Session 3 - Hernias Flashcards
Give three sites of potential weakness in the abdominal wall?
• Inguinal canal, femoral ring and umbilicus
What is the inguinal canal?
• The canal through which structures leave and enter the abdomiopelvic cavity
In which direction does the inguinal canal travel?
• Downward and medial direction
Where does the inguinal canal begin and end
- Starts at the deep inguinal ring
- Continues 4cm
Ends at superficial inguinal ring
Where does the inguinal canal lie?
• In between the muscles of the anterior abdominal wall and runs parallel and superior to the medial half of the inguinal ligament
What runs through the inguinal canal in men?
- The spermatic cord
* The ilioinguinal nerve
What runs through the inguinal canal in women?
- The round ligament of the uterus
* The iliolinguinal nerve
What is a hernia?
• A protrusion of part of the abdominal viscus through a defect in the abdominal wall
What is a hernial sac usually covered in?
- Skin
- Subcutaneous tissue
- Layers of the abdominal wall
Give three common locations of hernias
- Inguinal
- Umbilical
- Epigastric
What is a direct inguinal hernia?
• Gut protrudes into the inguinal canal through a weakened area in the transversalis fascia near the medial inguinal fossa within an anatomical region know as Hesselbach’s triangle
What are the borders of Hesselbachs triangle?
- Inferiorly - Medial half of the inguinal ligament
- Medially - Lower lateral border of rectus abdominis
- Laterally - Inferior epigastric artery
What is an indirect inguinal hernia?
• Protrudes throught he deep inguinal ring
Why do indirect inguinal hernias often occur?
• Result of the failure of embryonic closure of the deep inguinal ring after the testicle has passed through
What is an epigastric hernia?
• Hernia which occurs in the epigstric region in the midline between the xiphoid process and the umbilicus, through the linea alba
What are the two primary risk factors?
• Primary risk factors are obesity and pregnancy
What is an umbilical hernia?
• Occur through the umbilical ring
Why do umbilical hernias occur?
• As a result of a increased intra-abdominal pressure in the presence of weakness and incomplete closure of the anterior abdominal wall after ligation of the umbilical cord at birth
What causes an acquired umbilical hernia?
• Pregnant women
Obese people
Where do femoral hernias occur?
Occur through femoral ring into femoral canal
What are femoral hernias bounded by laterally and medially?
• Femoral vein laterally
Lacunar ligament mediall
What can femoral hernia do?
• Compresses the contents of the femoral canal and distends the wall
How are femorl hernias enlarged?
• By passing through saphenous opening into subcutaneous tissue of the thigh
Why are femoral hernias more common in female?
• Wider pelvis
Why does strangulation of femoral hernias occur?
• Sharp, rigid boundaries of femoral ring
What are two main complications of hernia?
- Strangulation
* Incarceration
What is strangulation?
• The constriction of blood vessels, preventing flow of blood to tissue
What is incarceration?
Hernia cannot be reduced, or pushed back into place.
What is the commonest hernia in females?
• Indirect Hernia
What is a divarication hernia?
• Weakness of lina alba
What is a richter’s hernia?
• Part of bowel strangulates through hernia
No bowel obstruction
What is a spigelian hernia?
• Area of weakness in linea semilunaris
Why operate on hernias?
• Strangulation can cause ischaemia
What is an incisional hernia?
• Post-surgical weakness in muscle wall
