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Flashcards in Hernias Deck (30)
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1
Q

Define a hernia

A

A protrusion of an organ or part of an organ though a deficit in the walls of its containing cavity into an abnormal position

2
Q

Give some features which help define a lump as a hernia

A

Occur at weak spots
Reduce on lying down or with manipulation
Have an expansile cough impulse

3
Q

What can occur if a hernia is not treated?

A

Strangulation

Incarceration

4
Q

Describe strangulation

A

Bload vessels become constricted, preventing blood flow into the tissue. This leads to construction and necrosis.

5
Q

What symptoms occur with strangulation?

A
Red and painful lump which is tense an irreducible 
Associated with:
- vomiting
- abdo distention
- colicky abdominal pain
- constipation
6
Q

Define incarceration

A

Hernia cannot be reduced unless there is significant external effort.

7
Q

Describe the inguinal canal

A

4cm passage lying between the muscles of the anterior abdominal wall.
Runs parallel and superior to the inguinal ligament

8
Q

What is the inguinal ligament?

A

The inferior border of the aponeurosis of the external oblique muscle.

9
Q

Where does the inguinal ligament attach?

A

ASIS to pubic tubercle

10
Q

What are the contents of the inguinal canal in males?

A
Ilioinguinal nerve
Spermatic cord
Ext. spermatic fascia
Cremasteric fascia
Transversus abdominus and internal spermatic fascia
11
Q

What is found in the spermatic cord?

A

3 arteries: testicular, ductus deferens, cremasteric
3 nerves: genital branch of the genitofemoral nerve, cremasteric, autonomic
3 others: pampiniform plexus, lymphatics, ductus deferens

12
Q

What are the borders of the inguinal canal?

A

MALT
Roof = transverses abdomens and internal oblique fibres
Ant = aponeurosis of ext and int oblique
Floor = ilioinguinal ligament and lacunar ligament
Post = transcersalis fascia and medially conjoint tendon

13
Q

How can you distinguish between a direct and indirect inguinal hernia clinically?

A

Occlude the deep inguinal ring with two fingers and ask the pt to cough or stand.
Indirect = hernia cannot protrude
Direct = hernia can protrude

14
Q

Define a direct inguinal hernia

A

Hernia protrudes into the inguinal canal through a weakened patch in the transversalis fascia (Hasselbach’s Triangle).

15
Q

What are the borders of hasselbach triengle?

A
Inferior = medial half of inguinal ligament
Medially = lateral border of rectus abdomens
Laterally = medial border of inferior epigastric artery
16
Q

Describe an indirect inguinal hernia

A

Hernia protrudes through the deep inguinal ring within the diverging arm the transversalis fascial sling.

17
Q

What is the main reason that indirect inguinal hernias arise?

A

There is a failure of embryonic closure of the deep inguinal ring after the testicle has passed through it

18
Q

Where can you find the deep inguinal ring?

A

Mid point of the inguinal ligament which is 1.5cm above the femoral pulse

19
Q

What will be the difference in coverings between direct and indirect inguinal hernias?

A

Indirect will be covered by internal spermatic fasciaDirect will not.

20
Q

Describe a femoral hernia

A

Protrusion of abdominal viscera into the femoral canal, appearing as a mass in the femoral triangle.

21
Q

Give the borders of the femoral canal

A
Medial = lacunar ligament
Lateral = femoral vein
Anterior = inguinal ligament
Posterior = pubic ramus and pectineus
22
Q

Give the borders of the femoral triangle

A
Superior = inguinal ligament
Medial = lat border of adductor longus
Lateral = med border of sartorius
Roof = fascia lata
Floor = pectinous, iliopsoas, adductor longus
23
Q

What are the contents of the femoral triangle?

A

Femoral nerve
Femoral artery
Femoral vein
Femoral canal

24
Q

What is contained in the femoral sheath?

A

Artery, vein and canal

25
Q

What does the femoral canal contain?

A

Lymphatic vessels and lymph nodes

26
Q

Describe epigastric hernias

A

Hernias that occur in the epigastric region.

27
Q

What are the main risk factors for epigastric hernias?

A

Pregnancy

Obesity

28
Q

Describe umbilical hernias

A

Occur though the umbilical ring

29
Q

Why do umbilical hernias occur?

A
  • Increased intra-abdominal pressure

- Weakness and incomplete closure of the anterior abdominal wall after ligation of the umbilical cord at birth

30
Q

What is the epigastric region?

A

The midline between the xiphoid process and the umbilicus, through the linea alba