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SA gastro-intestine > S4) Abdominal Wall and Hernias > Flashcards

S4) Abdominal Wall and Hernias Flashcards

1
Q

What is a hernia?

A

A hernia is a protrusion in the fascia of part of the abdominal contents beyond the normal confines of it containing cavity e.g abdominal wall

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2
Q

A hernia contains 3 parts.

Identify them

A
  • The sac
  • Contents of the sac
  • Coverings of the sac
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3
Q

What is the sac of a hernia?

A

The sac is a pouch of peritoneum

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4
Q

What are the contents the sac of a hernia?

A

- Contents are any structure found within the abdominal cavity

  • Commonly: loops of bowel and omentum
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5
Q

What does the covering of the sac of a hernia consist of?

A

Covering of sac consists of the layers of the abdominal wall through with the hernia has passed

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6
Q

What generally causes abdominal hernias?

A

Weaknesses in abdominal wall due to genetics, surgery or normal points of weakness

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7
Q

Identify 4 points of weakness in the abdominal wall

A
  • Inguinal canal
  • Femoral canal
  • Umbilicus
  • Previous incisions
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8
Q

What is the inguinal canal?

A

The inguinal canal is an oblique passage through lower part of the abdominal wall

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9
Q

Distinguish between the contents of the inguinal canal in males and females

A
  • Males: structures pass through from abdomen-testis
  • Females: round ligament goes from Uterus-labium majus
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10
Q

What is the inguinal canal made up of?

A
  • Anterior and posterior walls
  • Superficial and deep rings (openings)
  • Roof and floor (superior and inferior walls)
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11
Q

What composes the anterior wall of the inguinal canal?

A

The anterior wall is formed by the aponeurosis of the external oblique, and reinforced by the internal oblique muscle laterally

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12
Q

What composes the posterior wall of the inguinal canal?

A

The posterior wall is formed by the transversalis fascia and conjoint tendon

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13
Q

What composes the roof of the inguinal canal?

A

The roof is formed by the transversalis fascia, internal oblique and transversus abdominis

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14
Q

What composes the floor of the inguinal canal?

A

The floor is formed by the inguinal ligament and thickened medially by the lacunar ligament

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15
Q

Describe the location and formation of the deep ring

A
  • The deep ring is found above the midpoint of the inguinal ligament
  • The ring is created by the transversalis fascia
  • it is the only entrance to the inguinal Canal
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16
Q

The superficial ring marks the end of the inguinal canal.

Describe its location and its formation

A
  • The superficial ring lies just superior to the pubic tubercle
  • Formed by the evagination of the external oblique
  • it forms the only exit of the inguinal canal
17
Q

What are the different types of abdominal hernias that occur and how often do they occur?

A
  • 75% Inguinal
  • 10% Umbilical
  • 10% Incisional
  • 3-5% Femoral
18
Q

What two types of inguinal hernias are there?

A
  • Indirect (2/3)
  • Direct (1/3)
19
Q

What is an indirect inguinal hernia?

A

Indirect inguinal hernia is when the peritoneal sac enters the inguinal canal through the deep inguinal ring and passes through the canal to the superficial inguinal ring

20
Q

How can one determine the severity of the indirect inguinal hernia?

A
  • The degree to which the sac herniates depends on the amount of processus vaginalis still present
  • It can potentially descend into the scrotum
21
Q

Who is more likely to get an indirect inguinal hernia and how is it likely to occur?

A
  • Males (7:1)
  • Mainly right sided
22
Q

What is a direct inguinal hernia?

A

- Direct inguinal hernia is where the peritoneal sac enters the inguinal canal through the posterior wall of the inguinal canal

  • It bulges through Hesselbach’s triangle and is in the vicinity of the superficial inguinal ring
  • does not travel through the deep inguinal ring only the superficial one - the hernia therefore does not enter the inguinal canal as it is passing through the exit
23
Q

What are the boundaries of Hesselbach’s triangle?

A
  • Lateral: inferior epigastric artery
  • Medial: lateral border of rectus abdominus
  • Inferior: inguinal ligament
24
Q

What is the anatomical difference between direct and indirect inguinal hernias?

A
  • Indirect inguinal hernia: lateral to the inferior epigastric vessels
  • Direct inguinal hernia: medial to inferior epigastric vessels
25
Q

What is a femoral hernia?

A

A femoral hernia is a hernia which occurs just below the inguinal ligament, where abdominal contents pass through the femoral canal

26
Q

How do femoral hernias present?

A
  • Relatively uncommon (affects more females)
  • Present as a painful lump in the groin or inner part of the upper thigh
27
Q

What is a strangulated femoral hernia?

A

A strangulated femoral hernia occurs when a femoral hernia blocks blood supply to part of the bowel

28
Q

What is an acquired infantile hernia?

A

Acquired infantile hernia is a type of umbilical hernia where the contents herniate through weakness in scar of umbilicus

29
Q

What is an acquired adult hernia?

A

An acquired adult hernia is a type of umbilical hernia where the contents go through the linea alba in region of umbilicus

30
Q

How do epigastric hernias occur?

A
  • Epigastric hernias occurs through the linea alba between xiphoid process→umbilicus
  • They usually starts with small hernia (extra-peritoneal fat)
  • Chronic straining forces more fat out which eventually pulls peritoneum through
31
Q

What symptoms can one expect with abdominal wall hernias?

A
  • Varied symptoms as it’s based on what happens if loops of bowel get trapped
  • Commonly: pain, vomiting, sepsis
32
Q

signs and symptoms of a hernia

A

hernias that are stuck:

  • swelling
  • larger when abdominal pressure increases
  • aches

hernias that are not stuck:

  • increased pain
  • nausea and vomiting
33
Q

What is processus vaginalis

A
  • in development it starts in abdomen and grows down to the scrotum
  • the in between part gets obliterated and it leaves part of the abdomen that become part the testes
34
Q

what happened if the processes vaginalis in males doesn’t close up

A
  • it becomes an open sac of peritoneal cavity
  • possible infections can spread
  • It can herniate and become a hernia in the scrotum
35
Q

what is an omphalocele

A
  • failure of the midgut to return to the abdomen during development
  • hernia within the umbilical chord
36
Q

what is gastroschsis

A
  • defect in ventral abdominal wall, the abdomen comes out the body
  • can be hard to put contents back in
37
Q

what is a para - umbilical hernia

A
  • goes through lines alba in region of umbilicus
  • issue if intrabdominal pressure is raised

Symptoms

  • pain
  • vomiting
  • sepsis
38
Q

what does incarcerated mean

A

stuck

39
Q

strangulated

A

blood supply is disrupted and can lead to tissue necrosis

SA gastro-intestine (19 decks)

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