Lecture 7.1: Abdominal Wall & Hernias

Question 1

What is the Anatomical Location of a Femoral Hernia?

Answer 1

• Occurs in the femoral canal
• It is bordered by the inguinal ligament
  anterosuperiorly, Cooper’s ligament inferiorly
• The femoral vein laterally
• The junction of the iliopubic tract, and Cooper’s
  ligament (lacunar ligament) medially

Question 2

What makes up the anterior wall of the inguinal canal? (2)

Answer 2

• External Oblique Aponeurosis
• Internal Oblique Aponeurosis

Question 3

What makes up the posterior wall of the inguinal canal?(2)

Answer 3

• Transversalis Fascia
• Conjoint Tendon

Question 4

The Inguinal Canal: Structure + Contents

Answer 4

• Males: transmits spermatic cord to scrotum
• Females: transmits round ligament to attach at labia
  majora
• Ilioinguinal nerve: contributes to sensory innervation
  of genitalia
• Genital branch of genitofemoral nerve

Question 5

Where in the inguinal canal do the spermatic cord/round ligament enter and exit?

Answer 5

Enter: Deep Inguinal Ring
Exit: Superficial Inguinal Ring

Question 6

What makes up the floor of the inguinal canal? (2)

Answer 6

• Inguinal Ligament
• Lacunar Ligament

Question 7

What makes up the roof of the inguinal canal? (2)

Answer 7

• Internal Oblique Muscle
• Transversus Abdominis Muscle

Question 8

What are Langer Lines? What is their significance?

Answer 8

• Linear clefts in the skin that indicate the direction of
  orientation of the underlying collagen fibres
• During surgery incisions made in the direction of the
  line of cleavage in skin so to promote hairline scar
  results

Question 9

Midline Abdominal Incisions: Advantages (5)

Answer 9

• Almost bloodless
• No muscle fibres divided
• Nerves at lower risk of injury
• Good access to upper abdomen
• Very quick to make e.g. emergency laparotomy

Question 10

Midline Abdominal Incisions: Disadvantages

Answer 10

• Susceptible to significant scars

Question 11

What is a Gridiron Abdominal Incision?

Answer 11

• A downward and inward incision from McBurney’s
  point
• Choice for most appendicectomies (unless done
  laparoscopically)
• Don’t divide the muscles as much, but spread them
  apart to access the abdomen

Question 12

What is a Hernia?

Answer 12

A hernia is an abnormal protrusion of the content of a cavity through a weakness in the wall of that cavity, taking with it the accompanying serosal linings

Question 13

Causes of Hernias (7)

Answer 13

• Aging
• Degenerative weakness of muscle and fibrous tissue
• Intra-abdominal pressure (pregnancy, ascites)
• Trauma
• Collagen Disease
• Obesity
• Malnutrition

Question 14

Types of Hernia: By Complexity

Answer 14

• Occult
• Reducible
• Irreducible (Incarcerated)
• Strangulated
• Infarcted