Herniation Flashcards

(48 cards)

1
Q

Herniation definition

A

Any structure passing through another but ending up in the wrong place

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2
Q

Two factors required for development of a hernia

A

Structural weakness, increased pressure

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3
Q

Normal anatomical weakness for hernias to develop

A

Diaphragm - diaphragmatic hernia
Umbilicus - umbilical hernia
Inguinal canal - inguinal hernia
Femoral canal - femoral hernia

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4
Q

Abnormal anatomical weakness for hernias to develop

A

Congenital diaphragmatic hernia, surgical scars - incising hernia

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5
Q

Causes of increased pressure that can lead to hernia

A

Chronic cough, pregnancy, strenuous activity, straining bowel movements or urination

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6
Q

Where is the linea alba?

A

Xiphoid process to pubic symphysis

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7
Q

Where does the umbilicus lie in relation to the linea alba?

A

Partway along it

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8
Q

Where is the inguinal region?

A

Around the area of the hip crease

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9
Q

What is the linea semilunaris

A

Semilunar line separating the anterior abdominal wall from the lateral abdominal wall. It is the line lateral to where your abs would be

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10
Q

What does the inguinal ligament mark?

A

An anterior boundary between the abdomen and thigh

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11
Q

Where does the inguinal ligament run?

A

Anterior superior iliac spine inferomedially to the pubic tubercle

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12
Q

Where is the sublingual space? What does it do?

A

Below the inguinal ligament and allows communication from the abdominal structures with the thigh

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13
Q

Where is the inguinal canal? What does it do?

A

Just above the inguinal ligament and allows communication from the abdominal structures with the perineum

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14
Q

What is the inguinal canal?

A

Oblique passage between the abdomen and perineum

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15
Q

Which direction does the inguinal canal run?

A

Inferomedially

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16
Q

Where is the entrance to the inguinal canal?

A

Deep inguinal ring in contact with abdominal structures

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17
Q

Where is the exit from the inguinal canal?

A

Superficial inguinal ring in contact with body wall structures or perineum

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18
Q

Contents of the inguinal canal

A

Spermatic cord or round ligament of the uterus, blood and lymphatic vessels, ilioinguinal nerve

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19
Q

Where do testes develop?

A

Posterior abdominal wall

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20
Q

When do the testes descend?

21
Q

Gubernaculum

A

Fibrous cord which during development shortens and contracts

22
Q

What does the gubernaculum attach?

A

Inferior pole of the testes to the skin of the body wall

23
Q

What does the gubernaculum become in adults?

A

Spermatic cord in males and round ligament of uterus in females

24
Q

What is the vaginal process?

A

Area of peritoneum that gets deeper at about the 12th week

25
Tunica vaginalis
Pocket of peritoneal fluid created by two layers of the vaginal process
26
What happens when the two borders of the vaginal process do not form?
It can create a pathway for herniation to occur
27
What makes up the boundaries of the inguinal canal of the: - Anterior wall - Posterior wall - Roof - Floor
Anterior - external oblique aponeurosis, internal oblique muscle (laterally) Posterior - transversus fascia (laterally), conjoint tendon (medially) Roof - transversalis fascia (laterally), arches of internal oblique and transversus abdominus aponeurosis, external oblique aponeurosis Floor - gutter of infolded inguinal ligament
28
Hesselbach's triangle (inguinal triangle)
Inferior epigastric artery, inguinal ligament, lateral border of rectus abdominus
29
Site of direct inguinal herniation
Hesselbach's triangle
30
Direct inguinal hernia: | - Path taken
Directly through the abdominal wall structures to gain access to inguinal canal, medial through the inferior epigastric artery, through Hesselbach's triangle to superficial ring parallel to the spermatic cord
31
Indirect inguinal hernia: | - Path taken
Uses inguinal canal and deep inguinal ring. Uses a pathway already created by the body to get access to the inguinal canal. Passes lateral to inferior epigastric artery, through the superficial ring and within the spermatic cord or layers of abdominal wall
32
Where is the sub-inguinal space?
Posterior and inferior to the inguinal ligament
33
What does the sub-inguinal space contain?
Hip flexors, femoral artery and vein, lymphatics, nerves
34
Where can femoral herniation arise?
Femoral canal
35
Classification of hernias (3)
Reducible, incarcerated or irreducible hernia, strangulated hernia
36
Reducible hernia
Hernia can be easily pushed back into the abdomen
37
Incarcerated/irreducible hernia
When a hernia cannot be manipulated back to the abdomen
38
Strangulated hernia
Vascular supply to the contents contained within the hernia is compromised, resulting in ischaemic and gangrenous tissue
39
Treatment for hernias
Conservative management or surgical management
40
Epigastric hernia: - Definition - Presentation
- Fascial defect in the linea alba between the xiphoid process and umbilicus - Midline lump, 75% asymptomatic but can present with pain
41
Paraumbilical hernia: - Aetiological factors - Presentation - Management
- Stretching of abdominal wall by obesity, multiple pregnancies or ascites - Frequently asymptomatic or present with pain - Nearly always surgical - do not resolve spontaneously and high incidence of incarceration and strangulation
42
3 coverings of the spermatic cord
Internal spermatic fascia, cremasteric fascia, external spermatic fascia
43
6 contents of the spermatic cord
Vas deferens, arteries (testicular artery, artery to Vas deferens, cremasteric artery), pampiniform plexus, lymphatics, nerves, remains of the processus vaginalis
44
Are direct inguinal hernias or indirect inguinal hernias more common?
Indirect
45
Diagnosis of inguinal hernia
Groin swelling which usually disappears lying down, usually located above and medial to the pubic tubercle, palpable cough impulse on examination, dynamic ultrasound can be helpful
46
Management of inguinal hernia
Non-surgical or surgical
47
Management of femoral hernia
Surgical
48
Predisposing factors to incisional hernia
Wound complications, inherited collagen abnormalities, advanced age, smoking, morbid obesity, malignancy, surgical technique