18. Hernias Flashcards Preview

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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


hernias definition

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

1. tenderness
2. erythema
3. fever


hernias - types

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


diaphragmatic hernia ?

abdominal structures enter thorax


causes of diaphragmatic hernia

1. congenital defects of pleuroperitoneal membrane
2. trauma


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
*inguinal ligament


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

Poupart ligament


• 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


• 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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