Lecture 8-Abdominal Wall and Hernias

Question 1

Define hernia

Answer 1

Protrusion of part of the abdominal contents beyond the confines of its containing cavity

Question 2

What are the 3 parts of a hernia?

Answer 2

• sac = pouch of peritoneum
• contents of the sac = structures within the abdominal cavity
• coverings of the sac = layers of abdominal wall through which hernia has passed

Question 3

What are areas of potential weakness in the abdominal wall?

Answer 3

• inguinal canal
• femoral canal
• umbilicus
• previous incisions

Question 4

The inguinal canal is halfway between which structures?

Answer 4

Pubic tubercle and ASIS

Question 5

What forms the anterior wall of the inguinal canal?

Answer 5

Aponeurosis of external oblique muscle

Question 6

What forms the floor of the inguinal canal?

Answer 6

Inguinal ligament and lacunar ligament medially

Question 7

What forms the roof of the inguinal canal?

Answer 7

Arching fibres of internal oblique and transversus abdominus

Question 8

What forms the posterior wall of the inguinal canal?

Answer 8

Transversalis fascia and conjoint tendon (internal oblique and transversus abdominus)

Question 9

When do the testes descend in males?

Answer 9

7/8th month

Question 10

What does the processus vaginalis form when it is obliterated?

Answer 10

Tunica vaginalis

Question 11

What happens if the processus vaginalis doesn’t obliterate?

Answer 11

There will be a connection between the scrotum and peritoneal cavity -> inguinal or scrotal hernia

Question 12

What do indirect inguinal hernias pass through?

Answer 12

Through deep inguinal ring -> canal -> superficial inguinal ring (could descend into scrotum if processus vaginalis not obliterated)

Question 13

Anatomically, what is the difference between indirect and direct inguinal hernias?

Answer 13

Indirect - lateral to inferior epigastric vessels

Direct - medial to inferior epigastric vessels

Question 14

What do direct inguinal hernias pass through?

Answer 14

Hesselbach’s triangle (near superficial inguinal ring)

Question 15

What forms the medial border of Hesselbach’s triangle?

Answer 15

Rectus abdominus

Question 16

What forms the superior border of Hesselbach’s triangle?

Answer 16

Inferior epigastric vessels

Question 17

What forms the inferior border of Hesselbach’s triangle?

Answer 17

Inguinal ligament

Question 18

Why are femoral hernias more common in females?

Answer 18

Females have a wider femoral ring (entrance to femoral canal)

Question 19

What is medial to the femoral ring?

Answer 19

Lacunar ligament

Question 20

What is lateral to the femoral ring?

Answer 20

Femoral vein

Question 21

What happens if a hernia gets strangulated?

Answer 21

Blood supply gets compromised -> necrosis -> sepsis

Question 22

What happens if a hernia is incarcerated?

Answer 22

Irreducible (can’t be pushed back into abdomen)

Question 23

What is a congenital umbilical hernia?

Answer 23

Omphalocoele = persistence of physiological herniation of midgut, contents herniate into umbilical cord and have a peritoneal covering

Question 24

What is an acquired infantile umbilical hernia?

Answer 24

Contents herniate through weakness in scar of umbilicus, has skin covering

Question 25

What is an acquired adult umbilical hernia?

Answer 25

Para-umbilical, goes through linea alba near umbilical

Question 26

What is an epigastric hernia?

Answer 26

Through linea alba, between xiphoid process and umbilicus

Question 27

What are the symptoms of an epigastric hernia?

Answer 27

Pain
Vomiting
Sepsis due to strangulation