Anatomy of Hernias Flashcards
(22 cards)
Boundaries of the inguinal triangle
Inferiorly - Inguinal ligament Medially - Lateral border of rectus femorus Laterally - Inferior epigastric vessels
Which is congenital - direct or indirect inguinal hernia?
Indirect inguinal hernia
Lumbar plexus in the groin is made of fibers from __ to ___.
L1-L4
Inguinal ligament are formed by what muscles?
Aponeurosis of external oblique attach to the pubic crest, forming the inguinal ligament.
Deep inguinal ring made out of
The transversalis fascia mainly makes up the deep inguinal ring (though internal oblique also contributes)
Femoral artery and vein come out of the
deep inguinal ring
Superficial inguinal ring is made from the
aponeurosis of the external oblique
Inguinal ligament is an extension of ___ that attaches to the ___ and the ___.
Aponeurosis of the ext oblique. Attaches to the anterior superior iliac spine and the pubic crest.
Gonads start in the posterior abdomen and then the ____ contracts, pulling down the gonads down into the scrotum.
gubernaculum Layers of abdominal wall are brought down with it.
Processus vaginalis is an extension of
peritoneum that is brought down with the fascia of the abdominal wall in the descent of the gonads into the scrotum. Should close off later.
Indirect inguinal hernias occur lateral to the epigastric vessels; They pass through the ___ into the ___. They are the result of a deformation in what structure? These are congenital.
Indirect inguinal hernias pass through the deep inguinal ring and into the inguinal canal; often descends through the superficial ring into the scrotum or labium. PATENT PROCESSUS VAGINALIS - peritoneal fluid and anything mobile in the abdomen can enter
The gubernaculum remnant for the female is the
round ligament of the uterus
how can you recognize an indirect inguinal hernia on an MRI?
Ext oblique are clearly pulled back
Testes are pulled to the side
Direct inguinal hernias occur medial to the epigastric vessels. Where can the intestines herniate into? Why does this occur?
Through Hasselbach’s/inguinal triangle. Can pass through the superficial inguinal ring, but not the deep like indirect does. Occurs because of weakness in the abdominal wall
Iliohypogastric nerve of lumbar plexus in hernia repair
Arises from L1.
Innervates the internal oblique & transverse muscles.
>Anterior branch supplies hypogastric (pubic) region skin
>Lateral branch supplies lateral buttock/thigh skin
Ilioinguinal nerve of lumbar plexus in hernia repair
Efferent to the internal oblique and transversus abdominis.
Provide sensory to…
> skin of upper & medial thigh
> root of penis and upper scrotum in men
> mons pubis & labum majus in women.
What are the 3 nerves from L1 that can be affected in hernia repair (superior to inferior)?
Iliohypogastric
Ilioinguinal
Genitofemoral
Genitofermoral nerve’s two branches
Genital branch: efferent that draws up testes in the Cremaster reflex when skin on medial upper thigh is stroked
Femoral branch provides sensation to the skin of upper & medial thigh, anterior scrotum, penis/mon pubis, scrotum/labium majus
Femoral hernia
Hernia through the femoral ring and femoral canal (medial to the femoral vessels and femoral sheath) into the medial aspect of the thigh. Occurs in women with wide pelvises. Loss of natural fat pad creates a canal for the bowel to herniate through.
If an examiner puts their pinky into the superficial ring and asks the patient to cough: ___ inguinal hernia will be felt on the tip ___ inguinal hernia will be felt on the side
INDIRECT inguinal hernia at the tip DIRECT inguinal hernia on the side
___ hernia is the most common groin hernia in females.
Indirect inguinal hernia
What causes a direct inguinal hernia? A defective ___.
Aponeurosis of the transversus abdominus, because it forms a significant portion of the posterior wall of the inguinal canal and the lower part of the inguinal triangle.
