Inguinal Canal and Abdominal Hernias

Question 1

what is the definitive treatment for all hernias?

Answer 1

surgical repair

Question 2

what are groin hernias?

Answer 2

protrusions of viscera or adipose tissue through the inguinal or femoral canal

Question 3

what are factors that contribute to hernias?

Answer 3

-normal developmental pathway (inguinal canal)
-developmental defects (abdominal wall, rotation of the gut)
-existing opening (umbilicus, omental foramen, recesses)
-area of weakness (groin, surgical incisions)
-increased intra-abdominal pressure (obesity, fluid in abdominal cavity, heavy lifting, constipation, chronic cough)

Question 4

the posterior rectus sheath ends at the ___________________, so the lower part of the muscle is covered only with transversalis fascia.

Answer 4

arcuate line

Question 5

describe the location of the inguinal ligament

Answer 5

distal border of the aponeurosis of external oblique that stretches between the anterior superior iliac spine and the pubic tubercle

Question 6

what is the superficial inguinal ring?

Answer 6

triangular opening in the aponeurosis of external oblique muscle

Question 7

what is superior to the pubic tubercle?

Answer 7

superficial inguinal ring

Question 8

when does descent of the testis occur?

Answer 8

between 10-23 weeks of gestation

Question 9

during testis descent, a herniation of the abdominal cavity, __________________, develops along the course of the gubernaculum, forming the ________________and descending with the testis into the scrotum.

Answer 9

processus vaginalis
inguinal ring and canal

Question 10

as the abdominal wall and muscles develop, the inguinal rings close, and the processus vaginalis obliterates to form the ________________________, which covers the anterior and lateral portion of the testes.

Answer 10

tunica vaginalis

Question 11

incomplete obliteration of the process vaginalis with accumulation of serous fluid results in a _____________________

Answer 11

hydrocele

Question 12

what structures run through the spermatic cord?

Answer 12

-ductus deferens
-artery to the ductus deferens
-testicular artery
-pampiniform plexus of veins
-cresmasteric artery and vein
-genital branch of genitofemoral nerve
-sympathetic and visceral afferent nerve fibers
-lymphatics
-remnants of the processus vaginalis

Question 13

a cord-like structure that passes from the uterus to the deep inguinal ring where it enters the inguinal canal

Answer 13

round ligament of the uterus

Question 14

what forms the roof of the inguinal canal?

Answer 14

the arching fibers of the transversus abdominis and internal oblique muscles

Question 15

what muscles merge to form the conjoint tendon?

Answer 15

transversus abdominis and internal oblique muscles

Question 16

where does the conjoint tendon attach?

Answer 16

medially to the pubic crest

Question 17

what forms the posterior wall of the inguinal canal?

Answer 17

transversalis fascia

Question 18

conjoined tendon function

Answer 18

principal line of defense against hernia, acting as a protective shutter on exertion

Question 19

what is the most important structure to repair on the conjoined tendon?

Answer 19

transversus arch (edge)

Question 20

what are the other names for the inguinal triangle?

Answer 20

medial inguinal fossa
Hesselbach’s triangle

Question 21

what fossa contains the deep inguinal ring?

Answer 21

lateral inguinal fossa

Question 22

formed by the tendinous structure of the transversus abdominis muscle

Answer 22

interfoveolar ligament (ligament of Hesselbach)

Question 23

what runs in the medial border of the deep inguinal ring?

Answer 23

inferior epigastric vessels

Question 24

what is found in the inguinal canal?

Answer 24

spermatic cord in male and round ligament of the uterus in female

Question 25

describe the lacunar ligament?

Answer 25

-a triangular band of fibrous tissue lying mainly posterior to the medial end of the inguinal ligament -attaches to the pectineal ligament that runs on the pectineal line of the pubic bone -joins the posterior border of the inguinal ligament

Question 26

what are the boundaries of the inguinal canal?

Answer 26

anterior: external oblique aponeurosis posterior: transversalis fascia, parietal peritoneum roof: internal oblique, transversus abdominis floor: inguinal ligament

Question 27

how does an inguinal hernia occur?

Answer 27

when a portion of the small intestine enters the inguinal canal

Question 28

reducible hernias

Answer 28

-contents might be pushed back into abdominal cavity -present as a lump; initially might be painless -later dull ache; increased by activity

Question 29

irreducible or incarcerated hernias

Answer 29

contents no longer be pushed back into abdominal cavity

Question 30

describe indirect inguinal hernias

Answer 30

-congenital -processus vaginalis does not become obliterated 1)leave the abdominal cavity lateral to the inferior epigastric artery through the deep inguinal ring 2) follow the path of descent of the testis through the inguinal canal 3) exit via the superficial inguinal ring

Question 31

describe direct inguinal hernias

Answer 31

-acquired; mainly in elderly -leave the abdominal cavity medial to the inferior epigastric artery and push directly through or around the Hesselbach's triangle -has a hernial sac formed by parietal peritoneum and transversalis fascia -has a wide neck thus less likely to become incarcerated -less likely to descend into the scrotum than an indirect inguinal hernia

Question 32

what is an important area for direct hernia formation?

Answer 32

Hesselbach's triangle

Question 33

which hernias are congenital?

Answer 33

indirect

Question 34

which hernias have a wide neck?

Answer 34

direct

Question 35

which hernia has a higher danger of strangulation

Answer 35

indirect

Question 36

which hernias are mostly seen in children and young adults?

Answer 36

indirect

Question 37

in which type of hernia does the sac enter medial to inferior epigastric vessels?

Answer 37

direct