Inguinal Hernia Flashcards
How long is the inguinal canal?
approximately 4- to 6 cm-long .
What are the boundaries of the inguinal canal ?
- Anteriorly: The external oblique aponeurosis.
- Posteriorly:The transversalis fascia and transversus abdominis muscle.
- Laterally: The internal oblique muscle.
- Superiorly: the internal oblique muscle.
- Inferiorly: The inguinal (Poupart’s) ligament.
What are the contents of the spermatic cord ?
3 arteries, 3 nerves, 3 fascias, 3 other things:
- 3 arteries: Testicular, Deferential (artery of the ductus deferens), Cremasteric.
- 3 nerves: genital branch of the genitofemoral, sympathetic nerve fibers +/- cremasteric nerve.
- 3 fascias: external spermatic fascia, cremasteric fascia, internal spermatic fascia.
- 3 other things: ductus deferens, pampiniform plexus, lymphatic vessels.
What are the ligaments that contribute to the inguinal canal ?
1- Inguinal ligament.
2- Cooper’s ligament ((pectineal ligament).
3- The lacunar ligament (ligament of Gimbernat).
What is the iliopubic tract ?
- It is an aponeurotic band that begins at the anterior superior iliac spine and inserts into Cooper’s ligament from above.
- It forms on the deep inferior margin of the transversus abdominis and transversalis fascia.
- It helps form the inferior margin of the internal inguinal ring as it courses medially, where it continues as the anteromedial border of the femoral canal.
What is the lacunar ligament, or ligament of Gimbernat ?
It is the triangular fanning of the inguinal ligament as it joins the pubic tubercle.
What is Cooper’s (pectineal) ligament ?
Cooper’s (pectineal) ligament is the lateral portion
of the lacunar ligament that is fused to the periosteum of the
pubic tubercle.
What is the the conjoined tendon ?
The conjoined tendon is commonly described as the fusion of the inferior fibers of the internal oblique and transversus abdominis aponeurosis at the point where they insert on the pubic tubercle.
What is the difference between Indirect hernias direct
hernias ?
- Indirect hernias:
protrude lateral to the inferior epigastric vessels, through the deep inguinal ring. - Direct hernias:
protrude medial to the inferior epigastric vessels, within
Hesselbach’s triangle.
What are the borders of Hesselbach’s triangle ?
- Inferiorly: inguinal ligament
- Medially: lateral edge of rectus sheath
- Superolaterally: the inferior epigastric vessels.
What are the borders of the femoral ring?
- Anteriorly: the iliopubic tract and inguinal ligament.
- Posteriorly: Cooper’s ligament.
- Medially: the lacunar ligament.
- Laterally: the femoral vein.
What is the the classification that categorizes hernia defects by location, size, and type ?
Nyhus classification system.
- Type I.
- Type II
- Type IIIA
- Type IIIB
- Type IIIC
- Type IV
What is Nyhus classification Type I ?
Indirect hernia; internal abdominal ring
normal; typically in infants, children,
small adults.
What is Nyhus classification Type IIIB ?
Indirect hernia that has enlarged enough to encroach upon the posterior inguinal wall; indirect sliding or scrotal hernias are usually placed in this category because they are commonly associated with extension to the direct space; also includes pantaloon hernias.
What is the space of Retzius ?
It is the most medial aspect of the preperitoneal space, that which lies superior to the bladder.
The rectus abdominis muscle supplied by which artery ?
inferior epigastric artery.
The inferior epigastric artery is derived from which artery ?
External iliac artery.
What are the Nerves of interest in the inguinal region?
- The ilioinguinal nerve.
- The iliohypogastric nerve.
- The genitofemoral nerve.
- The lateral femoral cutaneous nerves.
What does the ilioinguinal nerve supplies?
It supplies:
- somatic sensation to the skin of the upper and medial thigh.
- In males: the base of the penis and upper scrotum.
In females: the mons pubis and labium majus.
What are the borders and contents of the Triangle of doom in laparoscopic hernia repair?
- Medially: by the vas deferens.
- Laterally: by the vessels of the spermatic cord.
The contents of the space include:
- The external iliac vessels.
- Deep circumflex iliac vein.
- Femoral nerve.
- The Genital branch of the genitofemoral nerve.
What are the borders and contents of the The triangle of pain in laparoscopic hernia repair ?
Bordered by: -The iliopubic tract. - Gonadal vessels. Contains: - The lateral femoral cutaneous. - Femoral branch of the genitofemoral. - Femoral nerves.
What is The circle of death in laparoscopic hernia
repair ?
It is a vascular continuation formed by: - The common iliac. - Internal iliac. - Obturator. - Inferior epigastric. - External iliac. vessels
What are the assumed causes of groin herniation ?
- Weakness in the abdominal wall musculature.
- Coughing
- Chronic obstructive pulmonary disease
- Obesity
- Straining: Constipation or Prostatism.
- Pregnancy
- Birthweight <1500 g
- Family history of a hernia
- Valsalva’s maneuver
- Ascites
- Upright position
- Congenital connective tissue disorders
- Defective collagen synthesis
- Previous right lower quadrant incision
- Arterial aneurysms
- Cigarette smoking
- Heavy lifting
- Physical exertion
In which trimester does the testes descend from the intra-abdominal space into the scrotum?
In the third trimester.
