18. Hernias Flashcards Preview

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Flashcards in 18. Hernias Deck (46):
1

conjoint tendon is

fused aponeuroses of internal abdominal oblique and transversus abdominis muscles that attach to pubic crest

2

structures inner of the deep inhuinal ring

extraperitoneal tissue and parietal peritoneum ( abdominal wall )

3

site of protrusion of direct hernia

inguinal ( hesselbach( triangle

4

abdominal wall represents the

boundaries of the abdominal cavity ( posterior, lateral and anterior walls)

5

structures that penetrates extraperitoneal tissue ( at the location of inguinal canal ) - outer to inner

outer- inferior epigastric artery - vein - medial umbilical ligament - median umbilical ligament

6

linea alba is a... ( location)

fibrous structure ( no primary nerves or blood vessels ---> surgical approach) that runs down the midline of the abdomen - from the xiphoid process to the pubic symphysis

7

linea alba is formed by

the fusion of the aponeuroses of the abdominal muscles

8

pyramidalis muscle ?

small and triangular musle , anterior to the rectus abdominis, and contained in the rectus sheath

9

rectus abdominis muscle

muscle running vertically on each side of the anterior wall of huma abdomen

10

from abdominal wall to skin

adomianl wall --> parietal peritoenum --> extraperitoneal tissue --> tranversalis fascia --> ( rectus abdominis and pyramidalis muscles - both medially ) --> transversus abdominnis --> internal onlique ( internal oblique and tranversus abdominis medially are conjoined tendon ) --> external oblique

11

from abdominal wall to skin (only medialy

abdomnial wall --> parietal peritoneum ---> extraperitoneal tissue --> tranversalis fascia --> rectus abdominis and pyramidalis muscles --> conjoined tendon --> linea alba

12

hernias definition

a protrusion of peritoneum through an opening, usually at a site weakness

13

hernias contes may be at risk for

1. incarceration --> not reducible back to abdomen / pelvis
2. strangulation --> ischemia and necrosis

14

clinical presentation of complicated hernia

1. tenderness
2. erythema
3. fever

15

hernias - types

1. diaphragmatic
2. indirect inguinal
3. direct inguinal
4. femoral

16

diaphragmatic hernia ?

abdominal structures enter thorax

17

causes of diaphragmatic hernia

1. congenital defects of pleuroperitoneal membrane
2. trauma

18

pleuroperitoneal membranes are

a pair of membranes which gradually separate the pleural and peritoneal cavities

19

diaphragmatic hernia - location

commonly on the left side due to relative protection of right hemidiaphragm by liver

20

diaphragmatic hernia is most commonly a .... hernia ( explain )

a hiatal hernia --> stomach herniates upward through the esophageal hiatus of the diaphragm

21

diaphragmatic hiatal hernia - types and defintion ( MC?)

1. sliding hernia ( MC) --> gastroesophangeal junction displaced upward --> " jourglass stomach "
2. paraesophageal hernia --> normal gastroesophangeal junction, fundus protrudes into the thorax

22

indirect inguinal hernia - direction

--> follows the path of sescent of the testes enters the internal inguinal ring laterally to inferior epigastric vessels --> external inguinal ring --> into scrotum - COvered By ALL 3 LAYERS OF SPERMATIC FASCIA )

23

indirect inguinal hernia - occurs in ( mechanism )

infants owing to failure to processus vaginalis to close --> can form hydrocele ( MUCH mORE COMMON in MALES )

24

direct inguinal hernia - direction

protrudes through the inguinal ( Hesselbach triangle ) --> bulges directly through abdominal wall ( medially of inferior epigastric vessels ) --> goes through the external superficial ring. Covered by external spermatic fasxia

25

direct vs indirect hernia according to coverage and according to inferior epigastric vessels

direct --> covered by external spermatic fascia, medial to vessels
indirect --> coverrd by al 3 layers of spermatic fascia --> lateral to vessels

26

inguinal ( hesselbach ) triangle - borders

-inferior epigastric vessels
- lateral border of rectus abdominis
*inguinal ligament

27

femoral hernia - direction

protrudes below inguinal ligament through femoral canal ( femoral ring) below and lateral to pubic tubercule

28

femoral hernia is more common in

females

29

femoral v inguinal according to risks

femoral hernia is more likely to present with incarceration or strangulation than inguinal hernias

30

hernias that are more common in males or females

indirect inguinal --> males
femoral --> females

31

inguinal ligament is AKA

Poupart ligament

32

• A baby boy is brought to your clinic with a type of hernia. How did this hernia likely develop?

Failure of the process vaginalis to close (male Infant = Indirect hernia)

33

• How do sliding hernias and paraesophageal hernias each affect the gastroesophageal junction?

Sliding hernias cause a displaced gastroesophageal junction, paraesophageal hernias have normal gastroesophageal junction

34

• Which type of hiatal hernia is associated with gastroesophageal reflux disease refractory to medical treatment?

Sliding hernias (“hourglass stomach”) result in a displaced gastroesophageal junction, increasing risk for gastroesophageal reflux disease

35

• What structures are displaced in a paraesophageal hernia?

The fundus of the stomach is displaced into the thorax, whereas the gastroesophageal junction is unaffected

36

• In a boy, an indirect hernia travels through the internal inguinal ring, then the external inguinal ring, and finally into the ____.

Scrotum

37

• Through which structure do both direct and indirect hernias pass?

The external (superficial) inguinal ring

38

• What structure is a useful landmark for differentiating direct inguinal hernias from indirect inguinal hernias?

The inferior epigastric artery (Medial to inferior epigastric = Direct, Lateral toInferior epigastric = Indirect—MDs don't LIe)

39

• An indirect inguinal hernia enters the internal inguinal ring ____ (medial/lateral) to the inferior epigastric artery.

Lateral

40

• You examine a boy with an indirect inguinal hernia. Given the affected developmental structure, what complication is possible?

Hydrocele (indirect inguinal hernia is caused by incomplete closure of the processus vaginalis)

41

• A direct inguinal hernia bulges directly through the abdominal wall ____ (medial/lateral) to the inferior epigastric artery.

Medial

42

• If an elderly man presents to your clinic with an inguinal hernia, what type of hernia is most likely observed?

Direct inguinal hernia

43

• Relative to the pubic tubercle, where is a femoral hernia typically located?

Inferior and lateral to the pubic tubercle (through the femoral canal)

44

• A patient is found to have an incarcerated bowel due to a hernia. What is the patient's most likely gender?

Female, as this is a femoral hernia (most likely cause of bowel incarceration, and femoral hernia is more common in females)

45

• How many layers of the spermatic fascia cover the sac of an indirect hernia? A direct hernia?

Indirect hernia = all three layers; direct hernia = only the external spermatic fascia

46

• An elderly man presents with a hernia through the inguinal triangle. How many layers of spermatic fascia cover this hernia?

Only the external spermatic fascia covers a direct inguinal hernia, which courses through the inguinal (Hesselbach) triangle

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