Week 3 - Anterior abdominal wall and hernias

Question 1

What is the inguinal canal? Where is it?

Answer 1

• An oblique passage between the deep and superficial inguinal rings
• Lies between external oblique and internal oblique and directly above the inguinal ligament

Question 2

Where is the inguinal ligament?

Answer 2

• Inferior border of aponeurosis of external oblique

- Runs from ASIS to pubic tubercle

Question 3

What are the normal contents of the inguinal canal?

Answer 3

• Spermatic cord in men
• Round ligament of uterus in women
• Ilioinguinal nerve (partially)

Question 4

What are the two potential sites of weakness in anterior abdominal wall which lead to inguinal hernias?

Answer 4

• Hesselbachs triangle

- Deep inguinal ring

Question 5

What is a hernia?

Answer 5

-Protrusion of part of an abdominal organ through the abdominal wall

Question 6

What is a hernial sac covered by?

Answer 6

-structures through which it passes

eg skin, SCT

Question 7

Describe an indirect inguinal hernia

Answer 7

-Bowel pushes through deep inguinal ring travels down the inguinal canal and pushes through superficial inguinal ring to appear in scrotum or labia majora

Question 8

Who is indirect inguinal hernia most common in?

Answer 8

-Men

Question 9

Describe hesselbachs triangle

Answer 9

-Weak area of anterior abdominal wall defined by:
Medial border -> lateral margin of rectus sheath/linea semulunaris
Superiolateral border -> Inferior epigastric vessels
Inferior border -> Inguinal ligament

Question 10

Describe a direct inguinal hernia

Answer 10

-Bowel pushes through an area in hesselbachs triangle and extends down and out of the superficial inguinal ring to appear in scrotum or labia majora

Question 11

Describe a femoral hernia

Answer 11

• Bowel protrudes through femoral ring of femoral canal

- More common in females due to wider pelvis (but overall still less common than inguinal)

Question 12

Describe an umbilical hernia

Answer 12

• In children it is protrusion through umbilical scar
• in adults it is protrusion through linea alba anywhere between xiphersternum and umbilicus (includes epigastric and paraumbilical hernias

Question 13

Describe a diaphragmatic hernia

Answer 13

-Caused by developmental defects of the diaphragm which allows the intestine to herniate into the chest

Question 14

Describe a hiatus hernia

Answer 14

• Special diagphragmatic hernia
• Can be sliding whereby gastro-oesophageal junction slides through diaphragm into chest
• Can be rolling where fundus of stomach passes into chest alongside oesophagus

Question 15

What is an incisional hernia?

Answer 15

-Surgical scar breakdown due to obesity or poor abdominal musculature

Question 16

What lines the internal surface of anterior abdominal wall?

Answer 16

-Parietal peritoneum