Hernias

Question 1

indirect inguinal hernia

Answer 1

• hernia through the internal ring of the inguinal canal

- travels down the external ring

Question 2

which nerve travels on the spermatic cord?

Answer 2

ilioinguinal nerve

Question 3

what happens if you cut the ilioinguinal nerve?

Answer 3

numbness of inner thigh or lateral scrotum

goes away w/in 6 mo (typically)

Question 4

what is the conjoint tendon made of?

Answer 4

aponeurosis of the transversus abdominus + internal oblique

Question 5

what is the floor of the inguinal canal?

Answer 5

inguinal ligament / poupart’s

Question 6

what are the 3 nerves of the groin?

Answer 6

iliohypogastric
genital branch of the genitofemoral nerve
ilioinguinal nerve

Question 7

what is the roof of the inguinal canal?

Answer 7

conjoint tendon

Question 8

where do you find the ilioinguinal nerve?

Answer 8

between the internal/external oblique

Question 9

What is the surface marking of the deep inguinal ring?

Answer 9

midpoint of the inguinal ligament - between the ASIS / pubic tubercle

Question 10

What is the surface marking of the deep inguinal ring? midpoint of the inguinal ligament

Answer 10

between the ASIS / pubic tubercle

Question 11

what is the anterior wall of the inguinal canal?

Answer 11

external oblique aponeurosis

Question 12

what is the posterior wall of the inguinal canal?

Answer 12

transversalis fascia

Question 13

what is the length of the inguinal canal?

Answer 13

pubic tubercle to ASIS

Question 14

what is in the spermatic cord (6)?

Answer 14

1) cremasteric muscle fibers
2) vas deferens
3) testicular artery
4) testicular pampiniform venous plexus
5) genital branch of the genitofemoral nerve
6) +/- hernia sac

Question 15

what is the hernia sac made of?

Answer 15

peritoneum (direct)

patent processus vaginalis (indirect)

Question 16

what is ddx of inguinal hernia?

Answer 16

lymphadenopathy
psoas abscess
ectopic testis
hydrocele of the cord
saphenous varix
lipoma
varicocele
testicular torsion
femoral artery aneurysm
abscess

Question 17

what is the difference b/w herniorrhaphy vs. herniotomy vs. hernioplasty?

Answer 17

Herniotomy: removal of sac only

herniorrhaphy: removal of sac plus repair of posterior wall of inguinal canal
hernioplasty: removal of sac + reinforcement of posterior wall of inguinal canal with mesh

Question 18

what are the borders of the hesselbach’s triangle?

Answer 18

epigastric vessels (superior-lateral)
inguinal ligament (inferior)
lateral border of the rectus (medial)

Question 19

what nerve is in found on top of the spermatic cord?

Answer 19

ilioinguinal nerve

Question 20

what attaches the testicle to the scrotum?

Answer 20

gubernaculum

Question 21

what is the most common organ in an inguinal hernia sac in men vs. women?

Answer 21

men = small intestine
women = ovary/fallopian tube

Question 22

from what abdominal muscle layer is the cremaster muscle derived?

Answer 22

internal oblique muscle

Question 23

from what abdominal layer is the inguinal ligament

Answer 23

external oblique muscle aponeurosis

Question 24

what lies in the inguinal canal in the female instead of the VAS?

Answer 24

round ligament

Question 25

where in the inguinal canal does the hernia sac lie in relation to the other structures?

Answer 25

anteromedially

Question 26

what is a cord lipoma?

Answer 26

``` preperitoneal fat on the cord structures (pushed in by the hernia sac) not a real lipoma remove surgically (if feasible) ```

Question 27

internal ring

Answer 27

transversalis fascia

Question 28

external ring

Answer 28

external oblique aponeurosis

Question 29

what percentage of the strength of the floor repair does the external oblique aponeurosis represent

Answer 29

ZERO

Question 30

what are the boundaries of the femoral canal?

Answer 30

1) cooper's ligament posteriorly 2) inguinal ligament anteriorly 3) femoral vein laterally 4) lacunar ligament medially

Question 31

what factors are assoc. w/ femoral hernia?

Answer 31

women, pregnancy, and exertion

Question 32

what is a femoral hernia?

Answer 32

hernia traveling beneath the inguinal ligament down the femoral canal medial to the femoral vessels (FM radio)

Question 33

what is the howship-romberg sign?

Answer 33

pain along the medial aspect of the proximal thigh from nerve compression - caused by obturator hernia

Question 34

what must you do before leaving the OR after an inguinal hernia repair?

Answer 34

pull the testicle back down to the scrotum

Question 35

how can an incarcerated hernia be reduced in the ER?

Answer 35

1) apply ice 2) sedate 3) use the trendelenburg for inguinal hernias 4) apply steady gentle manual pressure 5) admit & observe for signs of necrotic bowel after reduction 6) perform surgical herniorrhaphy ASAP

Question 36

what is the floor of hasselbach's triangle?

Answer 36

external oblique aponeurosis, internal oblique, transversus abdominis muscles