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GI > W7: GI Herniation: Anatomy & Clinical > Flashcards

W7: GI Herniation: Anatomy & Clinical Flashcards

1
Q

What are 4 causes of a hernia?

A
  • structural weakness
  • increased pressure
  • sites where surgical incisions are made
  • inherited collagen disorders
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2
Q

What can cause a congenital diaphragmatic hernia?

A

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

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3
Q

What 4 factors can increase intra-abdominal pressure?

A
  • chronic cough
  • pregnancy
  • strenuous activity
  • straining during bowel/urinary movements
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4
Q

What does the linea semilunaris mark the separation of?

A

the anterior abdominal wall and the lateral abdominal wall

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5
Q

What does the inguinal ligament mark the anterior boundary between?

A

the abdomen and the thigh

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6
Q

From what two points does the inguinal ligament connect?

A

ASIS to pubic tubercle

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7
Q

Why is inguinal ligament not a true ligament?

A

Because it is actually an inferior thickening of external oblique muscle

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8
Q

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

A

The floor of the inguinal canal

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9
Q

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

A

Inguinal canal

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10
Q

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

A

Subinguinal space

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11
Q

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

A

Deep inguinal ring

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12
Q

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

A

Superficial inguinal ring

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13
Q

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

A
  • Blood and lymphatic vessels
  • ilioinguinal nerve
  • spermatic cord (males)
  • round ligament of the uterus (female)
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14
Q

Where do the testes develop in the foetus?

A

On the posterior abdominal wall

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15
Q

What is the gubernaculum and what happens during embryonic development?

A
  • fibrous cord

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

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16
Q

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

A

Transversalis fascia

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17
Q

What does the gubernaculum join together?

A

Attaches inferior side of the testes to the body wall

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18
Q

What does the gubernaculum become in the female?

A

Round ligament of the uterus

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19
Q

What does gubernaculum become in the male?

A

Testicular ligament

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20
Q

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

A

Vaginal process

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21
Q

What happens to the vaginal process in adults?

A

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

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22
Q

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

A

reduce friction from movement of testes up and down in adult

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23
Q

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

A

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

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24
Q

Where do the layers of the spermatic cord originate from?

A

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

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25
Q

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

A

dartos muscle/fascia

26
Q

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

A

External spermatic fascia

27
Q

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

A

Cremaster muscle

28
Q

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

A

Cremasteric fascia

29
Q

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

A

Internal spermatic fascia

30
Q

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

A

Transversus abdominis muscle

31
Q

What is the conjoint tendon?

A

combination of internal oblique and trasnversus abdominis aponeurosis

32
Q

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

A
  • bottom -> inguinal ligament
  • upper -> inferior epigastric artery
  • inside -> lateral border of rectus abdominis
33
Q

What is Hesselbach’s Triangle a site of?

A

Site of direct inguinal herniation

34
Q

What is the deep inguinal ring a site of?

A

Indirect inguinal herniation

35
Q

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

A

Hesselbach’s triangle -> medial

Deep inguinal ring -> lateral

36
Q

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

A

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

37
Q

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

A

Parallel to spermatic cord

38
Q

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

A

Within spermatic cord

39
Q

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

A

Direct inguinal hernia

40
Q

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

A
  • external oblique aponeurosis

- internal oblique muscle -> only lateral

41
Q

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

A
  • transversalis fascia -> laterally

- conjoint tendon -> medially

42
Q

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

A
  • Trasnversalis fascia -> laterally
  • arches of internal oblique and transversus abdominis aponeurosis -> centrally
  • external oblique aponeurosis -> medially
43
Q

What lies below the inguinal canal?

A

Subinguinal space

44
Q

What 4 structures pass through the subinguinal space?

A
  • nerves
  • lymphatics
  • hip flexors
  • femoral artery and vein
45
Q

What does the femoral canal contain?

A

lymphatics

46
Q

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

A

Myopectineal orifice

47
Q

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

A

halfway along the inguinal ligament

48
Q

List 9 types of hernia.

A
  • umbilical
  • lumbar
  • inguinal
  • femoral
  • epigastric
  • spigelian
  • parastomal
  • incisional
  • port-site
49
Q

Where does a spigelian hernia occur?

A

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

50
Q

What is a port-site hernia?

A

Hernia that occurs at port-sites after a laparoscopic surgery

51
Q

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

A

-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
-

52
Q

What are three possible causes of paraumbilical hernias?

A

abdo stretching due to

  • obesity
  • pregnancy
  • ascites
53
Q

What is the usual management for umbilical and paraumbilical hernias?

A

surgical

54
Q

What is the usual cause of umbilical hernias in adults?

A

persistent elevation of intra-abdo pressure

55
Q

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

A
  • 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)
56
Q

How does inguinal hernia present and how is it examined?

A
  • 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
57
Q

What forms the anterior border of the femoral ring?

A

Inguinal ligament

58
Q

What forms the posterior border of the femoral ring?

A

Iliopectineal ligament

59
Q

What forms the lateral border of the femoral ring?

A

femoral vein

60
Q

What forms the medial border of the femoral ring?

A

lacunar ligament

GI (29 decks)

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