W7: GI Herniation: Anatomy & Clinical

Question 1

What are 4 causes of a hernia?

Answer 1

• structural weakness
• increased pressure
• sites where surgical incisions are made
• inherited collagen disorders

Question 2

What can cause a congenital diaphragmatic hernia?

Answer 2

If oesophagus grows slower than normal in foetus then stomach can be drawn up into chest

Question 3

What 4 factors can increase intra-abdominal pressure?

Answer 3

• chronic cough
• pregnancy
• strenuous activity
• straining during bowel/urinary movements

Question 4

What does the linea semilunaris mark the separation of?

Answer 4

the anterior abdominal wall and the lateral abdominal wall

Question 5

What does the inguinal ligament mark the anterior boundary between?

Answer 5

the abdomen and the thigh

Question 6

From what two points does the inguinal ligament connect?

Answer 6

ASIS to pubic tubercle

Question 7

Why is inguinal ligament not a true ligament?

Answer 7

Because it is actually an inferior thickening of external oblique muscle

Question 8

The medial half of the inguinal ligament curves to form what structure?

Answer 8

The floor of the inguinal canal

Question 9

Through what structure is there abdominal communication with the the perineum?

Answer 9

Inguinal canal

Question 10

What is name of the the space that allows abdominal structure communication to thigh and vice versa?

Answer 10

Subinguinal space

Question 11

What is the name of the entrance of the inguinal canal?

Answer 11

Deep inguinal ring

Question 12

What is the name of the exit of the inguinal canal?

Answer 12

Superficial inguinal ring

Question 13

What 2 structures does the inguinal canal contain in everyone and what 2 extra structures does it contain specific to males and females?

Answer 13

• Blood and lymphatic vessels
• ilioinguinal nerve
• spermatic cord (males)
• round ligament of the uterus (female)

Question 14

Where do the testes develop in the foetus?

Answer 14

On the posterior abdominal wall

Question 15

What is the gubernaculum and what happens during embryonic development?

Answer 15

• fibrous cord

- contracts and also shortens in size in relation to growth of embryo

Question 16

What lies between the parietal peritoneum and the transversus abdominis muscle?

Answer 16

Transversalis fascia

Question 17

What does the gubernaculum join together?

Answer 17

Attaches inferior side of the testes to the body wall

Question 18

What does the gubernaculum become in the female?

Answer 18

Round ligament of the uterus

Question 19

What does gubernaculum become in the male?

Answer 19

Testicular ligament

Question 20

What is the name of the outpouching of the peritoneum created by the descent of the testes in embryonic development?

Answer 20

Vaginal process

Question 21

What happens to the vaginal process in adults?

Answer 21

Two borders of the processus vaginalis fuse together to form a pocket of peritoneal fluid called the tunica vaginalis

Question 22

What is the function of the tunica vaginalis in which the testes lie?

Answer 22

reduce friction from movement of testes up and down in adult

Question 23

What embryonic development failure in descent of the testes can be a predisposing factor for gut herniation?

Answer 23

If the two borders of the vaginal process fail to join together and you have a patent vaginal process

Question 24

Where do the layers of the spermatic cord originate from?

Answer 24

layers of the abdominal wall are pulled down along with testis when they descend

Question 25

What does the subcutaneous tissue layer in the abdominal wall become in the spermatic cord?

Answer 25

dartos muscle/fascia

Question 26

What does the external oblique muscle and fascia layer in the abdominal wall become in the spermatic cord?

Answer 26

External spermatic fascia

Question 27

What does the internal oblique muscle layer in the abdominal wall become in the spermatic cord?

Answer 27

Cremaster muscle

Question 28

What does the fascia of the internal oblique muscle layer in the abdominal wall become in the spermatic cord?

Answer 28

Cremasteric fascia

Question 29

What does the transversalis fascia layer in the abdominal wall become in the spermatic cord?

Answer 29

Internal spermatic fascia

Question 30

What muscle in the abdominal wall does not form part of the spermatic cord when the testis descend in embryonic development?

Answer 30

Transversus abdominis muscle

Question 31

What is the conjoint tendon?

Answer 31

combination of internal oblique and trasnversus abdominis aponeurosis

Question 32

What are the 3 borders of Hesselbach's Triangle? (bottom, upper and inside)

Answer 32

- bottom -> inguinal ligament - upper -> inferior epigastric artery - inside -> lateral border of rectus abdominis

Question 33

What is Hesselbach's Triangle a site of?

