PATH - Hernias

Question 1

Diaphragmatic hernia

Answer 1

Abdominal structures enter the thorax

may occur due to congenital defect of pleuroperitoneal membrane, or as a result
of trauma.

Commonly occurs on *left side due to relative protection of right hemidiaphragm by liver

Question 2

hiatal hernia

Answer 2

Most common Diaphragmatic hernia

stomach herniates upward through the esophageal hiatus of the diaphragm

Question 3

Sliding hiatal hernia

Answer 3

Diaphragmatic hernia

is most common

Gastroesophageal junction is displaced upward

*“hourglass stomach”

Question 4

Paraesophageal hernia

Answer 4

Diaphragmatic hernia

Fundus protrudes into the thorax

gastroesophageal
junction is usually normal

Question 5

Indirect inguinal hernia

Answer 5

Goes through the *internal (deep) inguinal ring, external (superficial) inguinal ring, and into the scrotum

Enters *internal inguinal ring
*lateral to inferior epigastric vessels.

Occurs in infants owing to failure of (processus vaginalis
to close (can form hydrocele). 

Much more common in *males

*An indirect inguinal hernia follows the path of descent of the testes

Covered by *all 3 layers of
spermatic fascia

MDs don’t LIe:
Medial to inferior epigastric vessels = Direct hernia.
*Lateral to inferior epigastric vessels = *Indirect hernia.

Question 6

Direct inguinal hernia

Answer 6

Protrudes through the *inguinal (Hesselbach)
triangle.

Bulges directly through abdominal wall *medial to inferior epigastric vessels.

Goes through the *external (superficial) inguinal ring
only.

Covered by external spermatic fascia.

Usually in older men

MDs don’t LIe:
*Medial to inferior epigastric vessels = *Direct hernia.
Lateral to inferior epigastric vessels = Indirect hernia.

Question 7

Femoral hernia

Answer 7

Protrudes *below inguinal ligament through *femoral canal *below and lateral to pubic tubercle.

More likely to present with *incarceration or *strangulation than inguinal hernias

More common in females