lecture 1 groin

Question 1

inguinal region

Answer 1

junction between anterior abdominal wall and thigh; area between ASIS and pubic tubercle

Question 2

anterior abdominal wall

Answer 2

weakened in this region

Question 3

clinical importance - popular question to describe walls of canal

Answer 3

potential site for most abdominal hernias (4 walls of femoral (lymphatics) and inquinal canal): male (testes outside) > female (ovaries inside)

Question 4

anatomical importance

Answer 4

structures exit and enter abdominal cavity; femoral sheath covers femoral artery and vein and canal (canal not part of artery and sheath), nerve outside of sheath

Question 5

inguinal canal

Answer 5

testis and spermatic cord descend from abdomen into scrotum via developing inguinal canal; in female uterine round ligament descends through developing inguinal canal

Question 6

femoral canal

Answer 6

below inguinal ligament through which femoral artery and vein pass; medial compartment of femoral sheath (lymphatics through); artery and vein lateral to canal

Question 7

define hernia

Answer 7

condition which part/whole of organ or tissue abnormally protrude through wall of structure containing organ/tissue

Question 8

anatomy of hernia

Answer 8

abdominal sac, neck of hernia between abdominal wall with defect, hernia coverings (skin) so appears large lump, intestinal loop contains contents of hernial sac (e.g. bowel, bladder)

Question 9

clinical signs and symptoms of hernia

Answer 9

lump/protrusion from groin, intermittently/persistently, painless/painful and uncomfortable, may be reducible or irreducible, may be strangulated with tissue death - associated with vomiting, constipation and intestinal obstruction - emergency to remove section of gut as will never recover

Question 10

facts about hernias in groin

Answer 10

slide 33; iguinal hernias > femoral hernias

Question 11

inguinal hernias

Answer 11

indirect or direct

Question 12

femoral hernia

Answer 12

slide 34

Question 13

inguinal canal

Answer 13

slide 35 - landmarks, formation and causes of hernia

Question 14

males: genital branch of genito-femoral nerve also

Answer 14

female: genital branch of genito-femoral nerve also

Question 15

anterior wall

Answer 15

3 areas of anterio-abdominal muscles

Question 16

floor

Answer 16

37

Question 17

roof

Answer 17

37

Question 18

posterior wall

Answer 18

37

Question 19

conjoint tendon

Answer 19

lowest fibres of internal oblique aponeurosis and similar fibres of transversus abdominis aponeurosis join to form conjoint tendon attached medially to linea alba

Question 20

direct - acquired

Answer 20

tends to go through Hesselbach’s (inguinal) triangle which is awlays medial to inferior epigastric vessels

Question 21

indirect - congenital - slide 40

Answer 21

always an internal ring which is lateral to inferior epigastric vessels; through the canal and though upper ring?

Question 22

direct

Answer 22

older age as weaker, posterior wall of canal, chronic straining and weak masculature; hernia path straigh through posterior wall of inguinal canal

Question 23

Hasselbach’s triangle

Answer 23

3 structures: rectus abdominis muscle, inferior epigastric vessels, inguinal ligament

Question 24

indirect

Answer 24

most common, younger, indirect path, dilated deep ring, enters deep ring then passes through inguinal canal, external inguinal ring and scrotum

Question 25

femoral hernias

Answer 25

slide 47

Question 26

femoral canal borders

Answer 26

superior: inguinal ligament, inferior: pectineus fascia, medial: lacunar ligament, lateral: femoral vein

Question 27

femoral hernias on examination

Answer 27

irreducible - can’t be pushed back, hot and painful if strangulated, distinguished from inguinal as appear below and lateral to pubic tubercle (inguinal are above and medial to pubic pubic tubercle)