Inguinal Hernia Anatomy

Question 1

Where does the inguinal canal extend?

Answer 1

extends between the deep/internal and superficial (external) ring

Question 2

roof of the inguinal canal?

Answer 2

internal oblique and transverses muscles

Question 3

floor of the inguinal canal?

Answer 3

inguinal ligament and lacunar ligament

Question 4

posterior wall of the inguinal canal

Answer 4

transversals fascia

Question 5

anterior wall of the inguinal canal

Answer 5

external oblique aponeurosis and internal oblique muscle

Question 6

hesselbach triangle borders

Answer 6

medially: rectus sheath

laterally: inferior epigastric vessels

inferiorly: inguinal ligament

Question 7

pathophysiology of a direct inguinal hernia

Answer 7

weakening of the transversals fascia due to an increased extrabadominal pressure

within the hesselbach triangle

surrounded by external spermatic fascia

Question 8

indirect inguinal hernia pathophysiology

Answer 8

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

Question 9

what labs to get for a strangulated or incarcerated inguinal hernia

Answer 9

CBC, blood glucose, electrolytes, BMP, serum lactate, urinalysis

Question 10

clinical symptoms of obstructed, incarcerated, and strangulated hernias

Answer 10

obstructed: sudden pain, constipation, abdominal distension

incarcerated: irreducible, normal overlying skin

strangulatedL severe groin pain, sepsis, shock, warm, red overlying skin

Question 11

contents of the inguinal canal

Answer 11

ilioinguinal nerve, genitofemoral nerve, spermatic cord- MEN

round ligament of the uterus- women

Question 12

spermatic cord contents

Answer 12

vas deferens,
testicular artery,
artery to the ductus deferens,
cremasteric muscle fibers

pampiniform plexus

genital branch of the genitofemoral nerve

Question 13

covering of the spermatic cord

Answer 13

external spermatic fascia, cremasteric fascia, internal spermatic fascia

Question 14

layers of the abdominal wall (skin to deep)

Answer 14

external abdominal oblique, internal abdominal oblique, transverse abdominal muscle, transversales fascia, subserosa, peritoneum

EITTSP

1. skin
2. subcutaneous tissue
3. scarpa’s fascia
4. external oblique
5. internal oblique
6. transversus abdominus
7. tranversalis fascia
8. preperitoneum fat
9. peritoneum

Question 15

external abdominal oblique turns into

Answer 15

external spermatic fascia

Question 16

internal abdominal oblique turns in to?

Answer 16

cremasteric fascia

Question 17

transversals fascia turns into

Answer 17

internal spermatic fascia

Question 18

what is more dangerous a small or large hernia defect

Answer 18

small because it can become strangulated

Question 19

reducible

Answer 19

the ability to return the displaced organ or tissue to their usual anatomic location

Question 20

incarcerated

Answer 20

swollen or fixed within the hernia sac = imprisoned and can cause obstruction

Question 21

strangulated

Answer 21

an incarcerated hernia with resulting ischemia with signs of intestinal necrosis or bowel obstruction

Question 22

littres hernia

Answer 22

hernia involving meckles diverticulum

Question 23

spigelian hernia

Answer 23

hernia through linea semilunaris

Question 24

internal hernia

Answer 24

hernia involving intrabdominal stucture

Question 25

Peterson hernia

Answer 25

hernia after gastric bypass

internal herniation of the small bowel through the mesenteric defect from the roux limb

Question 26

obturator hernia

Answer 26

hernia through the obturator canal (female)

Question 27

pantaloon hernia

Answer 27

both direct and indirect hernia that straddles the inferior epigastric vessels

Question 28

richters hernia

Answer 28

incarcerated or strangulated hernia involving only one sidewall of bowel

Question 29

differential diagnosis for a direct and indirect hernia

Answer 29

lymphadenopathy, hematoma, abcess

Question 30

what nerve runs with the spermatic cord in the inguinal canal

Answer 30

ilioinguinal

Question 31

indication for laparoscopic inguinal hernia repair

Answer 31

bilateral inguinal hernias

recurring hernia

need to resume full time activity as soon as possible

Question 32

what is the first identifiable subcutaneous named layer

Answer 32

scarpas fascia

Question 33

name of the subcutaneous vein that is ligated

Answer 33

superficial epigastric vein

Question 34

what happens if you cut the ilioinguinal nerve

Answer 34

numbness of inner thigh or lateral scrotum that goes away in 6 months

Question 35

from what abdominal muscle layer is the cremaster muscle derived

Answer 35

internal oblique

Question 36

from what abdominal muscle layer is the inguinal ligament derived

Answer 36

external oblique

Question 37

what does the inguinal ligament (poupart) attach

Answer 37

ASIS to the pubic tubercle

Question 38

what attaches the testicle to the scrotum

Answer 38

gubernaculum

Question 39

most common organ in an inguinal hernia sac in men vs women

Answer 39

small intestine

ovary/Fallopian tube

Question 40

what lies in the inguinal canal in females instead of the artery to the ductus deferens

Answer 40

round ligament