Inguinal Hernia Anatomy Flashcards
Where does the inguinal canal extend?
extends between the deep/internal and superficial (external) ring
roof of the inguinal canal?
internal oblique and transverses muscles
floor of the inguinal canal?
inguinal ligament and lacunar ligament
posterior wall of the inguinal canal
transversals fascia
anterior wall of the inguinal canal
external oblique aponeurosis and internal oblique muscle
hesselbach triangle borders
medially: rectus sheath
laterally: inferior epigastric vessels
inferiorly: inguinal ligament
pathophysiology of a direct inguinal hernia
weakening of the transversals fascia due to an increased extrabadominal pressure
within the hesselbach triangle
surrounded by external spermatic fascia
indirect inguinal hernia pathophysiology
incomplete obliteration of the processes vaginalis
outside of hesselbach triangle
runs with the spermatic cord
surrounded by external spermatic fascia, cremasteric muscle fibers and internal spermatic fascia
what labs to get for a strangulated or incarcerated inguinal hernia
CBC, blood glucose, electrolytes, BMP, serum lactate, urinalysis
clinical symptoms of obstructed, incarcerated, and strangulated hernias
obstructed: sudden pain, constipation, abdominal distension
incarcerated: irreducible, normal overlying skin
strangulatedL severe groin pain, sepsis, shock, warm, red overlying skin
contents of the inguinal canal
ilioinguinal nerve, genitofemoral nerve, spermatic cord- MEN
round ligament of the uterus- women
spermatic cord contents
vas deferens,
testicular artery,
artery to the ductus deferens,
cremasteric muscle fibers
pampiniform plexus
genital branch of the genitofemoral nerve
covering of the spermatic cord
external spermatic fascia, cremasteric fascia, internal spermatic fascia
layers of the abdominal wall (skin to deep)
external abdominal oblique, internal abdominal oblique, transverse abdominal muscle, transversales fascia, subserosa, peritoneum
EITTSP
- skin
- subcutaneous tissue
- scarpa’s fascia
- external oblique
- internal oblique
- transversus abdominus
- tranversalis fascia
- preperitoneum fat
- peritoneum
external abdominal oblique turns into
external spermatic fascia
internal abdominal oblique turns in to?
cremasteric fascia
transversals fascia turns into
internal spermatic fascia
what is more dangerous a small or large hernia defect
small because it can become strangulated
reducible
the ability to return the displaced organ or tissue to their usual anatomic location
incarcerated
swollen or fixed within the hernia sac = imprisoned and can cause obstruction
strangulated
an incarcerated hernia with resulting ischemia with signs of intestinal necrosis or bowel obstruction
littres hernia
hernia involving meckles diverticulum
spigelian hernia
hernia through linea semilunaris
internal hernia
hernia involving intrabdominal stucture
Peterson hernia
hernia after gastric bypass
internal herniation of the small bowel through the mesenteric defect from the roux limb
obturator hernia
hernia through the obturator canal (female)
pantaloon hernia
both direct and indirect hernia that straddles the inferior epigastric vessels
richters hernia
incarcerated or strangulated hernia involving only one sidewall of bowel
differential diagnosis for a direct and indirect hernia
lymphadenopathy, hematoma, abcess
what nerve runs with the spermatic cord in the inguinal canal
ilioinguinal
indication for laparoscopic inguinal hernia repair
bilateral inguinal hernias
recurring hernia
need to resume full time activity as soon as possible
what is the first identifiable subcutaneous named layer
scarpas fascia
name of the subcutaneous vein that is ligated
superficial epigastric vein
what happens if you cut the ilioinguinal nerve
numbness of inner thigh or lateral scrotum that goes away in 6 months
from what abdominal muscle layer is the cremaster muscle derived
internal oblique
from what abdominal muscle layer is the inguinal ligament derived
external oblique
what does the inguinal ligament (poupart) attach
ASIS to the pubic tubercle
what attaches the testicle to the scrotum
gubernaculum
most common organ in an inguinal hernia sac in men vs women
small intestine
ovary/Fallopian tube
what lies in the inguinal canal in females instead of the artery to the ductus deferens
round ligament
