Urology - Urology, Hernia and Perineum Flashcards
4 types of hernia
Inguinal (Direct/ Indirect)
Femoral
Incisional
Para-umbilical
3 ways to d/dx type of hernia
- Cough impulse: inspect for location of hernia
and Expansive cough impulse - Palpation: Get-above or get-below
- Occlusion test (direct vs indirect hernia)
Describe Occlusion Test for inguinal hernia
- Press on the deep inguinal ring by thumb > ask patient to cough
- If the hernia is controlled (hernia doesn’t come back during compression), it is indirect inguinal hernia
- If the hernia is not controlled, it is direct inguinal hernia
Location of inguinal and femoral hernia
INGUINAL: neck of hernia medial and superior to pubic tubercle
FEMORAL: Neck of hernia lateral and inferior to pubic tubercle
Differentiate groin mass by palpation (get above or below)
Can Get above the lesion> suspect scrotal mass and check consistency and trans illumination
Cannot get above the lesion > can be assumed as hernia
Femoral hernia
- Cause
- Morphology
- Common associated complication
Abdominal content via femoral canal goes below and lateral to pubic tubercle
globular lump (instead of pear shaped lump seen in inguinal hernia
High incidence of strangulation of abdominal content
D/dx of mass extending into scrotum
Inguinoscrotal hernia
Infantile Hydrocele up to inguinal ring
Incisional hernia
- typical location
- D/dx
Occur over previous abdominal incision, More common in midline incisions because there is no rectus muscle
D/dx:
- Diastasis recti > separation of rectus abdominals muscle (e.g. after pregnancy)
- Abdominal wall haematoma
- Abdominal mass
D/dx inguinal hernia in male
Male:
- Femoral hernia
- Lipoma of cord
- Hydrocele
- Undescended testis
- Enlarged LN
D/dx inguinal hernia in female
Female:
- Femoral hernia
- Hydrocele of canal of Nuck
Direct vs indirect hernia:
- difference in cause
- Which is more common
Direct:
- Peritoneal bulge against conjoint tendon of inferior abdominal wall (abdominal muscle weakness)
Indirect:
- Peritoneal sac perforates Deep and Superficial inguinal ring (patent process vaginalis)
- Passes to scrotum in male (inguino-scrotal hernia)
- Passes to Labia Majora in female
Indirect is the most common (5x)
Define the site where most direct and supra-vesical inguinal hernia occurs
Define its borders
Hesselbach’s triangle borders:
- Superior - inferior epigastric vessels
- Medial: Rectus muscles
- Latero-inferior: Inguinal ligament
Spermatic cord:
- Layers
External spermatic
Cremasteric
Internal spermatic
Spermatic cord:
- Arteries and nerves
3 arteries:
- Artery to ductus vas deferencs
- Testicular artery
- Cremasteric artery
3 nerves:
- Gential branch of genitofemoral nerve (L1/L2)
- Sympathetic and visceral afferent fibres
- Ilioinguinal nerve (exits from superficial inguinal ring only)
Spermatic cord:
- plexus, lymphatics and other structures
Pampiniform plexus
Ductus vas deferents
Testicular lymphatic
