hernia easily become strangulated?
Sharp rigid boundaries of femoral ring
