Inguinal Hernias Flashcards
What are the two types of inguinal hernias?
- Direct
- Indirect
Differential Diagnosis for lump in inguinal region
5/7
- Femoral
- Lymph node enlarged
- Sephena varinx (dilation of saphenous vein at junction with femoral vein in groin)
- Femoral aneurysm
- Abcess
- Undescended/ ectopic testes
- Kidney transplant
Indirect Inguinal Hernias
Herniate inside or outside the inguinal canal?
Specific findings to differenciate?
What group of people do they occur in and why?
Complication?
- Inside inguinal canal
- When reduced and pressure is applied to the deep inguinal ring (at the midpoint between to Ant. Sup Iliac Spine and to the pubic tubercle) the hernia will REMAIN REDUCED.
- Young male patients due to congential reasons, patent processus vaginalis
- Indirect can strangulate!!
Anatomy
What does the inguinal canal run between?
In males what is in the inguinal canal function?
In females what is contained within the inguinal canal and what does it attach to?
Runs between the Deep Inguinal Ring (connects to peritoneal cavity) to the Superficial Inguinal Ring (connected to scotum)
Males
Inguinal canal carries the spermatic cord to travel from peritoneal cavity to scotum
Females
The round ligament which attaches to the uterus and passes through the deep inguinal ring and attaches to the labia majora
Anatomy
During fetal development the_____is a pouch of peritonium which extends from the abdominal cavity and allows for the testes to pass into the inguinal canal.
What happens in some patients?
Processus vaginalis
What happens normally?
- The deep inguinal ring closes
- processus vaginalis is obliterated
Some people the Deep inguinal ring remains patent and the processus vaginalis intact-> Abdo contents spills into scotum
Direct Inguinal Hernia
What do they occur due to and where?
Differentiating factor
Group of people they occur in and why?
- Due to weakness in abdominal walls at Hasselbach’s triangle
- The hernia will not reduce over the deep inguinal ring
- Older males due to weakness in abdominal wall and increase in intra-abdominal pressure -> lifting, chronic cough
Hasselbachs triangle boundaries
RIP
- Rectus abdominus muscle (medial)
- Inferior epigastric vessel (superior)
- Poupart’s ligament/ inguinal ligament (inferior)
Management of both inguinal hernias?
When would they not have this?
- Surgery for laproscopic or open MESH repair
- If completely asymptomatic or not fit for surgery
