Inguinal Hernias Flashcards
What is an inguinal hernia?
It defined as an abnormal protrusion of abdominopelvic contents through the superficial ring into the groin
What is the most common abdominal hernia classification?
Inguinal hernias
Where is the inguinal ligament located?
It extends between the anterior superior iliac spine (ASIS) and the pubic tubercle (PT)
Where is the inguinal canal located?
It runs above the inguinal ligament
What is the function of the inguinal canal?
It provides a passageway between the peritoneal cavity and the external genitalia
Where is the deep ring of the inguinal canal located?
It is located just above the mid-point of the inguinal ligament
Where is the superficial ring of the inguinal canal located?
It is located just above and lateral to the pubic tubercle
What are the two classifications of inguinal hernias?
Direct Inguinal Hernia
Indirect Inguinal Hernia
What are direct inguinal hernias?
They are defined as the abnormal protrusion of abdominal contents direct through the Hesselbach’s triangle, due to a weakness in the posterior wall of the inguinal canal
The hernia enters the inguinal canal medial to the deep ring and exits via the superficial ring
What are indirect inguinal hernias?
They are defined as the abnormal protrusion of abdominal contents, which enter the deep ring, pass along the length of the inguinal canal and exit via the superficial ring
How do we differentiate between direct and indirect inguinal hernias?
We can reduce the hernia and then press on the deep inguinal ring
What is the feature of indirect inguinal hernias on clinical examination? Explain
The groin lump will not reappear
This is due to the fact that its entry point is the deep inguinal ring
What is the feature of direct inguinal hernias on clinical examination? Explain
The groin lump will reappear
This due to the fact that its entry point is Hesselbach’s triangle – not the deep inguinal ring
What are the three risk factors of inguinal hernias?
Older Age > 70 Years Old
Male Gender
Low BMI
What are the two clincial features of inguinal hernias?
Groin Lump
Dull Groin Pain
Where are groin lumps associated with inguinal hernias located?
They are located superior and medial to the pubic tubercle
In which two circumstances, are inguinal hernias reducible?
Pressure Application
Lying Down
What are the four characteristic features of the groin pain associated with inguinal hernias?
Exacerbated by exercise
Exacerbated by coughing
Exacerbated by bending over
Exacertbated by standing for extended period
How are inguinal hernias diagnosed?
Clinically
In most cases, there is not a requirement of futher investigations
What investigation is used to diagnose inguinal hernias?
Ultrasound Scan
How are ultrasound scans used to investigate inguinal hernias?
In cases of diagnostic uncertainty in order to exclude differential diagnoses of inguinal hernias – including enlarged lymph nodes, fatty lumps or vascular pathology
When do we conduct management of inguinal hernias?
It is recommended that all medically fit patients should undergo surgical management, even in cases where individuals are asymptomatic
What are the two surgical management options of inguinal hernias?
Open Mesh Repair
Laparoscopic Mesh Repair
When is an open mesh repair used to manage inguinal hernias?
It is the first line management option used to treat unilateral inguinal hernias
