Flashcards in 18. Hernias Deck (46):
conjoint tendon is
fused aponeuroses of internal abdominal oblique and transversus abdominis muscles that attach to pubic crest
structures inner of the deep inhuinal ring
extraperitoneal tissue and parietal peritoneum ( abdominal wall )
site of protrusion of direct hernia
inguinal ( hesselbach( triangle
abdominal wall represents the
boundaries of the abdominal cavity ( posterior, lateral and anterior walls)
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
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
linea alba is formed by
the fusion of the aponeuroses of the abdominal muscles
pyramidalis muscle ?
small and triangular musle , anterior to the rectus abdominis, and contained in the rectus sheath
rectus abdominis muscle
muscle running vertically on each side of the anterior wall of huma abdomen
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
from abdominal wall to skin (only medialy
abdomnial wall --> parietal peritoneum ---> extraperitoneal tissue --> tranversalis fascia --> rectus abdominis and pyramidalis muscles --> conjoined tendon --> linea alba
a protrusion of peritoneum through an opening, usually at a site weakness
hernias contes may be at risk for
1. incarceration --> not reducible back to abdomen / pelvis
2. strangulation --> ischemia and necrosis
clinical presentation of complicated hernia
hernias - types
2. indirect inguinal
3. direct inguinal
diaphragmatic hernia ?
abdominal structures enter thorax
causes of diaphragmatic hernia
1. congenital defects of pleuroperitoneal membrane
pleuroperitoneal membranes are
a pair of membranes which gradually separate the pleural and peritoneal cavities
diaphragmatic hernia - location
commonly on the left side due to relative protection of right hemidiaphragm by liver
diaphragmatic hernia is most commonly a .... hernia ( explain )
a hiatal hernia --> stomach herniates upward through the esophageal hiatus of the diaphragm
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
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 )
indirect inguinal hernia - occurs in ( mechanism )
infants owing to failure to processus vaginalis to close --> can form hydrocele ( MUCH mORE COMMON in MALES )
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
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
inguinal ( hesselbach ) triangle - borders
-inferior epigastric vessels
- lateral border of rectus abdominis
femoral hernia - direction
protrudes below inguinal ligament through femoral canal ( femoral ring) below and lateral to pubic tubercule
femoral hernia is more common in
femoral v inguinal according to risks
femoral hernia is more likely to present with incarceration or strangulation than inguinal hernias
hernias that are more common in males or females
indirect inguinal --> males
femoral --> females
inguinal ligament is AKA
• 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)
• 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
• 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
• What structures are displaced in a paraesophageal hernia?
The fundus of the stomach is displaced into the thorax, whereas the gastroesophageal junction is unaffected
• In a boy, an indirect hernia travels through the internal inguinal ring, then the external inguinal ring, and finally into the ____.
• Through which structure do both direct and indirect hernias pass?
The external (superficial) inguinal ring
• 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)
• An indirect inguinal hernia enters the internal inguinal ring ____ (medial/lateral) to the inferior epigastric artery.
• 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)
• A direct inguinal hernia bulges directly through the abdominal wall ____ (medial/lateral) to the inferior epigastric artery.
• If an elderly man presents to your clinic with an inguinal hernia, what type of hernia is most likely observed?
Direct inguinal hernia
• Relative to the pubic tubercle, where is a femoral hernia typically located?
Inferior and lateral to the pubic tubercle (through the femoral canal)
• 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)
• 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