S2 L1 Hernia's Flashcards
What is a hernia?
2 ‘types’ (clue: one more ‘complications’ than the other)?
Signs and symptoms?
A hernia is a protrusion of part of the abdominal contents beyond the normal confines of the abdominal wall
◦ Hernias occur outside the abdomen so we might say…beyond the confines of its containing cavity
Hernias that are not stuck:
◦ Fullness or swelling
◦ Gets larger when intra-abdominal pressure increases
◦ Aches
◦ Can be reducible
Hernias that are stuck (incarcerated)
◦ More painful
◦ Cannot be moved
◦ Nausea and vomiting (and other signs of bowel obstruction)
◦ Systemic problems if bowel has become ischaemic (infection → sepsis)
◦ Can’t be reducible (can’t be pushed back in)
Causes of hernia’s
Weakness in the containing cavity
o Congenitally related (we will talk about descent of the testis)
o Post surgery where wounds have not healed adequately (incisional hernia) (tissues around scar can be weaker, where the muscles have been divided)
o Normal points of weakness
Anything that increases intra-abdominal pressure (internal force pushing out through weak-points)
o Obesity
o Weightlifting
o Chronic constipation/coughing
o Pregnancy
What is a hernia?
- 3 parts
- Examples of what is each
The sac
oIs a pouch of peritoneum
o You need to understand Parietal/visceral peritoneum
Contents of the sac
o Any structure found within the abdominal cavity
o Commonly
o Loops of bowel
o Omentum
Coverings of the sac
o Consist of the layers of the abdominal wall through with the hernia has passed
o You need to know your abdominal layers
Basis of abdominal hernias…
Weaknesses in abdominal wall….
◦ Inguinal canal
◦ Femoral canal
◦ Umbilicus
◦ Previous incisions
What is the inguinal canal?
____ passage through ____ part of the ________ ____
In males, what structures pass through this canal?
Oblique, lower, abdominal wall
How do the testis descend?
- 2 key bits of anatomy
- What is this anatomy, describe it?
Processus vaginalis - pouch of the peritoneum
Gubernaculum - condensed band of mesenchyme that guides route of testes downwards to scrotum, it srhink and then the ligament secures the testes to the most inferior part of the scrotum (reduces the amount the testes can move)
Full process of the testes descending
- Processus vaginalis proceeds descent of testes
- Testes are initially retroperitoneal
- Gubernaculum guides the descent of the testes (shrinking as it is doing this)
- The gubernaculum shrinks and becomes the scrotal ligament. It secures the testes to the most inferior part of the scrotum (reduces amount testes can move)
- The processus vaginalis obliterates and becomes the tunica vaginalis
Another image showing the testes, before they descent
Normal development
- Picture showing the processus vaginalis and tunica vaginalis
Picture showing - The Processus vaginalis that doesn’t close
Creates a route from peritoneum to scrotum
Closes less than should = inguinal hernia
Structure of the inguinal canal
- Structure
- Borders
- Where does the inguinal ligament go from and to?
- Anterior wall – aponeurosis of the external oblique, reinforced by the internal oblique muscle laterally.
- Posterior wall – transversalis fascia.
- Roof – transversalis fascia, internal oblique, and transversus abdominis. Makes sense with diagram
- Floor – inguinal ligament (a ‘rolled up’ portion of the external oblique), aponeurosis), thickened medially by the lacunar ligament.
- Makes sense with diagram*
Inguinal ligament:
ASIS to pubic tubercle
Lacunar ligament
- What is this?
Reinforces the inguinal ligament
2 types of inguinal hernias
List some other types of hernias
Which hernia is most common?
– which side of the body most likely occur on?
2 types: Direct and indirect
Inguinal hernias Comprise approx: 75% of all abdominal hernias
- 50% Indirect
- M>F (7:1)
- Mainly right sided
- 25% Direct
Remaining hernias:
- 10% Umbilical
- 10% Incisional
- 3-5% Femoral
Important landmarks for Direct and Indirect Hernias
- To differentiate them?
Indirect inguinal hernias: Leaves cavity lateral to epigastric vessels
Direct inguinal hernias: Leaves cavity medial to epigastric vessels
NAME HERNIAS - WHERE THEY LEAVE THE CAVITY
Important landmarks - Hesselbachs triangle
- Boundaries
Superior/lateral: Inferior epigastric artery
Medial border: Rectus abdominus muscle
Inferior: Inguinal ligament
pic - looking inside out