Answer 33

Site of direct inguinal herniation

Question 34

What is the deep inguinal ring a site of?

Answer 34

Indirect inguinal herniation

Question 35

Of Hesselbech's triangle and the deep inguinal ring, which is medial to and which is lateral to the inferior epigastric artery?

Answer 35

Hesselbach's triangle -> medial | Deep inguinal ring -> lateral

Question 36

What is the difference between a direct inguinal hernia and an indirect inguinal hernia?

Answer 36

Direct hernia pushes directly through abdominal wall whereas indirect hernia uses inguinal canal

Question 37

Where does herniation lie in relation to spermatic cord in direct inguinal herniation?

Answer 37

Parallel to spermatic cord

Question 38

Where does herniation lie in relation to spermatic cord in indirect inguinal herniation?

Answer 38

Within spermatic cord

Question 39

Which type of inguinal hernia passes through Hesselbech's Triangle before going through the superficial ring?

Answer 39

Direct inguinal hernia

Question 40

What two structures (muscle and aponeurosis) form the anterior wall of the inguinal canal? (which just laterally?)

Answer 40

- external oblique aponeurosis | - internal oblique muscle -> only lateral

Question 41

What two structures form the posterior wall of the inguinal canal? (laterally and medially)

Answer 41

- transversalis fascia -> laterally | - conjoint tendon -> medially

Question 42

What three structures form the roof of the inguinal canal? (laterally, centrally and medially)

Answer 42

- Trasnversalis fascia -> laterally - arches of internal oblique and transversus abdominis aponeurosis -> centrally - external oblique aponeurosis -> medially

Question 43

What lies below the inguinal canal?

Answer 43

Subinguinal space

Question 44

What 4 structures pass through the subinguinal space?

Answer 44

- nerves - lymphatics - hip flexors - femoral artery and vein

Question 45

What does the femoral canal contain?

Answer 45

lymphatics

Question 46

What is the name given to the area of innate weakness where both inguinal and femoral hernias can occur?

Answer 46

Myopectineal orifice

Question 47

In terms of surface anatomy, where is the deep inguinal ring located?

Answer 47

halfway along the inguinal ligament

Question 48

List 9 types of hernia.

Answer 48

- umbilical - lumbar - inguinal - femoral - epigastric - spigelian - parastomal - incisional - port-site

Question 49

Where does a spigelian hernia occur?

Answer 49

Weakness in the spigelian fascia between transversus and rectus abdominal muscles that comes out at the semilunar line

Question 50

What is a port-site hernia?

Answer 50

Hernia that occurs at port-sites after a laparoscopic surgery

Question 51

What are the three classifications of hernia and what does each mean?

Answer 51

-reducible -> hernia can be pushed back in -incarcerated/irreducible -> hernia can't be manipulated back into abdo -strangulated -> vascular supply to hernia is cut off and so is ischaemic and gangrenous -

Question 52

What are three possible causes of paraumbilical hernias?

Answer 52

abdo stretching due to - obesity - pregnancy - ascites

Question 53

What is the usual management for umbilical and paraumbilical hernias?

Answer 53

surgical

Question 54

What is the usual cause of umbilical hernias in adults?

Answer 54

persistent elevation of intra-abdo pressure

Question 55

What are the 6 structures contained in the the spermatic cord?

Answer 55

- vas deferens - 3 arteries: testicular artery, artery to the vas and cremasteric artery - Pampiniform plexus (veins) - lymphatics - nerves: genital branch of genitofemoral nerve and sympathetic twigs - remains of Processus Vaginalis (tunica vaginalis)

Question 56

How does inguinal hernia present and how is it examined?

Answer 56

- swelling superior to and medial to pubic tubercle (groin swelling) that goes away when lying down - examined by having patient cough and feeling it when they cough

Question 57

What forms the anterior border of the femoral ring?

Answer 57

Inguinal ligament

Question 58

What forms the posterior border of the femoral ring?

Answer 58

Iliopectineal ligament

Question 59

What forms the lateral border of the femoral ring?

Answer 59

femoral vein

Question 60

What forms the medial border of the femoral ring?

Answer 60

lacunar ligament