5. Direct inguinal hernia Flashcards Preview

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Flashcards in 5. Direct inguinal hernia Deck (45)
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1

INCIDENCE of Direct inguinal hernia

* Common in old males.

* 50 % bilateral

2

ETIOLOGY of Direct inguinal hernia

a. Weakness of lower abdominal wall muscles with chronic increased intra abdominal pressure.

b. Paralysis of conjoint tendon

3

Pathogenesis of Paralysis of conjoint tendon in ETIOLOGY of Direct inguinal hernia

Injury of the ilioinguinal nerve during appendectomy (only after muscle cutting).

4

PATHOLOGY & TYPES of Direct inguinal hernia

1 - Lateral Type "Commonest" :

2- Medial Type "Rare"

5

commonest type of Direct inguinal hernia

Lateral Type

6

Pathogenesis of Lateral Type of Direct inguinal hernia

* Bulges through the lateral part of Hasselbach's triangle (made of fascia transversalis only).

* Thus has a very wide neck and is less liable to complications.

* Never descends to the scrotum.

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Alternative name for Medial Type of Direct inguinal hernia

funicular form of Ogilvie

8

Pathogenesis of Medial Type of Direct inguinal hernia

Passes through a defect in the conjoint tendon in front of fascia transversalis in the medial half of the triangle.

* The edge of the defect is sharp & the neck is narrow )> liable to complicate.

* It may descend to the scrotum

9

Type of Direct inguinal hernia Passes through a defect in the conjoint tendon in front of fascia transversalis in the medial half of the triangle.

Medial Type of Direct inguinal hernia

10

Type of Direct inguinal hernia bulges through the lateral part of Hasselbach's triangle (made of fascia transversalis only)

Lateral Type of Direct inguinal hernia

11

Type of Direct inguinal hernia has a very wide neck and is less liable to complications

Lateral Type of Direct inguinal hernia

12

Type of Direct inguinal hernia in which The edge of the defect is sharp & the neck is narrow and liable to complications

Medial Type of Direct inguinal hernia

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Type of Direct inguinal hernia Never descends to the scrotum

Lateral Type of Direct inguinal hernia

14

Type of Direct inguinal hernia may descend to the scrotum

Medial Type of Direct inguinal hernia

15

the reason why Lateral Type of Direct inguinal hernia is less liable to complications

* Bulges through the lateral part of Hasselbach's triangle (made of fascia transversalis only).

* Thus has a very wide neck and is less liable to complications.

16

the reason why Medial Type of Direct inguinal hernia is more liable to complications

Passes through a defect in the conjoint tendon in front of fascia transversalis in the medial half of the triangle.

* The edge of the defect is sharp & the neck is narrow )> liable to complicate.

17

Difference between Oblique inguinal hernia and Direct inguinal hernia by

Age
Side

Shape
Descent
Descent to scrotum
Reducibility
Complications

Internal ring test
External ring test

Relation of neck of sac to inferior epigastric artery
(at operation)

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Age in Oblique inguinal hernia

Any Age

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Age in Direct inguinal hernia

Usually old age

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Side in Oblique inguinal hernia

Uni or bilateral

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Side in Direct inguinal hernia

Usually bilateral

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Shape in Oblique inguinal hernia

Oblong

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Shape in Direct inguinal hernia

Hemisherical

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Descent in Oblique inguinal hernia

Downwards, forwards and medially

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Descent in Direct inguinal hernia

Forward

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Descent to scrotum in Oblique inguinal hernia

May occur

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Descent to scrotum in Direct inguinal hernia

Very rare

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Reducibility in Oblique inguinal hernia

Upwards, backwards, and laterally

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Reducibility in Direct inguinal hernia

Backwards

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Complications in Oblique inguinal hernia

More common